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Gynecology

Enlarged uterus

04/14/2008

Question:

I am a 49 year old overweight woman who has never had children. 80 lbs to lose. I had my appendics out in January of 08. I had to be cut open because they could not locate my appendics when they went in laparascopically. (Please forgive my spelling) My intestines had pulled my appendics over to the left side. I was full of puss/infection as they found my appendics had been seeping poison from two small holes. While in there, the Dr. noticed that my uterus was very enlarged and I had fibroid tumors. He said I should have it removed. He told my husband my uterus was the size of a 5 month old fetus. The only problem I`ve ever had prior to my appendics problem was one or two days of painful cramps. This was only at the start of my period. I also had clots. So, I now have a nine inch scar that goes above and below my belly button. My question is.....with being cut open this way, must I be cut open again for the removal of my uterus??? Do I need surgery at all? I feel fine really. I`m a bit anemic and like I said, the first couple of days of my period are painful but managable. I am trying to lose weight and worry if I do have another surgery they may have to cut me across in the other direction. I have an overhang of flesh down there and worry about infection if I have an incision there that can`t "breath" under my skin flap. So, to recap, my questions are? Enlarged uterus with fibroids but doesn`t really interfere with my life. Do I need surgery? If so, can it be done vaginally even though it`s big.....5 month old fetus size. Thanks.

Answer:

A uterus does not need to be removed solely because of its size, but rather because of the symptoms. Searching the previously answered questions for fibroids, you will see that bleeding, pressure and pain during menses are the leading causes. Surgery only needs to be considered if the symptoms are unbearable or dangerous and not amenable to medical management. At 49, you are likely to go through menopause soon and the bleeding is unlikely to be an issue. Also, you could be treated in many different ways to improve your anemia and cramping. Finally, surgery could be attempted laparoscopically and avoid a major incision. Your pelvic infection from your appendicitis may preclude it.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated