Fibroids are benign tumors that are made of fibrous connective tissues and smooth muscle cells. They develop in the uterus, and up to 80% of women will have at least one of them in their lifetime. Most women do not develop symptoms or require treatment because they are not cancerous, and they do not have the capability of becoming malignant over time either. That is why observation tends to be the first line of treatment.
Fibroids can grow at different rates, ranging from the size of a bean to that of a watermelon. The reason why they appear is not entirely known, although there is a suspected genetic component to the issue. If you do experience bothersome symptoms, such as heavy periods, prolonged bleeding, pelvic pain, or intense discomfort during intercourse, then removal may be necessary.
One of the treatment options in severe situations is a hysterectomy for fibroids. These are the pros and cons to consider with this procedure.
List of the Pros of a Hysterectomy for Fibroids
1. It doesn’t need to be a complete hysterectomy to remove fibroids.
It is possible for a doctor to perform a partial hysterectomy instead of a complete one to remove the fibroids. You will want to speak with your medical provider about whether a myomectomy is an option in your situation. You might also talk about the options of that don’t include the complete surgical removal of the cervix. Make sure that you ask any and all questions that come to mind because some topics might not come up with you discuss these key points with your doctor.
Up to 90% of women with fibroids can use embolization to cut off the blood supply to the tissues instead of having the uterus removed. Ablation can help to burn or freeze the uterine lining to control bleeding as well.
2. Hysterectomies can reduce the future risk of some cancers.
If there is a surgical removal of tissues from the body, then those components can no longer become malignant over time. That’s why a hysterectomy can be useful in situations where there could be a family history or a genetic risk for certain cancers. You will have the option to treat the fibroids while taking a proactive approach to your health.
This advantage is especially beneficial for women who have the BRCA1 or BRCA2 gene defects if your doctor decides that taking the ovaries during the hysterectomy is necessary to treat your fibroids.
3. There is a reduction in abnormal bleeding.
If you have abnormal bleeding during your periods, then a doctor might recommend a hysterectomy for your fibroids because this intervention will help to alleviate your other symptoms. Abnormal bleeding can cause excessive draining, discomfort, and intense pain. You will want to discuss whether a uterine balloon therapy could be helpful in your case before opting for the surgery. Hormonal treatments might be an option for some women as well.
4. Doctors have five different methods from which to choose for the operation.
There are several medical interventions for fibroids to consider if surgery is the primary option. Laparoscopic and robotic hysterectomies reduce the number of incisions that are necessary to complete the procedure, which means your recovery time is shorter. The standard approach is to use an abdominal hysterectomy because it requires less skill, but it does mean more scarring and a significantly longer time to recover. Some doctors work to remove the fibroids and uterus through the vagina as a way to minimize the visible scars and reduce post-operative pain.
5. It may be cheaper than other fibroid treatment options.
If your doctor recommends the removal of your fibroids through the use of a hysterectomy, then it may be cheaper to use this option than the other treatments that are available to alleviate your discomfort. The mean total patient costs for this procedure range from $31,000 for vaginal surgeries to $49,000 for a robotic procedure before adjustments and insurance coverage. Since it is no longer treated as an elective surgery, most policies provide whatever medical coverage applies in your situation.
If you need long-term treatments for your fibroids using medication or less invasive approaches, then your costs could run higher than the surgery over time.
6. Not all women go into menopause after a hysterectomy.
Many women expect to experience hot flashes, night sweats, and mood swings after their hysterectomy for fibroids, but that outcome isn’t always the case. Once the uterus is removed, you won’t get your periods and can’t get pregnant, but your ovaries will still be there unless there is a reason to remove them as well. Only women who were not in menopause already and must have their ovaries removed will experience that post-op outcome. The timing of natural menopause is not usually affected otherwise.
7. Hormone therapies can help with physical changes.
If your fibroids require a hysterectomy that includes your ovaries too, then you should speak with your OB/GYN about using estrogen therapy to manage your post-operative symptoms. The hormones can help to relieve some of the most uncomfortable symptoms of menopause that develop afterward. There can be risks with this benefit as well, which is why you should speak with your treatment team to see if it is the right approach.
List of the Cons of a Hysterectomy for Fibroids
1. It creates a loss of fertility.
The most significant disadvantage of having a hysterectomy for fibroids is that it creates an immediate loss of fertility. Once the surgery is complete, then you cannot conceive. For women who are of childbearing age, this is an intense loss that can cause feelings of grief, guilt, and shame. If a doctor is pushing a woman toward this treatment option without exploring non-invasive solutions, there may be an adverse reaction to the idea. It helps to get a second opinion before proceeding with the surgery to see if there are any other options.
2. This procedure is a significant surgical intervention.
Any medical procedure that your doctor or physician performs brings with it an additional risk of injury, unwanted side effects, or life-threatening results. Every surgery, including a hysterectomy, brings with it a small risk of death. Although this disadvantage is below 1%, there is a 30% rate of complications with this surgery that you will want to consider. Infections and fever are the most common issues, but there could be damage to other internal organs, hemorrhage, bladder problems, or bowel health issues that happen.
3. You may face a higher risk of other adverse health issues.
When women receive a hysterectomy before the age of 40, then there is an increased risk of suffering a stroke or heart attack compared to those who do not receive this procedure. Even if the doctor doesn’t remove your ovaries, the chances that you will experience an earlier menopause than expected are higher as well.
Hysterectomies are also associated with sexual function issues, urinary problems, depression, hormone deficiencies, and psychological stress.
4. It may not help with your endometriosis.
Hysterectomies for fibroids can sometimes improve the symptoms of endometriosis, but it is never a cure for the condition. Some women will not experience any improvement in their symptoms afterward, even if the procedure is highly recommended by your gynecologist. If you have fibroids, there is a chance that removing them could be the key that unlocks some relief for you in the future.
5. Minimally invasive surgeries have risks for you to consider.
There are several techniques and procedures that create a minimally invasive surgery for your hysterectomy, but there are risks to consider in addition to the advantages. Surgeons will remove the uterus in small sections using the morcellation process. If you have an undiagnosed cancer there as well, you could potentially spread the malignant cells by using this process. That is why there is informed consent going into the surgery, even though this malignancy is exceptionally rare, because there could be additional health issues to face in the future. This disadvantage may be why your doctor recommends the abdominal method instead.
6. You will need to go through psychological healing too.
It is not unusual for the psychological trauma of a hysterectomy to take longer to heal than the physical symptoms that occur after the operation. Most women feel a sense of loss after this procedure, and feeling “down” is fairly common. If your post-op depression goes longer than a couple of weeks, then you will want to seek out some help. Get professional assistance immediately if you have problems with insomnia, experience feelings of hopelessness, or you have changes to your appetite.
7. There is not a “best practice” treatment for fibroids.
Even though uterine fibroids are very common for women in the general population, there are only a few randomized clinical trials that serve as guides for treatment. If the procedure doesn’t go through the abdomen, then it is not considered a major surgery. That is why a conversation with your doctor is needed if this procedure is the recommendation. Unless you have tried other interventions, you will need to know what your personal risks and benefits happen to be with all of the possible medical interventions.
Verdict of the Pros and Cons of a Hysterectomy for Fibroids
Every year, doctors in the United States perform about 600,000 hysterectomies. It is the most common major operation that women have in the country after a Cesarean section. Most are done to treat fibroids and other non-cancerous conditions like endometriosis and uterine prolapse.
It may be necessary in some situations to take this approach, but the pros and cons of a hysterectomy for fibroids show that non-invasive treatment options should be chosen whenever possible.