What Type Of Hysterectomy Is Best For Fibroids?

What Type Of Hysterectomy Is Best For Fibroids?


This is a question that many women have asked their health practitioners. Even our medical experts encounter such questions when treating our female patients. Fibroids, although non-cancerous, can cause a lot of discomfort to women. Its symptoms can range from mild pain to severe bleeding.


There is no specific type of hysterectomy for fibroids as it depends on various factors like:


  • Severity of symptoms
  • Location of the fibroids
  • Size and number of fibroids


Although we can’t suggest the type of hysterectomy best for fibroids, we can share some scenarios of our patients to help you understand and make an informed decision accordingly. Through these experiences, we will see what combination of the above factors required which type of hysterectomy.


Case 1: Single And Small Subserosal Fibroid – Myomectomy


*Marissa from Kenya, a young lady in her mid-20s, started feeling mild discomfort in her abdomen region. She paid no heed to the pain in the beginning, but its persistent nature made her go see her doctor. Her reports showed a single, small subserosal fibroid in her uterus. As the fibroid was not causing severe symptoms and the patient wanted to retain her fertility, her doctor suggested she go for myomectomy for her uterine fibroid treatment. What is myomectomy, you ask. It is a surgical procedure where the fibroids are removed without affecting a woman’s fertility (by leaving the uterus intact).


As the size of the fibroid was relatively small, the doctor suggested Marissa undergo either a laparoscopic myomectomy or a robotic myomectomy.


Case 2: Multiple Small Intramural Fibroids – Subtotal Hysterectomy


*Simeen Begum, a happy-to-go housewife and mother of three from Bangladesh, started experiencing heavy discomfort within five years of her third child’s birth. What started as mild, occasional pain and spotting turned into extensive pain and heavy bleeding in a matter of months. When she couldn’t find the answer in her country, she contacted GoMedii and got the best gynecologists for her care. She was diagnosed with multiple small intramural fibroids. Having completed her childbearing, Simeen Begum agreed to a subtotal hysterectomy. Without further ado, the procedure was conducted, which was successful.


What Is Subtotal Hysterectomy?


It is a surgical procedure where the uterus is removed, but your cervix is preserved. Subtotal hysterectomy is done to control heavy bleeding due to genetic problems.


We also had a case a while back from Somalia who was suffering from heavy bleeding, pelvic pain, and pressure on the bladder/bowel. Upon examination, she was diagnosed with large, multiple intramural uterine fibroids. Here also, our doctor recommended her to undergo a Laparoscopic subtotal hysterectomy. While her uterus was removed, her cervix and ovaries were preserved.


Case 3: Giant Fibroid Distorting Uterus – Total Abdominal Hysterectomy


*Nala from Nigeria started having bleeding issues. From there, her pelvic pain started. She also started experiencing pain during physical intimacy. When she consulted with our doctor, she was told about the possibility of fibroids. Upon inspection, the possibility was confirmed: a giant subserosal uterine fibroid distorting the uterus. She underwent a total abdominal hysterectomy.


What Is a Total Abdominal Hysterectomy?


It is a surgical procedure where your entire uterus, cervix, and, in many cases, ovaries are also removed.


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Case 4: Multiple Fibroids With Suspected Adenomyosis – Total Hysterectomy With Bilateral Salpingectomy


We had another case from Zimbabwe where a woman in her early 50s had multiple fibroids with suspected adenomyosis. The symptoms started as irregular periods but became more prominent with chronic abdominal pain and heavy bleeding. She underwent a Robotic total hysterectomy or laparoscopic total hysterectomy with bilateral salpingectomy to address both issues at once.


What Is a Total Hysterectomy?


It is a surgical procedure where both your uterus and cervix are removed.


What Is Bilateral Salpingectomy?


Bilateral salpingectomy is a surgical procedure where both your fallopian tubes are removed. It can be due to various reasons like birth control, tubal rupture, tubal damage, or ectopic pregnancy. The procedure is often combined with a hysterectomy.


Case 5: Large Fibroid With Suspected Malignancy – Total Abdominal Hysterectomy With Bilateral Salpingectomy-Oophorectomy


We had a case of a large fibroid from Ethiopia where there was a suspected malignancy. Unlike in other cases, her symptoms were quite different. There was a sudden onset of pelvic pain, the growth of fibroid was rapid post-menopause, and there was unexplained vaginal bleeding post-menopause as well. Our doctor suggested some diagnostic tests, which included a biopsy. The woman had early stage Leiomyosarcoma and underwent Total abdominal hysterectomy with bilateral salpingectomy-oophorectomy (ovaries removal) to treat the condition.


