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Ask The Expert |
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"It is in your best health interest to see your gynecologist or primary care physician regarding specific medical problems or concerns." This month's topics |
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| Alternative Treatments | ||
| Question:
Hysterectomy for Bleeding I am 25 years old and I no longer have any ovaries. I have been having some bleeding and my doctor wants to do a hysterectomy. I have had 3 surgeries in 4 years and I don't want to have another one, now. I have small fibroids on my uterus. Can you tell me if there are any other options other than a hysterectomy that might help in my situation. My doctor wants to do a hysterectomy even though he says the fibroids are not what is causing the problems. He is not sure what is and so he wants to do the hysterectomy even though he can't find anything wrong with the uterus other than bleeding. I am currently taking r a hormone replacement and I was wondering if that could cause some of the bleeding. |
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| Answer: The bleeding certainly may be due to hormone replacement therapy, but it is one of a number of possibilities. One option to discuss is the possibility of endometrial ablation, which is an outpatient procedure that destroys the uterine lining and reduces (and in some cases eliminates) menstrual blood loss in many cases. It is less useful in the setting of fibroids and another condition known as adenomyosis, so additional information from your doctor or a second opinion consultant may be useful. Medical management may also be appropriate. From a fertility standpoint, which may or may not apply to you individually, it may be particularly desirable to preserve the uterus in order to do donor oocyte transfer and other assisted reproductive technologies. Regardless, it is important that you be made aware of any and all appropriate options to treat your symptoms. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question:
Hysterectomy and Alternatives I have several uterine fibroids and my gynecologist has recommended a total hysterectomy as only option. Could I be a candidate for Uterine Artery Embolization? Also, can you tell me about the Cryoablation procedure for fibroids? I don't want an unnecessary organs removal, nor large periods of recuperation. |
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| Answer: You might be a candidate for embolization-that would depend on many factors and it remains unproven if embolization is appropriate for women who desire future pregnancy (at least there have been no prospective, randomized controlled trials establishing safety to the best of my knowledge). Cryoablation is similar to myolysis in that it causes the fibroids to shrink over time using a laparoscopic procedure (myolysis does the same using electric current rather than freezing the fibroids). A potential downside to cryoablation is that it may not be applicable to all fibroids, but that is also true of myolysis. Your doctor should be able to provide individualized information about alternatives to hysterectomy, including myomectomy if appropriate. Second opinion consultants may be helpful as necessary. Thank you for your e-mail! |
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| Question:
Abnormal Uterine Bleeding I am a 51 year old woman who has had menopausal symptoms for a couple of years. My Ob-Gyn started me on Prempro in June. During the summer, I had several cases of spotting (sometimes heavy spotting). The bleeding stopped for a couple of months. When it started back, I bleed for 4 weeks straight. I had a sonogram which showed that the uterus was not enlarged. He suggested that we try a D&C to see if that would solve the problem. I had the D&C and thought the problem had been solved, but the bleeding has returned. The lab results from the D&C showed normal tissue. I am really tired of the bleeding, any suggestions as to appropriate measures to take from here?? |
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| Answer: A D&C is an excellent diagnostic tool, but it does not cure abnormal uterine bleeding. Hormone replacement therapy can cause occasional spotting or even menstrual-like bleeding, but it should not be excessive. It's something that you need to discuss with your gynecologist. One potential option might be an endometrial ablation, but whether or not that is appropriate for you is a matter best left to you and your doctor to decide. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question:
Alternatives to Hysterectomy for Prolapse I have a rectocoele which I know must be repaired, but am told I also have a grade 2 uterine prolapse and hysterectomy was recommended. But my doctor said it is a "gray area." I am 40 and would like to keep the uterus if possible. I am told that hormone treatment or other options exist. Is there anything you know of in recent research suggesting nonsurgical options for halting a uterine prolapse? Also is it true removal of the uterus typically results in bladder prolapses and other problems 20 years down the road, as my second opinion suggested? I am told physicians are rethinking the whole issue of hysterectomy vs. keeping the uterus intact. Your opinion would be greatly appreciated. |
