Is removal of the uterus recommended?
March 20, 2013 | 40,00 EUR | answered by Dr. med. Ralf Berg
I was in the hospital in February 2013 because of a PAP 3D finding that had been detected since February 2012. To explain: From February 2005 to February 2012, I had been using the hormonal intrauterine device Mirena due to very severe menstrual symptoms, and I was really happy with it. After 2 months, I had no more bleeding or cramps. Therefore, I really wanted to have a new hormonal intrauterine device inserted in February 2012, but unfortunately this was not possible due to the PAP 3D finding, hence the visit to the hospital. In February 2013 I had a curettage, the pathological finding is negative (in a positive sense). However, during the ultrasound examination prior to the curettage, I was informed that I have a greatly enlarged uterus, as well as several well-vascularized fibroids. I was advised to have the uterus removed. The ovaries would be preserved. I would like to add that I have been having major problems with my bladder for about 3 years, with constant urge to urinate. As I now know, this is caused by my enlarged uterus. Now I am faced with the question of whether this surgery really makes sense. I am also a bit unsure, because one does not decide on such an organ removal on a whim. Some information about me: I am 50 years old, 167cm tall, 88kg heavy, do not smoke or drink. Otherwise, I am healthy, I only take Berlthyrox 150 (for the thyroid) and evaluna 30 (for contraception) daily. I would be very grateful if you could advise me. Thank you very much!
Dear patient,
you are right, every procedure should be carefully considered. So what speaks in favor of the procedure?
1. It is clear that your menstrual complaints and bleeding would be permanently gone.
2. As you describe it, bladder problems could also improve.
3. While the histological examination this time was inconspicuous in terms of a tumor, with long-standing Pap 3D findings, it is not to be expected that these anomalies would disappear on their own. It is clear that with a hysterectomy, you would also permanently eliminate the risk of uterine cancer.
4. There is a (relative) medical indication: those are your large fibroids. These are not malignant, but often responsible for the above-mentioned problems.
5. I think that at 50 years old, your family planning is complete, and therefore there is no reason to keep the uterus.
So there are many reasons in favor of the surgery.
What speaks against it? Actually, only the risk of the surgery itself. But if everything were to worsen, you may eventually need surgery anyway, and the risk of the surgery would not necessarily be lower.
Since planned hysterectomies are not overall high-risk operations, I believe you would be well advised to decide on the procedure after careful consideration. If you were under my care as a primary care physician, I would advise you in this way. In your case, I believe that the potential benefits far outweigh the risks. I hope I could help you in your decision-making process. With warm regards, Dr. R. C. Berg.