What Is Hysterectomy Surgery?


A hysterectomy is a surgical procedure that removes your uterus. After surgery, you can’t become pregnant and no longer menstruate. Reasons for this surgery include abnormal bleeding, uterine prolapse, fibroids, and cancer.


What Are The Types Of Hysterectomy Surgery?


  • Total hysterectomy: Uterus and cervix are removed.
  • Subtotal or Supracervial or Partial hysterectomy: Only the uterus is removed.
  • Radical hysterectomy: Uterus, cervix, the top portion of your vagina, most of the tissue that surrounds the cervix, and sometimes the pelvic lymph nodes are removed.


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What Are The Techniques And Approaches Of Hysterectomy Surgery?


  • Abdominal Hysterectomy: Done through a six-inch incision in the abdomen area.
  • Vaginal Hysterectomy: Your surgeon removes your uterus through the vaginal opening.
  • Minimally Invasive Laparoscopic Hysterectomy: The surgeon removes the uterus through a tiny belly button incision & other minor cuts. Tools & cameras help remove it in pieces via laparoscope or vagina.
  • Robotic Hysterectomy: Mini robotic arms reach & remove your uterus using a belly button or minor abdominal cuts, aided by 3D vision and tiny tools.


What Are Fibroids?


Fibroids in the uterus are common growths of the uterus. They often appear during the years you’re usually able to get pregnant and give birth. Uterine fibroids are not cancer, and they rarely turn into cancer. Chances are less, but never zero.


What Are The Types Of Fibroids In Uterus?


  • Intramural: Located within the uterine wall.
  • Submucosal: Projecting into the uterine cavity.
  • Subserosal: Growing outwards from the outer uterine wall.
  • Pedunculated: Attached to the uterus by a stalk.


FAQs On Type Of Hysterectomy Best For Fibroids


Q: How long do you stay in hospital after a hysterectomy?


A: You must stay in the hospital for at least 1-2 nights after a hysterectomy. But if you go for a minimally invasive laparoscopic or robotic hysterectomy, then the time reduces to 6-12 hours.


Q: Is hysterectomy an abdominal surgery?


A: Yes, it is.


Q: Do you still go through menopause after a hysterectomy?


A: If you are fertile, you will go through menopause only if your ovaries are removed. This type of menopause is called surgical menopause.


Q: How long does it take to recover from a hysterectomy?


A: The average recovery time for a vaginal or laparoscopic hysterectomy is 3 to 4 weeks. For an abdominal hysterectomy, recovery may take 5 to 6 weeks. Rest as much as you can for starting two weeks.


Q: Are fibroids dangerous?


A: Fibroids are pretty standard — 20-70 percent of women will develop fibroids during their reproductive years. And they’re almost always (99 percent of the time) harmless. But that doesn’t mean you should ignore them. Fibroids can cause complications like excessive bleeding and reproductive problems.


Q: How can I treat fibroids medically?


A: Ways to treat fibroids in the uterus without surgery are:


  • GnRH Agonists for Fibroids: These medications shrink fibroids by temporarily mimicking menopause, stopping periods, and improving anemia. However, they cause side effects like hot flashes and bone loss. Used short-term (up to 12 months with add-back therapy) before surgery or to ease menopause transition.
  • GnRH Antagonists for Fibroids: Unlike agonists, these meds control heavy bleeding but don’t shrink fibroids. They’re suitable for up to two years, often with “add-back” therapy for reduced side effects like hot flashes and bone loss. Some even come pre-combined with hormones.
  • Progestin-releasing intrauterine device (IUD): A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. It only relieves symptoms, though. It doesn’t shrink fibroids or make them go away. It also prevents pregnancy.
  • Tranexamic acid (Lysteda, Cyklokapron): This nonhormonal medicine can ease heavy menstrual periods. You take it only on heavy bleeding days.


Q: What Is Uterine Fibroid Embolization (UFE)?


A: Uterine fibroid embolization is a minimally invasive alternative to hysterectomy or myomectomy. Performed instead of major surgery, this procedure requires minimal or no hospital stay and a shorter recovery. This procedure blocks the blood supply to the fibroid tumors, making them shrink.

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