Hysterectomy - following Gastric bypass

I'm a 49 year old African American.  In December 2003 I had an open roux-en-Y gastric bypass followed by an abdominoplasty in 2005. All my menstruating years my periods have been heavy and painful.  But for the past year my periods have been extremely heavy and extremely painful.  With accidents, hourly tampon changes (super plus/ultra absorption) and I also take Iron supplements.  Finally went to the doctor who performed a pelvic ultrasound and discovered I had multiple fibroids.  I also had an abdomen/pelvic MRI followed by a hysteroscopy and biopsy.  My doctor told me my uterus is the size of a 20 week pregnancy. I hate to wear any tight fitting clothes and when I lie on my stomach I can feel the enlarged uterus. My doctor also put me on Tranexamic acid which I didn't really think helps that much.  My surgeon has recommened a hysterectomy (reserving the ovaries).  He says he will cut through the previous abdominoplasty scar.  Here are my concerns. From my past 2 surgeries I am prone to hypertrophic scarring and  keloids.  Will cutting into this excision scar make it worse?  Also, does the fact that I had a gastric bypass make a hysterectomy more difficult?  I read that fibroids can shrink after menopause.  I was wondering if I could wait this surgery out.  What else can be do to relieve the symptoms?  If I do not have the surgery will these fibroids continue to grow?   I'm just very concerned about having another major surgery.  Thank you very much for your time and consideration.

[Erich T Wyckoff, MD]

Greetings Ebonyiyze,
Keloid formation is genetic; therfore with any injury to your skin that requires healing the formation of a keloid is a probability. True, fiboids do begin to regress in size and symptomatology with menopause; however it could be longer that you are willing to wait when dealing with a 20week size uterus. In the event that you have a total hysterectomy (this does not include removal of your ovaries) reoccurence of fibriods is highly unlikely. You could consider medical therapy such Mirena IUD, Lystedia etc... However hysterectomy is definitive. I am not certain how hysterectomy may or may not effect you gastric bypass being that I am not able to review your operative report. Perhaps this question is better addressed with your prior surgeon. Thank you