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| Answer: Unless the uterine prolapse is symptomatic, the decision could go either way, so your doctor is certainly correct in saying that this is a gray area in gynecology. One way of thinking is that if the rectocoele is going to be repaired and you are under anesthesia, it would be appropriate to perform a vaginal hysterectomy at the same time in order to save you from having to assume the anesthesia risk down the road. On the other hand, one could also argue that if the uterine prolapse is not causing any symptoms, it is possible that it might remain stable for many years and not require treatment. It is also possible to treat uterine prolapse with a pessary, but it might not be my own preference in a young woman like yourself since intercourse is impractical. I am not aware that hysterectomy, properly performed, predisposes to pelvic prolapse down the road. Indeed, if an enterocoele (a small bowel hernia that can predispose to additional pelvic prolapse) is present and repaired during vaginal surgery, future prolapse may be prevented There is a controversy (although to my mind the issue has been pretty much settled) regarding whether to routinely perform hysterectomy when other signs of pelvic prolapse are present such as a rectocoele. In other words, it had been held that a nonprolapsed uterus should be removed when fixing a cystocoele or rectocoele, since it was believed that when one part of the pelvis prolapses, the rest is at significant risk as well. This is not an illogical concept, but the data tends to support preserving the uterus unless prolapse is present. I would suggest you follow-up this issue with your physicians and additional consultants as necessary, since it is an individualized decision that only you and your physicians can make based on all the information. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question:
Balloon vs. Rollerball Ablations I'm 38 and want to have an ablation done to end, as much as possible, heavy and lengthy bleeding. I understand the differences between the procedures. I've found a doctor who does several kinds, including the rollerball ablation and balloon ablation. He's recommending the balloon ablation because of its lower incidence of complications. I can appreciate his caution, however, I would like to do whatever I can to maximize my chances of having *no more bleeding.* I've heard, anecdotally, that the rollerball ablation produces better results. Can you direct me to any studies or articles that specifically compare the results of the two types? The issue I'm trying to resolve is whether I should really push for the rollerball ablation, if it's "better", or are they a toss up in this situation? Won't I already be risking some of the complications anyway (from the fluid) during the hysteroscopy? |
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| Answer: While I have my own personal views regarding balloon ablation (an office procedure) vs hysteroscopic methods of endometrial ablation, I can say that there are no long-term, prospective controlled studies comparing the two methods. Because there is also considerable variation among physicians as to how each method is performed (in some cases, combining a rollerball with a resection loop during the same procedure) it is hard to make valid comparisons. An in-office procedure is in theory safer since it does not involve anesthesia and more importantly there is no significant risk of fluid overload. However, both risks can be minimized with appropriate attention to fluid input and output, so that in skilled hands major complications should be quite rare. One concern with the balloon procedure (and its variants) is that it is essentially blind-unless a thorough hysteroscopy with D&C has been done previously, it is hard to be certain that there are no fibroids or even endometrial cancer. Fibroids are not treated by a balloon procedure, nor any form of endometrial ablation unless they are removed hysteroscopically or otherwise. This can reduce the success rates of endometrial ablation unless the fibroids are addressed. The nice thing about office ablation is that it makes endometrial ablation more widely available, since it is easier to do and does not require the same skill set as a hysteroscopic ablation. In my opinion however, hysteroscopic endometrial ablation is not difficult to learn. At this time, it is hard to give any definitive recommendations since we lack long-term data on the balloon procedures. It may be as good as a hysteroscopic procedure, but right now we just don't know for certain. I'm not sure if this is helpful to you or not, but at least it may provide a useful perspective. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question:
Uterine Balloon Therapy I would like to know more about the Uterine Balloon Therapy. I am 45 years old, not menopausal and I am taking b/c pills to regulate my cycles. |
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| Answer: I'm assuming you're referring to an office procedure to perform endometrial ablation using a balloon device. It can be effective, but it remains to be proven if it is as useful as endometrial ablation performed with hysteroscopy in an operating room setting. Your doctor can provide individual information on this treatment. Regardless of the method used, I would strongly recommend some form of uterine sampling be performed before any ablation is done (assuming this step has not been done already). Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question:
