For more than two decades, an American woman referred to as Anna had lived with extremely heavy and painful periods.

Her symptoms began soon after her first menstruation at the age of 12. Heavy menstrual bleeding, severe cramps, dizziness, fatigue and frequent urination gradually became part of everyday life. During her periods, she sometimes needed to change sanitary products every 30 minutes and relied on pain medication to manage the discomfort.

For many years, she believed these symptoms were simply something she had to live with.

Eventually, however, her condition became much more serious.

Years of Heavy Bleeding and Recurrent Fibroids

In 2018, persistent abdominal pain led Anna to seek medical evaluation in the United States. An ultrasound revealed multiple uterine fibroids, and she subsequently underwent a myomectomy to remove them.

According to the case published by Peking University Shenzhen Hospital, the operation was complicated by significant bleeding, requiring multiple blood transfusions.

Although she recovered from the surgery, the fibroids later returned.

Over time, her abdomen became increasingly enlarged, and she could feel a noticeable mass below her navel.

Her condition eventually progressed to the point where excessive menstrual bleeding caused her to collapse. She required emergency blood transfusion and was diagnosed with severe iron-deficiency anemia.

Further evaluation identified a more unusual condition:

Diffuse uterine leiomyomatosis

Unlike conventional uterine fibroids, which are often relatively well-defined, diffuse uterine leiomyomatosis can involve numerous fibroid lesions distributed throughout the muscular wall of the uterus.

Anna's uterus had become enlarged and distorted by a large number of fibroids.

At that point, hysterectomy — removal of the uterus — was recommended to her.

For Anna, who was in her mid-30s, unmarried and had not yet had children, this was an extremely difficult prospect.

She wanted to explore whether there might be another option.

Searching Internationally for a Uterus-Preserving Option

Anna began researching medical literature and consulting different physicians.

Eventually, a friend in China suggested that she explore treatment there.

She first travelled to Fujian Maternal and Child Health Hospital, where doctors helped stabilize and treat her severe anemia.

She was then referred to the Gynecology and Obstetrics Center at Peking University Shenzhen Hospital, where Professor Wu Ruifang and her team had developed a uterus-preserving surgical approach for selected patients with diffuse uterine disease.

Rather than immediately recommending hysterectomy, the team reviewed Anna's condition, fertility wishes, previous surgery and surgical risks.

They discussed an approach known as PUSH surgery.

What Is PUSH Surgery?

PUSH stands for:

Protection of Uterine Structures for Healing

The technique was developed by the gynecological team at Peking University Shenzhen Hospital for selected patients with diffuse uterine disorders.

According to the hospital, the procedure has been used in conditions including:

• Diffuse uterine leiomyomatosis

• Diffuse adenomyosis

• Certain diffuse uterine vascular abnormalities

The objective is not simply to remove abnormal tissue.

The surgical principle is to remove as much disease as safely possible while preserving and reconstructing the anatomical structure of the uterus, particularly in patients who hope to retain fertility.

This can be technically challenging in diffuse uterine leiomyomatosis.

In conventional fibroids, individual tumors often have relatively clear boundaries separating them from the surrounding uterine muscle.

In diffuse disease, however, numerous small fibroids may be distributed throughout the myometrium and may not have clearly defined capsules.

Normal uterine muscle and fibroid tissue can therefore be closely intermixed.

This creates several surgical challenges:

• Removing all visible lesions may be difficult.

• Excessive removal can damage healthy uterine muscle.

• Fibroids located close to the endometrium can threaten the uterine cavity.

• Large or deeply located lesions may increase bleeding risk.

• Previous surgery may result in extensive pelvic adhesions.

For patients wishing to preserve their uterus, treatment therefore requires highly individualized surgical planning.

A Particularly Difficult Case

Anna's surgery was considered especially challenging.

According to the hospital's report, several factors increased the complexity.

She weighed approximately 108 kg (216 lb) and had substantial abdominal subcutaneous tissue, making surgical exposure more difficult.

Her uterus had enlarged to approximately the size expected at four months of pregnancy, despite her not being pregnant.

The fibroids were distributed extensively throughout the uterus.

The largest measured more than 10 cm, while many of the smallest lesions were extremely difficult to distinguish from normal uterine tissue.

She had also undergone previous laparoscopic fibroid surgery complicated by major bleeding, resulting in extensive pelvic adhesions.

