Should I have surgery to treat uterine fibroids?
Introduction
This is a general overview of issues that are important as you decide how to treat uterine fibroids. This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Consider the following when making your decision:
- If you have hard-to-treat fibroids that affect your quality of life or if you want to get pregnant, surgery is a reasonable treatment option to consider.
- If you are nearing menopause, consider that fibroids usually improve on their own after menopause. (For short-term relief of severe symptoms, you can consider hormone therapy with gonadotropin-releasing hormone analogue [(GnRH-a] therapy.)
- There are two surgical treatments for fibroids: cutting fibroids from the uterus (myomectomy) and removing the entire uterus (hysterectomy).
- If you have future plans for having children, myomectomy may improve your chances of conceiving and not miscarrying.1, 2 But myomectomy can lead to a problem with the placenta or can make a caesarean delivery more likely.
- Hysterectomy offers the only absolute cure for uterine fibroids. It is only a good option if you have no plans to get pregnant and have thought through the long-term benefits and risks of hysterectomy.
- Both myomectomy and hysterectomy have short-term risks, such as blood loss and infection. Both surgeries can lead to scar tissue formation.
- Hysterectomy results in permanent infertility.
Medical Information
What are uterine fibroids?
Uterine fibroids are non-cancerous growths in the uterus. Fibroids can grow on the inside of the uterus
, within the muscle wall of the uterus
The cause of uterine fibroids is not known. But after fibroids develop, the hormones estrogen and progesterone appear to influence their growth. A woman's body produces the highest levels of these hormones during her child-bearing years. After menopause, when hormone levels decline, fibroids often shrink or disappear.
Fibroids are also called myomas, leiomyomas, and fibromas.
What are the symptoms of uterine fibroids?
As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. About 80% of women have uterine fibroids by the time they reach age 50. Most have mild or no symptoms.3 But fibroids can cause serious problems that need treatment.
Uterine fibroids usually need treatment when they cause:
- Anemia from heavy fibroid bleeding.
- Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
- Infertility, when a fibroid changes the shape of the uterus or the location of the fallopian tubes.
- Complications during pregnancy, such as miscarriage or premature labour.
- Blockage of the urinary tract or bowels.
- Infection, if the tissue of a large fibroid dies (necrotic fibroid).
What is a myomectomy?
Myomectomy is the surgical removal of fibroids from the uterus. The uterus is repaired and left in place. For some women, this makes pregnancy possible. Myomectomy may improve your chances of having a healthy pregnancy after fibroid treatment.
Effectiveness. Myomectomy decreases menstrual bleeding and pelvic pain from fibroids. Myomectomy is the only fibroid treatment that may improve your chances of having a baby.2 Some studies suggest that myomectomy may also lower the risk of miscarriages among women with fibroids. But more study is needed to know for sure.2
Fibroid recurrence. With all fibroid treatments except hysterectomy, fibroids tend to grow back. New fibroids can also grow. After myomectomy, fibroids grow back in up to 50% of women. Larger and more numerous fibroids are most likely to recur.4 Talk to your doctor about whether your type of fibroid is likely to grow back.
Risks. When incisions have been made into the uterine wall to remove fibroids, future pregnancy may be affected. Sometimes, problems develop when the placenta grows during pregnancy, such as placenta abruptio or placenta accreta. During labour, the uterus may not function normally, which can make a caesarean delivery necessary.5
If you are hoping for a future pregnancy, an abdominal myomectomy may be safer than a laparoscopic myomectomy. There is limited research about pregnancy safety after laparoscopic myomectomy and isolated reports of the uterus rupturing during pregnancy after a laparoscopic myomectomy.2
What is a hysterectomy?
Hysterectomy is surgery to remove your uterus. The ovaries and fallopian tubes may also be removed at the same time. Hysterectomy is the one known cure for fibroids, but it usually is used as a last resort because it is a major surgery. You will not be able to get pregnant after having a hysterectomy. It also can cause long-term problems (see Risks below). But most women report improvement in physical symptoms (including pelvic pain, abdominal bloating, and physical and social functioning) after a hysterectomy.6
If you are considering a hysterectomy and are not close to menopausal age (about age 50), talk to your health professional about the question of ovary removal (oophorectomy). When comparing women who do and don't have their ovaries, experts estimate that women live longer when they keep their ovaries until at least age 65. This may be because women who have their ovaries have fewer hip fractures (stronger bones) and are less likely to develop heart disease.7
After early oophorectomy, estrogen replacement therapy (ERT) is recommended to prevent bone-thinning. For more information, see the topic Hysterectomy.
Fibroid recurrence. Fibroids do not grow back after hysterectomy.
