Hysterectomy for uterine fibroids

Hysterectomy may be recommended to remove uterine fibroids when:

• A growth in the uterine wall is growing rapidly, particularly during perimenopause, and the type of growth cannot be determined.
• Fibroids are large and interfere with the normal function of or block the bladder or bowel.
• The tissue of a large fibroid dies and causes an infection (necrotic fibroid).
• Anemia caused by heavy menstrual bleeding is not relieved by treatment with medicine or a procedure called dilation and curettage (D&C).
• Side effects and risks outweigh the possible benefits of medicine, myomectomy, or uterine fibroid embolization.
• Pain or pressure is not relieved by treatment with medicine, myomectomy, or uterine fibroid embolization.

The size, location, and number of fibroids determine which hysterectomy procedure is most appropriate.

Hysterectomy for uterine fibroids:

• Relieves ongoing pain caused by fibroids.
• Corrects anemia from prolonged, heavy, and irregular vaginal bleeding.
• Is the only fibroid treatment that prevents regrowth of fibroids.
• May correct leakage of urine (urinary incontinence) that is caused by fibroid pressure on internal organs.

What else should I know?

An accurate diagnosis of symptoms is essential for a successful outcome of a hysterectomy. If your symptoms are not accurately diagnosed, a hysterectomy may not relieve them.

Up to 50% of fibroids have grown back within 10 years of removal by myomectomy, depending on the original fibroid problem.¹ Because of this high recurrence rate, hysterectomy may be an appropriate treatment choice for women who have completed childbearing and have bothersome symptoms that have not responded to other treatment.

Hormone suppressors, such as gonadotropin-releasing hormone analogues (GnRH-as), used 2 months before a planned hysterectomy may:

• Shrink fibroids before surgery to make the surgery easier on you or to allow a vaginal hysterectomy instead of an abdominal hysterectomy.
• Increase your blood cell count, which reduces anemia before surgery.

Many women find heavy, prolonged, and irregular bleeding caused by fibroids to be bothersome. But a hysterectomy may have no long-term advantage over waiting for bleeding to stop with menopause. When considering this surgery, weigh the benefits against the risks and costs.

If you have a hysterectomy and you are not close to menopausal age, talk to your health professional about whether to also have your ovaries removed (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.² If you do have an oophorectomy, estrogen replacement therapy (ERT) is recommended to prevent bone-thinning. For more information, see the topic Hysterectomy.

Citations

1. Wallach E, Vlahos NF (2004). Uterine myomas: An overview of development, clinical features, and management. Obstetrics and Gynecology, 104(2): 393–406.

2. Parker WH, et al. (2005). Ovarian conservation at the time of hysterectomy for benign disease. Obstetrics and Gynecology, 106(2): 219–226.