I am a 35-year-old woman with fibroids and an ovarian cyst. My uterus is enlarged, and I'm having a lot of pain during my monthly cycle. My doctor has advised me to get a vaginal hysterectomy. What do you think of this type of procedure? Is it better than the abdominal type?

-- Ella

Depending on the size of your uterus and the skills of your gynecologist, a vaginal approach offers several advantages compared to an abdominal hysterectomy. The biggest advantage to a vaginal approach is the avoidance of a large incision on your abdomen. This means a vaginal hysterectomy is generally less painful than an abdominal, and recovery time is shorter. Many women are able to return to work two to three weeks after a vaginal hysterectomy, versus four to six weeks after an abdominal hysterectomy. Blood loss is often less with a vaginal hysterectomy. This can translate into fewer blood transfusions and more energy after surgery.

A variation is to use a laparoscope -- a small viewing device inserted through a tiny slit in the abdomen -- to complement a vaginal hysterectomy. This method allows us to use the vaginal approach in many cases that would otherwise have to be done abdominally. Sometimes it is difficult to assess and remove the ovaries during a strictly vaginal approach; the laparoscope is the perfect instrument for dealing with the ovaries. Also, using the laparoscope and performing part of the surgery via a few very small abdominal punctures can enable the surgeon to remove a larger uterus than may be feasible through a vaginal-only procedure.

Not all hysterectomies can be done vaginally. If you have the choice, opting for a vaginal hysterectomy will afford you excellent results and less post-operative pain. Be aware, however, that any time vaginal or laparoscopic surgery is done, there is a possibility that your doctor will need to convert to an abdominal approach during the operation, for any of a variety of reasons. This is not a "failure," but rather a reflection of good judgment on your doctor's part -- better to switch to the open procedure than to struggle or to have an avoidable complication due to an attitude of "vaginal at all costs."

Don't forget to ask your doctor about ALL the options for treating fibroids; hysterectomy is not the only one.