Abnormal Uterine Bleeding I am 50 years old and I have had a problem with heavy menstrual bleeding for well over one year. Recently I complained on my annual exam that my bleeding would last 7 to 10 days, changing a tampon and a pad every few hours for the first 3-4 days. The doctor ordered a ultrasound and found a polyp. In July, I had the polyp removed and a D&C was performed. In August, I began spotting for 14 days. After a brief break I began bleeding and have been since. I tried Premarin and then progesterone; this has not stopped the bleeding in fact it got worse. We have doubled the progesterone with the Premarin to see if this will help. I have been told that when the D/C was performed that the lining of the uterus was very vascular. I do not have uterine cancer per the path report. The doctor and I have discussed the possibility of a hysterectomy. I am considering having this done if my bleeding continues to be uncontrolled. Should I consider any other treatment prior to surgery?? What could possibly be causing my continued uncontrolled bleeding?? I had an FSH blood test done and it was normal. The doctor said I may need another D&C but wants to see if upping the progesterone helps. I am totally miserable and tired of all of this. Any recommendations? |
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| Answer: So long as the results from the D&C are unequivocally benign, you may want to ask your doctor about trying a GnRH agonist medication. These medications temporarily place a woman into a menopausal state, which may tide you over until menopause occurs naturally. Such medications cannot be used for over 6 months due to the risk of osteoporosis, but it may be appropriate in your situation for short-term use. I personally would suggest finding other options besides hysterectomy since you are at the age where menopause can be likely to occur, making such surgery unnecessary. But I would again make sure that, given your age and the presence of abnormal uterine bleeding, that everything is benign with regard to the D&C. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question:
Ablation or Hysterectomy? I am 36 years old and four weeks ago I began to hemorrhage. The doctor said my uterus was the size of a 16 to 20 week pregnancy, the endometrial lining was lifting and reattaching but not shedding. I was given two options, a D&C and a Hysterectomy or a D&C and Endometrial Ablation. I chose the later. One week ago I was admitted to the hospital with a uterine infection; this is my third in the past year. I find the pressure from the enlarged uterus makes it uncomfortable for sex, sitting and causes me to have to urinate frequently. I have visited websites to learn more about Hysterectomy's but they seem to be "fright sights." Is there a real possibility of loosing my sex drive or ability to have sex from the surgery? Also, after having nursed for 11 months, I know my uterus was not this big 2 to 3 months ago. Is there a risk of cancer or what can be causing it to be this big? |
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| Answer: It would be important to know what is responsible for the enlarged uterine size in the first place. If it is due to fibroids or adenomyosis (a condition in which cells from the uterine lining grow into the muscle layer, causing pain and bleeding), endometrial ablation is less likely to be successful. I would also assume that given your age (over 35), your gynecologist would have biopsied the uterine lining before proceeding with an ablation. This is something you may want to ask about to be safe. Because the reason for your enlarged uterus is not delineated in your e-mail, it is not possible to know if hysterectomy is or is not reasonable. I would certainly ask about alternatives to hysterectomy, since it is important to be aware of all appropriate options. The issue of sexual function and hysterectomy remains to be definitively resolved, although anecdotally the vast majority of women do not develop any new sexual dysfunction as a direct result of hysterectomy. It has not been ruled out, however, that a small subset of women may exist for whom hysterectomy can result in decreased libido and/or orgasmic function. This is something to discuss in more detail with your gynecologist. A second opinion may also be helpful as well before any elective major surgery.
Good luck, and thank you for your e-mail! |
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| Question:
Hysterectomy for Ovarian Cysts? I went for my annual GYN exam and my doctor found a large cyst. This will be my third. I had a dermoid removed 4 years ago and some endometriosis was found and treated. I was on lupron for several months after the surgery. A year and half ago, a fertility specialist found a smaller endometrial type cyst that was removed. I have been having irregular periods for 5 months and now I am faced with another surgery. My doctor has suggested a hysterectomy and wants me to think about it. I understand if the cyst is malignant that I have no choice in the matter but at 39 years old, I still held out hope for a baby. I want to keep my parts, but don't want to continuously have reoccurring surgeries for cysts. Are there any other options? |
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| Answer: I think that it might be a good idea to ask your doctor about whether or not hysterectomy is warranted in the face of a benign ovarian cyst, and why. There are many ways to manage irregular menstrual periods besides hysterectomy, which usually is more of a last resort in most women. You may want to consider a second opinion to get additional perspectives. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Post Hysterectomy | ||
| Question: Can Endo. Return after a Hysterectomy? I am 39 years old and I had a complete hysterectomy three years ago due to multiple fibroids and a serious case of endometriosis. I have been on HRT since the surgery. Recently, my menopausal symptoms returned and after testing my hormone levels, it was found that my estrogen and testosterone levels were very low. Progesterone was non existent. My HRT has been increased. My initial complaints were lack of sex drive and energy, night sweats and mood swings. I still have no sex drive, my energy level is coming up, night sweats and mood swings gone but I have been getting the abdominal pains and that are consistent to when I had the Endo. Could this mean that I have it back? Is there any other way to tell beside a laparoscopy? |
