Downsides to post-meno hysterectomy?
December 20, 2023 2:55 PM Subscribe
Routine pap with my NP shows ‘wow, big cervical polyp!’ so then off to the gyno who says ‘let’s just pull it all out!’ Is this a normal go-to solution for a healthy 55yo? YANMD. Have you done this? What do you know?
Seeking feedback and related experience around polyps and fibroids and hysterectomies. All my life I have been among the fortunate to have regular and painless periods. It’s now been a solid 3 years since my last. My recent pap showed an apparently giant cervical polyp, so off to the (new-to-me) gyn I went (to have it removed I thought). She tells me it’s very large and that my uterus is also, which apparently indicates to her that it’s full of fibroids. I am healthy and have no symptoms of anything.
She assures me there’s nothing to worry about (I lost my person to cancer so yes, this does scare me, because I know ‘nothing to worry about’ can also mean you’ll be dead in a year) and says if I was her sister, she would recommend ’removing it all.’
Apparently a hysterectomy is laparoscopic, and all the parts come out your vag and …it’s no big thang? (she had one herself and was ‘back to work 3 days later’). Next is me making an appt for a pelvic ultrasound, followed by another appt with her in early Feb to establish what we do next. Any thoughts? And sure, maybe it’s not cancer, but if they noticed a polyp 6 weeks ago and my post-ultrasound appointment to talk about next steps isn’t for another 6 weeks, and procedure maybe isn’t for yet another 6 weeks, I mean… what if it is cancer and I’m giving it all this time to grow? Also, is a decision like this something that merits a second opinion? I live in a small town with two gynos, and at least 2 hours from more.
Just trying to wrap my head around this (recognizing that I have some health anxiety due to my loss) and learn if it’s a totally standard approach. If you have something to share but don’t want to do it here, feel free to PM.
Seeking feedback and related experience around polyps and fibroids and hysterectomies. All my life I have been among the fortunate to have regular and painless periods. It’s now been a solid 3 years since my last. My recent pap showed an apparently giant cervical polyp, so off to the (new-to-me) gyn I went (to have it removed I thought). She tells me it’s very large and that my uterus is also, which apparently indicates to her that it’s full of fibroids. I am healthy and have no symptoms of anything.
She assures me there’s nothing to worry about (I lost my person to cancer so yes, this does scare me, because I know ‘nothing to worry about’ can also mean you’ll be dead in a year) and says if I was her sister, she would recommend ’removing it all.’
Apparently a hysterectomy is laparoscopic, and all the parts come out your vag and …it’s no big thang? (she had one herself and was ‘back to work 3 days later’). Next is me making an appt for a pelvic ultrasound, followed by another appt with her in early Feb to establish what we do next. Any thoughts? And sure, maybe it’s not cancer, but if they noticed a polyp 6 weeks ago and my post-ultrasound appointment to talk about next steps isn’t for another 6 weeks, and procedure maybe isn’t for yet another 6 weeks, I mean… what if it is cancer and I’m giving it all this time to grow? Also, is a decision like this something that merits a second opinion? I live in a small town with two gynos, and at least 2 hours from more.
Just trying to wrap my head around this (recognizing that I have some health anxiety due to my loss) and learn if it’s a totally standard approach. If you have something to share but don’t want to do it here, feel free to PM.
I had large cervical polyps and fibroids at about the same age. In my case the polyps bled unprovoked in a serious way, bleeding my hemoglobin down from a normal 12 or so to between 7 and 8 over a week's vacation far from good medical resources. It didn't stop until I got home when my gyn gave me some sort of oral hormone. Then it happened again. My gyn (also a new one) said "You can't keep doing this. It's not safe to continually give you large doses of hormones to stop the bleeding. You should consider a hysterectomy because there is no other safe option that will stop the bleeding." I was absolutely shocked at the suggestion. I thought of myself as healthy and "intact", even after one or two aberrant bleeds. I also had a sort of prejudice against hysterectomy, since in my mother's generation they were thought to be over-prescribed and misogynistic, but there was no doubt that it was a sensible suggestion.
I also had several vaginal ultrasounds to measure the size of the growths and the rate at which they were growing. That's absolutely routine.
