My Uterine Fibroid Experience: To Cut or Not to Cut?

I want to start by saying that everything I'm about to share in this review is based on my own experience. I've tried to gather information from my gynecologists, gynecologists-surgeons, and books, but I may be misinterpreting some of the information.

Introduction to the topic of formations in the small pelvis.My experience.What helped me when my gynecologist referred me to a surgeon.A relevant, but tricky for me question: "What are your reproductive plans?"Why I'm observing a cyst and operating on a myoma in my case.How the surgery went.

I want to say that everything I'm about to share in my review is based on my own experience. Here, I'll be sharing the information I received from my gynecologists and gynecologists-surgeons, as well as what I've learned from books. I've tried to make sense of the questions that happened to me, but I may be misinterpreting their answers.

Formations in the small pelvis in women are a complex topic, and even the medical community still doesn't know all the reasons why cysts and myomas appear. And the ways to prevent and treat them aren't always effective. But I've tried to share my story in this review, maybe it'll help someone else understand their diagnoses, at least by realizing they're not alone. But all decisions should be made with your doctor, with the one you're willing to trust. I wish each woman finds her specialists.

I'll start with the fact that when a formation in the small pelvis is discovered on a gynecologist's ultrasound, the patient usually hears: "We'll be observing". Provided regular check-ups every year.

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At least, that's what happened to me. Since 2018, I've been observing a cyst on my ovary. In 2020, an ultrasound first showed a myoma on my uterus. "We'll be observing" - I heard again. But I never even thought:

what would happen when the doctors would say something else?what the next step would be after observation wasn't an option anymore?This stage arrived for me in 2022.

Ultrasound of the uterus. MyomaA bit about my attitude towards doctors:

It so happened that I went to many gynecologists. And almost all of them, at different periods of my life, prescribed unnecessary tests, ineffective medications, and procedures that could have been avoided. Because of this, I developed distrust towards the medical field. Whether it was doctors from women's clinics or private clinic doctors. And now, I don't just rely on all recommendations, but before taking any action for my health:

I consult with several specialists to hear different expert opinions. It's every woman's right, and there's no need to be ashamed of it;I research articles on social media. Yes, approaching doctor searches on social media requires a very selective approach;I refer to books and clinical guidelines.

So, in 2022, instead of observation, I had to make several decisions about my health at once. When a gynecologist's appointment involves discussing three topics at once, my head spins. Myoma, cyst, and the third topic I won't discuss here to avoid overwhelming the review. And I simply couldn't understand or grasp anything until I started studying and delving into each of them.

Going to multiple specialists made things even more complicated, as it would've been easier to understand their approach if they were all on the same page. But that wasn't the case. Some said I needed to have my fibroid removed, while others just waved it off and said it was still small. There were also different opinions about the cyst.

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What helped me personally:

Doing my own research on my diagnoses. Firstly, it helped me understand what the gynecologists were talking about during appointments. It was tough to keep up with everything on the fly. Secondly, sometimes situations are critical, and surgeons don't offer alternatives – they just say an operation is necessary. In my case, I was given options, so the decision on which treatment to choose was still mine.It made me feel better to read a few reviews about what to expect during the operation, preparation, and recovery.I was lucky to find a gynecologist and a gynecological surgeon who gave me their contact info. I tried not to bother them, but I managed to ask a few questions during preparation and get some answers. Since things weren't going smoothly, and I was worried I might need to reschedule the operation, it really helped to have their support. Plus, being able to ask questions reduced my anxiety.Understanding the statistics. Fibroids occur in over 80% of women.

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But there was one thing that was really tough for me psychologically. All the specialists asked me the same question: 'What are your reproductive plans?' Why was it hard for me? It's a topic for a therapist, and I've even tried to work on it, but I haven't been very successful yet. I'm in a relationship with someone I want to build a future with, but having kids has never been a must-have for me. I believe it's essential to think about having a child only when I'm fully prepared, willing, and understand that I have the necessary resources to make it a positive experience. But on the other side of the scale, there's always a bit of doubt: will I regret my decision if I choose not to have kids?

When the gynecologists asked me this question during appointments, I felt like I needed to make a decision right then and there – whether I'd get pregnant and when. Honestly, I just wanted to cry because I didn't have a clear answer, like 'I don't plan on having kids' or 'I want to start planning a pregnancy in a year.'

Why did they ask about my reproductive plans?

Both fibroids and cysts can lead to infertility or difficulties carrying a child, depending on their type and size. However, surgery doesn't guarantee that a new growth won't appear in the near future. So, doctors advise having surgery and planning a pregnancy right away.

In my case, it was decided to wait on operating on the cyst in my ovary and operate on the fibroid first.

Why the decision was made not to operate on the cyst:

My experience with endometrioid cysts has been a bit of a rollercoaster. One of the key factors for removal in Russia is the size of the cyst. If it's 4 cm or more, the surgeon might recommend surgery. My cyst was exactly 39.9 mm, but since I'm not planning to get pregnant anytime soon, my doctor suggested taking hormonal meds for six months to see if they can slow down the growth of the cyst.

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I've learned that not all myomas require treatment or surgery.

Why I decided to operate on my myoma:

First things first: does the myoma cause any symptoms?I've always had heavy periods, but the duration has increased to 10-11 days over the past year. Myoma could definitely be the culprit. Prolonged bleeding can lead to anemia, so it's essential to keep an eye on your blood loss.

Heavy periods can be defined as those with a total volume of over 180 ml. Some doctors consider heavy bleeding to start at 80 ml. So, how do you measure it? I use a menstrual cup (which, by the way, can be a great alternative to tampons and pads). For example, if your period lasts six days, you need to add up the volume of each day's bleeding.

There's a classification system for myomas based on their location. It's called the FIGO classification. Make sure to get this information from your ultrasound report. I didn't know about it, so I had to redo the ultrasound. Some types of myomas can't be removed without taking out the uterus. The surgeon will decide on surgery based on the type of myoma. For instance, type 0 (submucosal myoma) is already a reason for removal.My myoma was a submucosal-intramural type (1 or 2). This type can be operated on, but it's more complicated.

Ultrasound of the uterus. Myoma During the ultrasound, they asked when I plan to get pregnant, explaining that pregnancy changes the hormonal balance (estrogen levels). Apparently, myomas and cysts can grow less after pregnancy. It's weird and unfair when a woman is told she needs to have a child to deal with her health issues. Some specialists don't hesitate to recommend this to their patients.

So, in my case, the decision to have the myomectomy was made because I'm not ruling out the possibility of planning a pregnancy in the future. The fibroid was growing in the uterine cavity and distorting it. It was probably making my periods heavier.

Maybe the operation could have been postponed since a pregnancy wasn't planned in the near future. The symptoms of heavy periods could have been alleviated with hormonal meds, as they make your periods lighter or even disappear on their background. Maybe if the fibroid had continued to grow, it would have been harder to remove. I still don't have answers to all my questions, and the decision for me is still not clear-cut. But the operation's been done, so I'll tell you about it.

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Myomectomy

To prepare for the operation, both physically and mentally, I read a few reviews about myomectomy. Now I knew what to expect and even made some notes on what to bring and what to expect.

I'll share them with you:

On the day before the operation, you should have a light dinner no later than 7 pm. Your last drink should be no later than midnight, or at the latest 5 am. After that, you can't even have water. In the morning, you can't eat or drink anything.After the anesthesia, you might feel a bit dizzy and it'll be very cold.In the hospital:I'll arrive, fill out the documents, consult with the anesthesiologist. I might have to wait a few hours. I'll put on compression stockings, get seated on the gynecological chair, and get attached (if needed). I'll be given anesthesia. To wake me up, they might slap me on the cheeks. I'll have a catheter in my hand. I'll need to ask them to remove it.After the operation, there might be a lot of blood, which is normal. When the anesthesia wears off, I can try to get up.