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| Answer: While it is certainly possible that your symptoms are secondary to endometriosis, it is unusual for HRT to cause endometriosis to flare up, particularly after removal of both ovaries. There are many other possibilities ranging from pelvic adhesions to musculoskeletal pain. Your treatment and evaluation will need to be individualized, and that is a function best left to your doctor. Good luck, and thank you for your e-mail! |
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| Question: Pap Smear with no Cervix? I had a total hysterectomy 13 years ago. My original surgeon, now retired, said I do not have to have pap smear's because I do not have a cervix. My new doctor insists I really need to have them. Has the recommendation changed over the years and do I really need to have them? |
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| Answer: This remains a bit of a grey area in gynecology. The yield for Pap smears in women after hysterectomy, assuming they have no history of cervical dysplasia, appears to be low. The incidence of vaginal cancer in the general population is low, so that the likelihood of a truly abnormal result is also small. Some studies suggest that it is not cost-effective to have a Pap after a hysterectomy, but by the same token I am not aware that large-scale, prospective studies have conclusively proven that Pap smears are not necessary after a hysterectomy. Also, regardless of whether or not Pap smears are necessary, regular gynecologic follow-up is still important after a hysterectomy. In a nutshell, this remains a controversial topic, which is why there are different opinions on the subject of Pap smears after hysterectomy. I would defer to your current doctor's opinion, since there is no data to definitively state which position is correct. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question:
Recent Hysterectomy & Pain My mother had a hysterectomy 6 days ago. My mother is 70 yrs old, in good health, except for bladder cancer which was operated on back in February 2000. She has questions about the amount of pain she should be experiencing, what is too much and where should the pain be (lower abdominal, etc.). I understand pain and pain management is a highly individual experience. However, any information you might have regarding what to expect post op would be greatly appreciated. |
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| Answer: I sympathize with your mother's current situation, but as you state this is a very individualized experience. It would be more appropriate for you or your mother to contact her physician, since what constitutes a "normal" level of pain relates in part to the findings at surgery, whether the procedure involved laparoscopy, and other factors. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Hysterectomy as Treatment | ||
| Question:
What is a Medical Necessity? I have had a long history of abnormal paps, back pain, painful periods, stomach pressure and pain. I have had many, many procedures to rectify abnormalities. I have asked for hysterectomy but was told there wasn't a medical necessity. Recently, I was told that the endometrial lining is thick and I need to have a biopsy. I would like to know what qualifies as medical necessity? I am tired of visiting the doctor every three to four months. I have completed my family and would love to have a hysterectomy. |
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| Answer: The concept of medical necessity involves a determination that a procedure is necessary to correct a problem that is a health hazard. Hysterectomy is not a procedure to be taken lightly, as is the case for any major surgery. You and your doctor must consider if any potential benefits outweigh the surgical and anesthetic risks. Hippocrates once said "Primum non nocere" (At first, do no harm) and this prudent concept should guide medical practice. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Hysterectomy Information | ||
| Question: Ovarian
Function after a Hysterectomy After a women's uterus is removed, is it true that the ovaries continue to function and produce estrogen as long as they would have with the uterus being in place? There is lots of controversy regarding this issue among women. My doctor said they'll keep going as long as they would have no matter what, until normal menopause. A friends doctor said they stop functioning after a few years. |
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| Answer: It is quite correct that ovarian function continues unabated after hysterectomy. I'm not aware that there is any particular controversy on this. Where there may be some dispute is the issue of whether or not the duration of ovarian function is shortened after hysterectomy. In other words, after a hysterectomy, menopause may tend to come earlier than it would have if the hysterectomy had not been performed. Admittedly, this is a difficult issue to study, but there is some evidence that menopause may occur earlier in women who have had a hysterectomy with ovarian conservation. I'm not sure the issue has been definitively settled, however. It is also unclear why this might happen in terms of the anatomy, since the ovarian blood supply is largely preserved at the time of hysterectomy (otherwise the ovaries would turn gangrenous, which would be very serious!). So in a nutshell, I don't have any definitive answer, but in the short-term at least there should be no change in ovarian function after hysterectomy, and perhaps in the long-term as well. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question: Removal of the Ovaries in a Hysterectomy What are the Pros and Cons of having your ovaries removed during a hysterectomy? My doctor suggests having them removed because 25% of women will require additional surgery due to ovarian pain. |