In my case I wasn't worried that the growths were cancerous. I don't know why I wasn't worried about it, but I wasn't. Ask your gyn about the stats on whether polyps and fibroids are often cancerous, but I don't remember hearing that they were. In my case, after I agreed to have the hysterectomy I focused on my ovaries because my mother had had ovarian cancer, a terrible experience, and I didn't want that, so I had them removed, too.
I had the same surgical approach your doctor mentioned - laparoscopic and vaginal. I live in a big city with several fine medical schools and hospitals, and I was referred to a surgery specialist in GYN surgery. That doctor was a gyn-oncologist because they specialize in gyn surgery, as distinct from obstetrics and gynecology, and sometimes patients do have cancer. Because of my mother's history of ovarian cancer, it was especially appropriate, and he had an excellent physician assistant in his office that I could call at any time for advice or access. The surgery went well, the ovarian pathology was negative, and I have been well since, not missing my uterus, cervix, or ovaries at all. It is an absolute pleasure to be done with worrying about it.
Best of luck to you!
posted by citygirl at 5:37 PM on December 20, 2023 [5 favorites]
I also had several vaginal ultrasounds to measure the size of the growths and the rate at which they were growing. That's absolutely routine.
In my case I wasn't worried that the growths were cancerous. I don't know why I wasn't worried about it, but I wasn't. Ask your gyn about the stats on whether polyps and fibroids are often cancerous, but I don't remember hearing that they were. In my case, after I agreed to have the hysterectomy I focused on my ovaries because my mother had had ovarian cancer, a terrible experience, and I didn't want that, so I had them removed, too.
I had the same surgical approach your doctor mentioned - laparoscopic and vaginal. I live in a big city with several fine medical schools and hospitals, and I was referred to a surgery specialist in GYN surgery. That doctor was a gyn-oncologist because they specialize in gyn surgery, as distinct from obstetrics and gynecology, and sometimes patients do have cancer. Because of my mother's history of ovarian cancer, it was especially appropriate, and he had an excellent physician assistant in his office that I could call at any time for advice or access. The surgery went well, the ovarian pathology was negative, and I have been well since, not missing my uterus, cervix, or ovaries at all. It is an absolute pleasure to be done with worrying about it.
Best of luck to you!
posted by citygirl at 5:37 PM on December 20, 2023 [5 favorites]
(I had a partial hysterectomy at 49 because of a uterine fibroid.)
The bit that concerns me is that it sounds as if the Gynecologist is guessing that there are fibroids in your uterus,(and not just your cervix) rather than establishing whether or not there are with an ultrasound, or did I misunderstand?
An abdominal or pelvic ultrasound would be a good idea.
Fibroids themselves are not a cancer risk, but they do cause heavy bleeding, which can be detrimental to your health.
I have a family history of ovarian cancer, so that was a part of the conversation for me. I ultimately decided to remove everything except my ovaries and cervix as I was not menopausal yet and my ovaries still functioning, and the benefit of that outweighed the cancer risk. Also, having my fallopean tubes removed reduced the cancer risk.
If you have a family history of ovarian cancer, however, then there's an argument to be made about removing ovaries after menopause, as you could still develop ovarian cancer after menopause.
Doctors absolutely do suggest full hysterectomies far too easily, so it's worth getting a second opinion.
posted by Zumbador at 8:31 PM on December 20, 2023 [4 favorites]
The bit that concerns me is that it sounds as if the Gynecologist is guessing that there are fibroids in your uterus,(and not just your cervix) rather than establishing whether or not there are with an ultrasound, or did I misunderstand?
An abdominal or pelvic ultrasound would be a good idea.
Fibroids themselves are not a cancer risk, but they do cause heavy bleeding, which can be detrimental to your health.
I have a family history of ovarian cancer, so that was a part of the conversation for me. I ultimately decided to remove everything except my ovaries and cervix as I was not menopausal yet and my ovaries still functioning, and the benefit of that outweighed the cancer risk. Also, having my fallopean tubes removed reduced the cancer risk.
If you have a family history of ovarian cancer, however, then there's an argument to be made about removing ovaries after menopause, as you could still develop ovarian cancer after menopause.