Most importantly, Anna strongly wished to preserve her uterus and future fertility.

Planning the Surgery

The surgical team developed several strategies before the operation.

Surgical access

Because of Anna's body size and the enlarged uterus, the team chose a lower abdominal vertical incision rather than a standard transverse incision.

Bleeding control

Measures were planned to reduce blood loss during removal of the numerous fibroids.

Large lesions were removed and the uterine muscle repaired progressively rather than leaving extensive open areas.

Uterine reconstruction

After fibroid removal, the remaining uterine muscle needed to be carefully reconstructed while protecting the uterine cavity as much as possible.

Postoperative care

Because of the increased risk associated with obesity and complex open surgery, the team also developed individualized strategies for wound healing, pain control and fertility preservation.

656 Countable Fibroids Removed

During surgery, the extent of the disease proved even greater than anticipated.

Extensive pelvic adhesions first had to be carefully separated.

The team then began removing fibroids from throughout the uterus.

Some lesions were visible on the surface, while numerous smaller fibroids were embedded deep within the uterine muscle.

According to the hospital's published account, some areas of Anna's uterine wall were less than 2 mm thick.

Other fibroids were positioned close to the endometrium, uterine arteries and ureters, making precise dissection particularly important.

The team progressively removed visible lesions and reconstructed the uterine muscle.

At the end of the operation, the hospital reported that:

656 individually countable fibroids had been removed.

The total did not include numerous additional small fibroid nodules located within some of the larger lesions.

Despite the complexity of the operation, the hospital reported that Anna recovered without major postoperative bleeding or infection.

She was able to gradually resume walking and was later discharged following postoperative assessment.

What Has the Hospital Reported About PUSH Surgery?

Peking University Shenzhen Hospital states that its team has spent approximately 15 years developing and refining the PUSH surgical approach.

According to figures published by the hospital, more than 550 patients with diffuse uterine disorders had undergone the procedure at the time of publication.

The hospital reported substantial improvement in pain and heavy menstrual bleeding among treated patients.

It also reported pregnancies and successful births among some patients who wished to preserve fertility.

These figures represent outcomes reported by the hospital's own clinical team and should not be interpreted as a guarantee of outcome for an individual patient.

Whether uterus-preserving surgery is appropriate depends on many factors, including:

• Type of uterine disease

• Number, size and location of lesions

• Age

• Severity of symptoms

• Previous surgery

• Anemia and general health

• Fertility goals

• Remaining healthy uterine tissue

• Individual surgical risk

Some patients may be better suited to medical treatment or other interventions, while hysterectomy may still be medically appropriate in certain circumstances.

Why This Case Matters for International Patients

Anna's experience demonstrates an important point for patients considering treatment abroad:

A second medical opinion can sometimes reveal treatment approaches that were not previously discussed.

This does not mean that treatment in China is automatically better, or that every patient who has been advised to undergo hysterectomy will be eligible for uterus-preserving surgery.

But for a patient facing a major or irreversible procedure, obtaining an additional specialist opinion can sometimes be worthwhile.

For complex uterine fibroids, adenomyosis or other diffuse uterine disorders, specialists may need to review:

• Pelvic ultrasound

• Pelvic MRI

• Previous operative records

• Pathology reports

• Hemoglobin and iron studies

• Previous treatment history

• Fertility plans

• Age and overall health

This information can often be reviewed before the patient travels internationally.

Considering Treatment in China?

If you have been diagnosed with complex uterine fibroids or another gynecological condition and would like to explore treatment options in China, China MedCare can help coordinate an initial specialist review.

China Specialist Second Opinion

You can obtain a medical-record-based opinion from a specialist in China before deciding whether to travel.

China MedCare can assist with:

• Organizing existing medical records

• Preparing a Chinese medical summary

• Identifying appropriate specialists

• Coordinating a written specialist consultation

• Translating the doctor's opinion into English

• Exploring hospital appointments if further evaluation in China is recommended

Second opinion service: US$49–99, depending on the specialist selected.

The medical opinion is provided by an independent licensed physician. China MedCare provides coordination and translation services and does not provide medical diagnosis or treatment.

Source: This article is adapted from a patient case published by Peking University Shenzhen Hospital. Clinical details, treatment outcomes and statistics relating to PUSH surgery are based on information published by the hospital. China MedCare was not involved in the patient's treatment.