I was operated on the same day I was admitted to the hospital. They were checking if I'd eaten or drunk anything. Operations weren't scheduled for those who hadn't fasted that day. But those who were scheduled for myomectomy were operated on the same day I was admitted. Those who were having a laparoscopy were operated on the next day.

If you know your operation is scheduled for the same day, you can put on compression stockings at home before leaving.

Door leading to the operating roomsThey distributed us to the wards at 9:30. At 12:00, they took me to the operating room. I was given a hospital gown. They took me to the operating room on a stretcher and I transferred to a bed. My legs were secured with soft restraints. They administered anesthesia intravenously. Before I fell asleep, I felt the medication spreading through my body and filling me with pleasant sensations.

'How nice,' I said.

'What's nice?' someone asked.

But I couldn't answer because I fell asleep.

I woke up when they took me to the ward and asked me to transfer to my bed. The nurses helped me, put a cold compress on my stomach, and let me rest. It was 1:30 pm.

When they took me to the ward, I was cold. But my neighbor covered me with another blanket. That was very thoughtful of her.

My surgeon came to check on me after the operation. He said that the fibroid was embedded deep in the uterine wall, so the procedure took about 40 minutes longer than usual. He carefully removed the fibroid layer by layer. I know that this type of intervention, where the fibroid is cut into pieces, can have bad consequences if the growth turns out to be cancerous (but that's rare). Plus, if they don't remove it completely, you might need another procedure. And during the operation, the uterus is inflated with gas, making it hard to determine the fibroid's contours. So, a month later, I had an ultrasound to check if the whole fibroid was removed. I'll get the biopsy results in three weeks.

Hospital roomI spent four days in the hospital, but I know some clinics offer a four-hour stay after this procedure, since it's considered minimally invasive. I would've been happy to go home on the second day after the operation. I didn't experience any pain in my lower abdomen, and the procedure went smoothly without any complications. The only thing that worried me was the burning sensation during urination after the operation. That's not a common side effect, but luckily, it went away on the third day after the operation.

I hope the fibroid was embedded deep enough in the uterine wall that it won't cause any problems in the future. Only time will tell.

What to bring to the hospital depends on how many days you'll spend there and the specific hospital. Here's my list:

- compression stockings,

- toothbrush, toothpaste,

- comb,

- sanitary pad packaging,

- toilet paper,

- moisturizing cream,

- slippers,

- nightgown,

- comfortable pants and a top (many people wore hospital gowns, but I didn't have one),

- spare underwear, socks,

- phone charger,

- book,

- cotton mask.

I was satisfied with the hospital food. Yes, it wasn't very tasty, and it would've been nice to bring some bananas as a dessert. After the operation, I was allowed to have dinner in the evening. What I would've brought with me: bottled water. But we had a water boiler in our room, and I drank boiled water.

When I was preparing for the hospital stay, I had some concerns:

that I'd be freezing in the operating room before I fell asleep;that the hospital conditions would be awful (I chose a private room. My main reason was that the free rooms have a shared bathroom on the floor. I wanted to ensure my comfort, and I'm glad I made that choice.)that the staff would be rude.I wasn't worried about something going wrong during the operation. That was out of my control. And if there were any complications after the operation, I promised myself to deal with them and not worry about them unless they arose.

My neighbor helped me with the cold after the medication-induced sleep. The hospital conditions weren't five-star, but for a budget hospital, everything was fine. The entire staff was caring and attentive. Huge thanks to them for that.

Of course, any procedure comes with its risks and potential complications. I'm talking about hysteroresectoscopy, for example - there's a risk of developing adhesions after the surgery. Your gynecologist should fill you in on all the details.

Thanks for sticking with me until the end! Take care of yourselves!