Hysterectomy or not?

I had a transvaginal scan in December which showed multiple fibroids (4 of note which are 6.5cm, 2 x 3cm and 2cm) and a 4 cm cyst on right ovary (probably dermoid).  My symptoms are heavy, prolonged and irregular periods, constant lower back pain, tired and emotional, weight gain (my uterous equivalent to 14 week pregnancy).

Saw Gynacologist last week who did CA-125 blood test and uterine biopsy (awaiting results) and told me to have another scan in 3 months but to consider hysterectomy.

I am 44yrs old and have never been pregnant.

Presumably I will need to have the dermoid cyst removed, whatever else I decide.  If I opt for a hysterectomy will they recommend taking my ovaries too?

My father died of Colon Cancer at age 65, does this increase my chances of ovarian cancer?  I am also recently dianosed with hypothyroidism (auto-immune), does this make any difference to my decision?

Sorry so many questions, so much to think about.

[Annekathryn Goodman, M.D.]

Hi There,
Yes there is always alot to think about. I would divide my answer into different issues:

Fertility:  At age 44, you are right at the edge of good fertile eggs and eggs that are not really capable of making a baby.  If fertility is an important issue, I would recommend a consultation with a reproductive gynecologist.  It may help your ultimate decision if you knew what your chance for a pregnancy are.

Family History of Cancer:  Colon cancer genetics is complex and varied area.  If you have many family members with cancers such as colon, breast, endometrial,  you should consider meeting with a genetic counselor . A careful family tree can help understand what your personal risks are.
Also at very least, now that you are in your 40's, I would suggest a screening colonoscopy now (as opposed to waiting until you are 50) because of your father's history.

Fibroids/Dermoids:  based on your symptoms, I think your fibroids are more to blame than that little dermoid ovarian cyst.  If you ultimately decide to have a hysterectomy and removal of the dermoid cyst, it is not necessary to remove one or both of your ovaries unless you have a malignancy.

If you discover based on your genetic evaluation that you have a higher risk for the development of uterine and / or ovarian cancer, then the prophylactic removal of your ovaries and fallopian tubes at the time of the hysterectomy is sensible.

best wishes