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| Answer: In a woman under the age of 45 with no abnormalities involving the ovaries, there is no significant benefit I am aware of in removing the ovaries unless the woman is at a significantly increased risk of ovarian cancer. In a woman over 45, it is not unreasonable to consider prophylactic removal of the ovaries at the time of hysterectomy since at that time a woman is closer to the age of menopause (at which time the ovaries no longer ovulate or produce estrogen) and also is closer to the average age at which ovarian cancer may occur. Ovarian cancer occurs in about 1 in 70 women over the course of a lifetime, and is unfortunately not always detected at an early stage. To put it in perspective however, all things being equal this is a much lower risk than that of breast cancer (which strikes about 1 in 8 women). In other words, a compelling case can be made either way, and in my view it is best left up to the individual woman after a thorough discussion with a healthcare provider. In that way, a woman has all the necessary information to make an informed, albeit difficult decision. Whether or not hysterectomy is necessary in your case requires a detailed knowledge of your medical history, although in a general case I would say that there usually are alternatives to hysterectomy for many women with fibroids. I am not aware of the statistic that your doctor quoted, but given that you are over 45 I would think it would be reasonable to discuss the pros and cons in relation to the 1 in 70 average risk of ovarian cancer. I'm unclear if one could make a case for removing both ovaries in a 46 year old woman on the basis of potential future surgery due to pelvic pain, since I am not aware that this occurs in 1 out of 4 women who have a hysterectomy with ovarian conservation. You may want to obtain a second opinion before any planned surgery if desired. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question: Vaginal or
TAH? Due to excessive menstrual bleeding, I decided to go for endometrial ablation. However, ultrasound showed enlarged uterus, 12.5 cm). I'm 41 and have two children, both were c-sections. I decided to consider a hysterectomy. My doctor suggested a "TAH" due to the size of the uterus and he is consulting with a partner about this. I would prefer to have vaginal. Is past c-section contraindication to vaginal hysterectomy? Also, if I go through with hysterectomy and do the estrogen injection or patch, do will I have fluid retention and possibly gain weight? |
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| Answer: The main concern in your case would be pelvic adhesions, although that is a matter of opinion that can be individualized. In experienced hands, pelvic adhesions may not always contraindicate a vaginal approach, but I would defer to the judgment and clinical experience of your doctor. A second opinion may be helpful as well. The size of your uterus is not out of the range of what can be done vaginally, based on your description. Fluid retention is not a common or major problem with estrogen replacement therapy, whereas weight gain is more commonly seen with progesterone-like medications. If you were to have a hysterectomy, ERT would not be needed at that time unless your ovaries were also removed or were currently postmenopausal. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| Question: Laparoscopic Vs Conventional Hysterectomy My wife is considering having a hysterectomy for fibroids, at her OBGYN's suggestion. Her doctor has not suggested laparoscopic options. Can you give any advise on the pros and cons of the various options? It seams to me that laparoscopic surgery would provide for an easier recovery and be less traumatic. Any insights would be greatly appreciated. |
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| Answer: In a general anecdotal sense, laparoscopic-assisted vaginal hysterectomy may have advantages over abdominal hysterectomy, but that has not yet been demonstrated in large prospective studies. I can also say from experience that even in the best of hands, large fibroids may make laparoscopic hysterectomy more difficult and even more perilous. I would suggest you may want to consider a second opinion, but I would also respect your doctor's clinical judgment as well. You may also want to ask about alternatives to hysterectomy, such as myomectomy. Thank you for your e-mail! |
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| Other Questions | ||
| Question: Post
Hysterectomy & Want a Baby I had a hysterectomy, when I was 23 years old due to a prolapsed uterus and living in a lot of pain at the time, in which, I was told my only cure would be a hysterectomy. I have children from a previous marriage and then thought I would never want anymore children and agreed to the surgery. I know this is an outrageous question, but with technology these days, I thought I would give it a shot to ask: Can the surgery be reversal at all in anyway? I still have my ovaries, the physician only took my uterus. My desires for another child are deep, I hope that somehow there is a solution. I may be out of my mind for even thinking there could be such a thing. Please stop my curiosity by answering my desires. I was also told since I have my ovaries, my egg could be taken and his sperm and planted into another females body and she could carry the baby to term. Is that such a procedure or am I out of reach with these desires? |
