Hysterectomy & Uterine Fibroids

A second opinion may just be your ticket out of surgery
The Fibroid fight and keeping your Uterus

Uterine Fibroids are a common occurrence in the female reproductive organs and generally affect women between the ages of 30-40 years old. Fibroids are benign growths of fibrous connective tissue and smooth muscle cells that develop in single or multiple locations in and around the uterus. Though they can exist harmoniously without causing disruption to wellbeing a lot of the time they bring about a series of troublesome symptoms including excessive and prolonged menstrual bleeding, recurring pain in the pelvic and lower back area, pain during sexual intercourse, bloating, frequent urination as well as constipation. Symptoms of fibroids can open the door to a range of other concerns including problems conceiving and anaemia.

Fibroids vary in size as well, with some fibroid masses being undetectable whilst others are so large that the uterus expands as a result. When classifying fibroids the location is the key determinant. Fibroids that grow within the muscular uterine wall are termed as intramural fibroids. Those that occur in the uterine cavity are referred to as submucosal fibroids whilst subserosal fibroids extend to the outside of the womb.

Fibroids become problematic when the quality of one’s daily life is adversely affected by the various symptoms of them. It is when these extreme conditions are experienced that patients seek medical advice. Treatment options vary with the choice of invasive and non-invasive paths. One such path is that of a Hysterectomy or the surgical removal of the uterus.

A hysterectomy is a surgical procedure whereby the uterus or womb is removed either in part or entirely. It can include removal of the uterus on its own, removal of the uterus and the cervix and in some cases removal of the uterus, cervix and the ovaries. The method used will also differ based on the doctor and the patient with some favouring the abdominal method and others choosing to perform the vaginal method. With a shorter down time and a less invasive approach, many doctors are leaning towards the vaginal method as their preferred method.
Uterine fibroids are considered to be the most common reason for the performance of a hysterectomy with other reasons being endometriosis, abnormal uterine bleeding, cervical dysplasia (which is a pre-cancerous condition) and fairly rarely, for cancer. A hysterectomy is a major procedure which has both physical and emotional implications. It is irreversible and as a result of this permanency requires a great deal of thought beforehand. It is concerning that in spite of this a hysterectomy is provided as one of the first lines of defence to a patient suffering from a benign condition such as fibroids.

Aside from the glaringly obvious effect on the ability to conceive, a hysterectomy may cause dryness in the vagina, impact on sexual pleasure, produce changes to the bladder and intestine functions as well as provoke mood swings and depression. What is often overlooked is that the uterus is not simply a bearer of children. Rather it is hormone responsive female organ with a role to play in numerous structural and physiological functions. Together with the ovaries, the uterus contributes to the functioning of the immune system, it protects against heart disease and osteoporosis and also plays a part in sexual stimulation. The misconception that older women don’t need their uterus is one that needs to be tackled to prevent unnecessary surgery and trauma.

Hysterectomy procedures worldwide have been on a steady decline particularly in first world countries where alternatives to surgery are easily accessible. These new methods are favoured over the traditional route as they keep the uterus intact and have little to no effect on fertility. Having said that, however, there are many doctors who remain loyal to traditional methods and remain in favour of surgical options over newer and minimally invasive procedures. Another challenge is the lack of doctors who are skilled and experienced enough to perform these procedures, resulting in many opting for a hysterectomy as a result of this. It is therefore essential to actively seek out more than one doctor and gain that all-important second, or third, or fourth opinion. A less distressing option may be possible and seeking this should be made a priority. For those not entirely opposed to surgery, a myomectomy is a procedure that preserves the uterus whilst surgically removing the fibroids. The most popular and effective non-surgical methods have been myolysis, fibroid embolisation and endometrial ablation. There is also the option to wait it out and let the magic of menopause shrink the fibroids out of existence.

Be an informed patient and don’t surrender to a hysterectomy at first mention. As unpleasant as uterine fibroids can be, a uterus is a terrible thing to waste.

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