Effectiveness. Hysterectomy for uterine fibroids:
- Is the only fibroid treatment that prevents regrowth of fibroids.
- Relieves ongoing pain caused by fibroids.
- Corrects anemia from prolonged, heavy, and irregular vaginal bleeding.
- Usually corrects problems caused by scar tissue (adhesions).
- May correct leakage of urine (urinary incontinence) if it has been caused by fibroid pressure on internal organs.
Risks. Most women do not have complications after hysterectomy. But possible long-term effects of hysterectomy include:
- The formation of scar tissue in the pelvic area. Scar tissue can bind organs and cause pelvic pain.
- Early menopause caused by a slow, yet early decline of the ovaries (premature ovarian failure).8
- Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum. The weakness can cause bladder or bowel problems, such as cystocele, rectocele, or urinary incontinence (most common in women older than 60).9Kegel exercises may help strengthen the pelvic muscles and ligaments. But some women need other treatments, including additional surgery.
- Difficulty urinating. This is more common after removal of lymph nodes, ovaries, and structures that support the uterus (radical hysterectomy, which is not normally done for fibroid treatment).
- Pelvic pain that was present before surgery may not be relieved by hysterectomy.
What are the general risks of surgery?
Most women do not have complications after myomectomy or hysterectomy for uterine fibroids. But complications that may occur include:
- Fever. A slight fever is common after any surgery.
- Rare complications. These include:
- Infection.
- Blood clots in the legs (thrombophlebitis) or lungs (pulmonary embolus).
- The formation of scar tissue (adhesions).
- Injury to other organs, such as the bladder or bowel.
- A collection of blood at the surgical site (hematoma).
- Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks after a hysterectomy is expected. But call your health professional if bleeding continues to be heavy.
- Severe blood loss that requires transfusion.
- Heart problems.
- Breathing problems.
For more information, see the topic Uterine Fibroids.
Your Information
Your choices are:
- Choose another method to treat symptoms caused by uterine fibroids.
- If you have pregnancy plans, have myomectomy to have fibroids cut from the uterus.
- If you have no pregnancy plans, have a myomectomy to preserve the uterus or have a hysterectomy to remove the entire uterus.
The decision about whether to have surgery takes into account your personal feelings and the medical facts.
Deciding about surgery for uterine fibroids Reasons to have surgery Reasons not to have surgery Surgery for uterine fibroids is a reasonable treatment option when:4
- Heavy uterine bleeding and/or anemia has continued after several months of therapy with birth control pills and a non-steroidal anti-inflammatory drug (NSAID).
- The uterus is misshapen by fibroids and you have had repeat miscarriages or trouble getting pregnant (myomectomy only).
- You have fibroid pain or pressure that affects your quality of life.
- You have urinary or bowel problems from a fibroid pressing on your bladder, ureter, or bowel.
- You are trying to get pregnant and fibroids may be affecting your fertility (myomectomy only).
- You are many years from menopause, when fibroids will improve on their own.
- You don't want more children or you don't want any children, and you do not wish to try medicines to treat your symptoms (hysterectomy only).
- Your symptoms are severe enough to outweigh the risks and discomforts of surgery.
- There is a possibility that cancer is present. This is a concern when a fibroid grows very quickly or grows after menopause.
Are there other reasons that you might want to have surgery?
- You do not have severe symptoms of uterine fibroids.
- Treatment with medicine effectively relieves your symptoms.
- You have not tried other treatments to control your symptoms.
- You are approaching menopause. When menopause is completed, uterine fibroids may get smaller and your symptoms should improve.
- Your symptoms are not severe enough to outweigh the risks and discomforts of surgery.
- You want to try uterine fibroid embolization.
Are there other reasons that you might not want to have surgery?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery to treat uterine fibroids. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I have severe symptoms of uterine fibroids. Yes No Unsure My symptoms are gradually getting worse. Yes No Unsure I have pain during intercourse. Yes No Unsure I have painful urination, blood in my urine, or an inability to control the flow of my urine. Yes No Unsure I wish to become pregnant. Yes No Unsure I am approaching menopause. Yes No Unsure Treatment with prescription medicines has failed to relieve my symptoms. Yes No NA* I have other medical conditions (such as kidney failure, liver failure, or a bleeding disorder) that would make surgery risky. Yes No NA I have had a blood clot in my legs or lungs. Yes No NA *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for uterine fibroids.
Check the box below that represents your overall impression about your decision.
Leaning toward having surgery
Leaning toward NOT having surgery
Return to the topic Uterine Fibroids.
| Author: | Kathe Gallagher, MSW | Last Updated: October 8, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine | |
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