Myomectomy vs. Hysterectomy Part I: How You Can Be Put into this Difficult Dilemma

A good organ.

Your uterus (womb) is an amazing organ, renewing itself as a brand new implantation vehicle for pregnancy every month during your reproductive years. One conception and implantation occurs, it expands from the size of a pear to that of a large pumpkin, with over 500 times its original carrying capacity. Even after such extreme distortion, after delivery it can “snap back” to exactly or near its original size. 

You simply can’t have a baby without your uterus, unless you explore the more extreme options of surrogate motherhood or the altruism of adoption. After your family is complete or when fertility is no longer desired, while it is true that your uterus can only give you periods and probably some cramping, it also serves as an organ of gender identity that has varying degrees of importance, depending on the woman.

When a good organ goes bad.

The plot thickens, however, when conditions begin effecting the relationship you enjoy with your uterus, such as fibroids, adenomyosis, or endometriosis.

The menstrual cycle is a natural yet life-affirming renewal of your reproductive potential. When all is well, it serves a beautiful purpose as well as defines your femininity. Unfortunately, no one is immune to the changes inherent in any complex biological system. Your uterus can begin causing troubles that can interfere with your quality of life by producing bleeding, pain, or the anatomical displacement of other organs by unwanted increases in its size. 

Naturally, when pregnancy potential is desired, you should turn to your physician to explore the options for fighting to keep your uterus for its important purposes. Alternately, if you no longer are interested in fertility (permanently!), you have to decide if your quality of life is so compromised such that it warrants removal altogether. This is a big decision, and this article explores the more intricate motifs that create this dilemma. 

Irregular bleeding.

Your uterus is a muscular organ. This is why its contractions are able to push a baby out into the world. It is a chamber that, quite simply, does not want anything occupying it for too long—from the critical mass that provokes labor to the cramping caused by clots that accumulate within. Anything, therefore, that creates abnormal bleeding will be noticed by you—either interfering with your best-laid plans for conception or by the cramping that blood clots and menstrual debris within will cause.

Just as your uterus can shrink back down after delivery (clamping uterine tissue around the normal bleeding vessels exposed in the process of placental separation), even when unpregnant and small it also can clamp down on these bleeding sites during a period. Anything that interferes with this “squinching down” will defeat the purpose, resulting in abnormal and extra bleeding and possibly even anemia.

Causes of irregular bleeding (other than hormone imbalance or thyroid disorders): 

Size matters.

Besides bleeding which causes cramping and interferes with fertility, anatomical distortion caused by uterine fibroids or even variations in the position of your uterus can impact your comfort and quality of life.

Your uterus is maintained in its position by several connective tissue ligaments. Because your cervix—the route out for both menstrual blood and babies, and the route in for sperm—opens through the back of your vagina, the uterine ligaments will pivot the cervix through the back of the vagina, hopefully for positioning favorable to exposure of semen. Truth be told, this positioning consideration is overrated and the proverbial “tilted uterus” is nothing more than a normal variation.

Increase in uterine size, however, can cause the pivoting and support of your uterus to swing more drastically, twanging those ligaments to cause chronic pelvic pain. Another problem is that if an enlarged uterus’s weight causes it to flop as a mass against your bladder or rectum, urology and GI symptoms can occur.

(Your rectum and bladder, in one respect, are “stupid” organs: they cannot tell whether pressure on them is coming from inside or outside. Therefore, pressure against them from a weighted, enlarged uterus will cause constant urinary urgency or the sensation of incomplete emptying during bowel movements. Such urgency can result in urinary incontinence and/or constipation.)


The Oxford Dictionary defines dilemma as a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones.” Nowhere is the word “dilemma” more apt—or ugly!—than when changes in your uterus back you into a corner in which you have to decide between fighting the good fight to keep it or give up and lose it. If you no longer want your fertility, hysterectomy can be a life-changing procedure (for the better); if you are seeking pregnancy or simply want to keep your reproductive options open, myomectomy (removal of uterine fibroids, sparing your uterus) can eliminate considerable misery while improving both your fertility and your quality of life.


Ulas Bozdogan, MD

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