To have a hysterectomy or not?

I recently found out through a pelvic ultrasound that I have a large (5.1 x 5.6 x 5.2cm) submucosal mass in my uterus.  I'm 47 years old and otherwise in good health.  My gyn. checked my hormone levels and they were good.  She suggested a hysterectomy.  When I asked about other options she said that I'm a good candidate for Uterine Fibroid Embolization.  I prefer the later because of the down time but am afraid I may have to have a hysterectomy in the near future anyway.  An MRI confirmed the mass and an Endometrial Biopsy was taken because the endometrial stripe could not be seen in the ultrasound do to the mass.  The results of the biopsy are still pending.  What would you suggest?  Hysterectomy or UFE?  Should I keep my ovaries because they are still producing hormones or not?  Thank you.

[Keith Downing, MD]

Hello,

My first question for you is are you symptomatic from this fibroid?  Do you suffer from excess and/or irregular menstrual bleeding, or notable pelvic pressure or pain that is thought to be related to the fibroid?  If no, you need not do anything.  

Additionally, awaiting the results of the endometrial biopsy is critical, because if any abnormal tissue is found (e.g., hyperplasia with or without atypia, or endometrial cancer) different management options will be before you.  

The other important information necessary to guide management (along with the above) is the exact location of the fibroid, and your medical and surgical history.  

Ovarian preservation versus removal should be considered in light of your individual risk of ovarian cancer.  The baseline population risk is ~1/70 (compared to breast cancer, which is ~1/9).  Modifying factors include family history, and/or personal history of other cancers (especially breast ca), >5yrs use of the pill, your race/ethnicity, your parity (# of pregnancies), history of tubal ligation, and duration of breastfeeding.  Additionally, after menopause the ovaries continue to secrete androgens (testosterone like hormone) that may affect a woman's libido and possibly play role in a woman's cardiovascular health (a current area of active research).

So you need to discuss these issues in greater detail with your ob/gyn.  Also, never feel bad about getting a second opinion as well (this forum does not qualify as such).  You need to do what will help you make the best decision for you.

Best regards,

Dr. Downing