Doctors absolutely do suggest full hysterectomies far too easily, so it's worth getting a second opinion.
posted by Zumbador at 8:31 PM on December 20, 2023 [4 favorites]
Did she do imaging to determine that the uterus is full of fibroids, or does she just suspect it? I would want to know that for sure before removing an organ. Also, doesn't a hysterectomy have the potential to introduce other hormone changes? I would want a second opinion, personally, before taking such a dramatic step.
posted by limeonaire at 9:01 PM on December 20, 2023 [1 favorite]
posted by limeonaire at 9:01 PM on December 20, 2023 [1 favorite]
I would absolutely get a second opinion even if you have to travel to do it. I am not a doctor or anything close, but I do have a uterus and before menopause it was full of fibroids. I have never heard of anyone with fibroids not having terrible periods with lots of bleeding and I was no exception. I am really surprised to hear that yours weren’t like that.
My doctor said I could consider hysterectomy but as I was heading into menopause anyway she thought I should wait and see if that calmed them down or even made them shrink, as, she said, usually happened. It did and I’ve had no trouble from them since.
Two of my friends had to have pre menopausal hysterectomies due to fibroids. In neither case was it quick and simple and nobody went back to work in 3 days. What your doctor said seems super weird to me and I would urge you to get a second opinion.
posted by mygothlaundry at 10:24 PM on December 20, 2023 [1 favorite]
My doctor said I could consider hysterectomy but as I was heading into menopause anyway she thought I should wait and see if that calmed them down or even made them shrink, as, she said, usually happened. It did and I’ve had no trouble from them since.
Two of my friends had to have pre menopausal hysterectomies due to fibroids. In neither case was it quick and simple and nobody went back to work in 3 days. What your doctor said seems super weird to me and I would urge you to get a second opinion.
posted by mygothlaundry at 10:24 PM on December 20, 2023 [1 favorite]
I know it’s hard, but wait and see what the ultrasound shows, and how they frame their next recommendation. If at that point you still don’t feel confident in their approach, take the ultrasound imaging and your other records to the other gyn in town for a second opinion.
I had a hysterectomy in 2011 for a similar issue. I was 40 and not menopausal. Fibroids caused 24/7/365 heavy bleeding for more than a year, even after less invasive treatments such as IUD insertion. I stopped trusting that doctor—she was just abrasive and for cultural or religious or internalized misogyny reasons (“you might still change your mind and want to have a child someday” lol)— to refuse to consider hysterectomy an option.
Next doctor was the loveliest doctor I’ve ever had. She explained that fibroids aren’t cancer. That I also had adenomyosis, a sub-type of endometriosis when your uterine cells have uncontrolled abnormal growth causing pain and bleeding. That my adenomyosis caused my uterus to be larger than normal. That a uterus that grows things abnormally like these things may increase my likelihood of developing cancer later. At that point I didn’t know family history (adopted), so I wanted the troublesome parts removed. I had a laparoscopic procedure, with vaginal removal, to remove uterus, cervix, and fallopian tubes. It’s still abdominal surgery. They still put instruments inside you, and there’s cutting and shifting around inside you causing internal bruising, and they insert gas to extend your belly so they can see what they’re doing. The pain and recovery time for me was akin to the surgeries where had my appendix and gall bladder removed. Back to work in three days? Not for me. I could have returned to my sedentary job in maybe a week, but not comfortably so. I think I took 3 weeks off, maybe a bit more than I legitimately physically required.
By the way, “hysterectomy” should be understood when used colloquially by non-medical lay people as “we don’t know whether this person means partial, or the full monty, so we’re going to wait for more info and not presume either one.” In fact even when a doctor uses the word we should next be specifying which parts, exactly, are we talking about? Decades ago, we could presume a person meant everything including ovaries. That’s no longer the default, since best practices have changed to generally not remove ovaries unless necessary.
posted by ImproviseOrDie at 1:25 AM on December 21, 2023 [5 favorites]
I had a hysterectomy in 2011 for a similar issue. I was 40 and not menopausal. Fibroids caused 24/7/365 heavy bleeding for more than a year, even after less invasive treatments such as IUD insertion. I stopped trusting that doctor—she was just abrasive and for cultural or religious or internalized misogyny reasons (“you might still change your mind and want to have a child someday” lol)— to refuse to consider hysterectomy an option.