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| Answer: You are correct that a surrogate can be used to carry a pregnancy conceived with your ova and your partner's sperm. There are many ethical and medical issues that come into play with this, and this is a matter that is best discussed with a reproductive endocrinologist in your area. Good luck, and thank you for your e-mail! |
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| Question: Mucinous
Cystadenoma & Pseudomyxoma Peritonei What are mucinous cystadenomas and psuedomyoma peritonei? How serious are these and must I have a hysterectomy? I am 31 years old. |
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| Answer: A mucinous cystadenoma is a benign ovarian tumor (it is not cancer) that can often grow to fairly large sizes. While benign, they contain a thick mucus-like material that can cause a serious condition called pseudomyxoma peritonei if ruptured. From a practical standpoint, such cysts may rupture during removal, particularly with laparoscopy, but with thorough irrigation the risk of pseudomyxoma peritonei can be minimized. I am not in a position to state if you should or should not have a hysterectomy, since that is most appropriately decided by you and your gynecologist. If a suspected mucinous cystadenoma is present, and confirmed by pathology, a hysterectomy is generally not necessary unless there is a malignancy detected. The treatment of pseudomyxoma peritonei is mainly via chemotherapy, and is an evolving science. Please consult your doctor for more individualized information. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question: Prolapsed
Uterus & Pregnancy I am 31 and have been told I have prolapse of the uterus and uterine fibroids. My insurance will not pay for a hysterectomy even though I was having periods every two weeks. The doctor put me on Medroxyprogesterone but now I'm not having any periods at all. Do you think I could be pregnant, and how would my problems affect me and the baby if I was pregnant? The doctor did a scope and he burnt off some scar tissue and cysts. Could he have hit my tubes and untied them with the laser he used? I am in constant pain in by back, legs, and lower abdomen. |
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| Answer: First, if there is any concern about pregnancy, a pregnancy test would be helpful in diagnosing a current pregnancy or ruling it out. It is not uncommon to have amenorrhea (lack of periods) while on medroxyprogesterone acetate or any progestin. Nonetheless, this is a very valid concern, especially in light of your previous tubal ligation, and you should consult your doctor as soon as possible about whether he or she thinks a pregnancy test is indicated. This is because if when a pregnancy occurs after tubal ligation, there is about a 50% chance of a tubal pregnancy which can be life-threatening. That being said, tubes do not simply become "untied." It is actually a very intricate procedure to reconnect fallopian tubes after sterilization, although failures can occur several years after the sterilization even when correctly performed. My best advice is for you to contact your doctor and raise your questions and concerns, since he or she is in the best position to provide an informed answer. Good luck, and Thank you for your e-mail! David Toub, M.D. |
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| Question: Ovarian Cyst In 1998, I had a hysterectomy for uterine fibroids and endometriosis. My fallopian tubes and ovaries were not removed. After suffering with constant abdominal pain, I had a pelvic ultrasound, which revealed a left ovarian cyst. A repeat ultrasound 2 months later shows no change. The ovarian cyst is approximately 7 cm, solid and cannot be aspired. He has recommended surgery (removal of both ovaries and fallopian tubes). Are there any tests that I can undergo in order to ascertain that I am not suffering with ovarian cancer? Also, I suffer from urinary stress incontinence, can a bladder suspension repair be done at the same time as the surgery for the removal of my ovaries and fallopian tubes? |
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| Answer: Unfortunately, no test can rule out ovarian cancer, so the best option in general may be to undergo surgery to allow a pathologist to determine what is going on. This is, of course, a matter for you to decide in conjunction with your physician. If you have undergone all the appropriate evaluation to diagnose genuine stress incontinence, it is certainly possible to have surgery performed simultaneously to correct this. This is also something to discuss with your doctor. Good luck, and thank you for your e-mail! David Toub, M.D. |
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| DISCLAIMER: The above represents material for educational and discussion purposes only. The material provided should NOT be used for diagnosing or treating any health problem or condition. It is NOT a substitute for consultation with and advice from qualified healthcare providers. If you have or suspect you have a health problem, consult a qualified healthcare provider. The author and any other party involved in the preparation or dissemination of the material presented are not responsible for any errors or omissions in the material provided above, or any results obtained from the use of such material. |
