A 59-year-old postmenopausal Mumbai woman who visited a clinic for persistent nausea was found to have a serious condition that had been silently progressing for years. She had no abdominal pain, no postmenopausal bleeding, and no clear gynecological complaints.
Initially treated for a urinary tract infection, further evaluation revealed acute pyelonephritis caused by ureteric compression. What makes this case significant is that even a simple per abdomen examination revealed a large abdominal mass.
A basic gynecological check-up was enough to raise suspicion. This highlights how routine examinations can detect major problems before they turn life-threatening.
An ultrasound (USG) was then performed for confirmation. Imaging showed a massively enlarged fibroid uterus, nearly the size of a 24-week pregnancy. The dominant subserosal fibroid measured about 14 cm in diameter. It had displaced bowel loops and was compressing an ureter. This pressure caused urinary stasis, leading to infection and putting the kidney at risk of long-term damage. The final surgical specimen weighed 2.8 kilograms, marking an unusually large fibroid uterus in a postmenopausal woman.
The patient later shared that she had noticed gradual abdominal enlargement over time. She assumed it was normal weight gain with age. Without alarming symptoms, she delayed seeking medical attention, allowing the fibroid to grow silently. The case was led by Dr. Hemakshi Mehta, Consultant Obstetrician and Gynaecologist at Apex Superspeciality Hospital in Borivali with both clinical precision and compassionate care. Dr. Hemakshi Mehta emphasized that the timing of surgery posed a clinical dilemma. Operating during an active kidney infection carried significant risk, including worsening sepsis and complications under anesthesia. At the same time, delaying surgery meant ongoing pressure on the ureters and continued threat to kidney function.
To balance these risks, Dr. Hemakshi Mehta and the team at Apex Superspeciality Hospital adopted a carefully staged plan. The patient was first stabilized with intensive intravenous antibiotics. A Nephrologist was involved to monitor kidney function & manage infection markers. Anesthesiologists evaluated operative readiness. This multidisciplinary approach ensured that every risk factor was addressed before proceeding. After approximately one month of optimized medical management and complete resolution of infection, the surgical team at Apex Superspeciality Hospital proceeded with a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy.
Removing a 2.8 kg fibroid uterus through a minimally invasive approach required advanced laparoscopic expertise, detailed preoperative planning, and strong coordination between gynecology, anesthesia, and nephrology teams. The surgery was completed safely, and the patient had a smooth postoperative recovery with preserved kidney function.
A Message for Postmenopausal Women from Dr. Hemakshi Mehta and the team at Apex Superspeciality Hospital, Borivali.
Dr. Hemakshi Mehta emphasizes that postmenopausal women should not ignore abdominal distension, urinary changes, or vague systemic symptoms. “Fibroids may grow silently, even after menopause. Regular gynecological evaluations are essential. Early detection allows safer intervention and prevents avoidable complications,” she said.
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