Next doctor was the loveliest doctor I’ve ever had. She explained that fibroids aren’t cancer. That I also had adenomyosis, a sub-type of endometriosis when your uterine cells have uncontrolled abnormal growth causing pain and bleeding. That my adenomyosis caused my uterus to be larger than normal. That a uterus that grows things abnormally like these things may increase my likelihood of developing cancer later. At that point I didn’t know family history (adopted), so I wanted the troublesome parts removed. I had a laparoscopic procedure, with vaginal removal, to remove uterus, cervix, and fallopian tubes. It’s still abdominal surgery. They still put instruments inside you, and there’s cutting and shifting around inside you causing internal bruising, and they insert gas to extend your belly so they can see what they’re doing. The pain and recovery time for me was akin to the surgeries where had my appendix and gall bladder removed. Back to work in three days? Not for me. I could have returned to my sedentary job in maybe a week, but not comfortably so. I think I took 3 weeks off, maybe a bit more than I legitimately physically required.
By the way, “hysterectomy” should be understood when used colloquially by non-medical lay people as “we don’t know whether this person means partial, or the full monty, so we’re going to wait for more info and not presume either one.” In fact even when a doctor uses the word we should next be specifying which parts, exactly, are we talking about? Decades ago, we could presume a person meant everything including ovaries. That’s no longer the default, since best practices have changed to generally not remove ovaries unless necessary.
posted by ImproviseOrDie at 1:25 AM on December 21, 2023 [5 favorites]
Jumping straight to surgery for a benign, asymptomatic, incidental finding seems like a gross overreaction to me. I would get a second opinion.
posted by Violet Hour at 9:03 PM on December 21, 2023
posted by Violet Hour at 9:03 PM on December 21, 2023
I have never heard of anyone with fibroids not having terrible periods with lots of bleeding
Me! I had fibroids. I didn't bleed excessively, my periods were perfectly normal. But there was pressure on my bladder and I was tired of having to urinate all the damn time. I was in my 40s, not close to menopause. I chose to keep my uterus and have a myomectomy instead. It was fine. (Just a data point, if it's helpful.)
posted by tangerine at 4:23 PM on December 22, 2023
Me! I had fibroids. I didn't bleed excessively, my periods were perfectly normal. But there was pressure on my bladder and I was tired of having to urinate all the damn time. I was in my 40s, not close to menopause. I chose to keep my uterus and have a myomectomy instead. It was fine. (Just a data point, if it's helpful.)
posted by tangerine at 4:23 PM on December 22, 2023
I had a transvaginal hysterectomy about 30 years ago to deal with bleeding fibroids. Everything was done through the vagina so I didn't even have laparoscopic incisions. I was conscious and chatting with the nurses throughout the procedure, which used spinal or epidural anesthesia. (This was my choice--I could have had general anesthesia if I wanted but that prospect made me more nervous.) Recovery was so easy, with minimal discomfort. Going back to work in less than a week would have been perfectly reasonable. I'm sure techniques have improved since then so if anything it may be even easier. So I think you can make your decision based on other factors. Good luck sorting it out.
posted by Corvid at 7:03 PM on December 22, 2023
posted by Corvid at 7:03 PM on December 22, 2023
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I am not able to answer any of the specific questions you posted but I do wonder if it would be helpful teasing out: do you specifically have any concerns about the removal procedure itself? Or is this more generalized anxiety around the decision making and unexpected, triggering information?
I'm asking because both are valid responses. And in my experience, medical providers are (mostly for better, but sometimes for worse) moving more toward a model of asking you as the patient what you want and are comfortable with. It sounds like you are grappling with multiple layers of concern within this one procedure (grief trauma, lack of trust in new dr., timeline question, lack of local second opinions, info came unexpectedly, etc.). The more you can be clear within yourself: which risk is worse to you, the known risk(s) of removal with an unknown doctor, or the unknown risk(s) of no removal and kicking the decision down the road? Anything you can do to really dig into why certain aspects of those two options concern you, that are specific to you and your personality/trauma/circumstances, will probably help you decide.
In my experience, proactive medical decisions like this are rarely black and white but each choice carries a certain amount of unknown and risk, so the more you can define what specifically about both the removal procedure may be a deal-breaker or an extra concern for you, it might help you come to a decision faster or gather the right type of specific opinions.
TL;DR if someone told you "there are essentially no downsides to doing the removal procedure exactly as the dr. ordered!" would that make the decision for you, or is there more to unpack? The more and sooner you can examine, the easier it will be to be proactive and confident about your decision.
Good luck.
posted by seemoorglass at 4:17 PM on December 20, 2023 [2 favorites]