Second surgical opinion in gynaecology: when and how?

Why ask for a second surgical opinion?

A gynaecological operation is rarely urgent, and many have alternatives. It is legitimate to want to be sure of the decision before committing. The most frequent reasons, found in the literature, are:

• confirming a diagnosis or an indication for surgery;
• knowing the alternatives (medical treatment, monitoring, less invasive technique);
• obtaining additional information, when you have not understood everything or there was not enough time in the consultation;
• persistent symptoms despite treatment, or a complication of a previous treatment;
• need for confidence before an operation that affects fertility or intimacy.

Seeking a second opinion is neither a lack of trust nor a move against the first doctor. It is a way of taking an active part in the decision.

What does the law say about second opinions?

The doctor consulted for a second opinion must therefore refrain from any disparagement. If they propose another strategy, they explain the medical reasons for it, and may, with your agreement, send a letter to the first practitioner.

In which situations is a second opinion particularly useful?

Hysterectomy proposed for a benign condition

Removal of the uterus is permanent. For fibroids, heavy periods or adenomyosis, there are often conservative options: hormonal treatment, levonorgestrel intrauterine device, myomectomy, operative hysteroscopy, embolisation. The surgical approach (vaginal, laparoscopic, abdominal) also deserves discussion.

Deep endometriosis

Surgery for deep endometriosis, especially when it affects the rectum, colon or bladder, is complex. Its benefits must be weighed against medical treatments and against any plan for pregnancy. An opinion from a team experienced in these operations is often recommended.

Uterine fibroids

The choice between monitoring, medical treatment, myomectomy and embolisation depends on the size, number and location of the fibroids (FIGO classification), on your symptoms and on your wish for pregnancy.

Ovarian cyst

A functional cyst most often disappears on its own. A second opinion, sometimes with a scan by an expert sonographer, can avoid unnecessary surgery, or on the contrary confirm that a suspicious mass should be operated on quickly.

Gynaecological cancer

In France, any proposed cancer treatment must be discussed at a multidisciplinary team meeting, which brings together doctors from several specialties (surgery, medical oncology, radiotherapy, radiology, pathology). The HAS (French National Authority for Health) points out that one purpose of the RCP is to check that the decision complies with guidelines. A second opinion remains possible, but it is often more useful to ask to see the RCP record and to have the options discussed explained.

When is a second opinion not reasonable?

In a genuine emergency, waiting for another opinion can be dangerous:

• ectopic pregnancy with pain or internal bleeding;
• ovarian torsion (sudden and intense pain);
• heavy haemorrhage;
• serious infection (pelvic abscess).

In these cases, the decision is made on the spot, with the emergency team.

How to prepare for a second-opinion consultation?

A second opinion is only valuable if the second doctor has the same information as the first. Bring:

• the consultation reports and the letter proposing the operation;
• the imaging (ultrasound, MRI, CT scan) with the images themselves, on CD or via a download link, and not only the reports;
• the laboratory results (hormone tests, tumour markers);
• the operative and pathology reports of previous procedures (biopsy, hysteroscopy, laparoscopy);
• the RCP record in the case of cancer;
• the list of your treatments and your medical history;
• your questions written down in advance.

You can ask for these documents directly from your doctor or the facility, or find them in Mon espace santé (the French national digital health record) when they have been uploaded there.

What questions to ask during the second opinion?

• Is the diagnosis certain? Is an additional test needed?
• Is the operation necessary now, or can it wait?
• What are the alternatives, including monitoring?
• Which surgical approach can be considered (laparoscopy, vaginal route, hysteroscopy, laparotomy)?
• What are the consequences for my fertility, my sex life, my menopause?
• What are the main risks and how frequent are they?
• How long is the hospital stay and the recovery?

Decision aids, when they exist, are useful: a Cochrane review of 209 trials shows that they improve patients' knowledge, the accuracy of their perception of risks and their active participation in the decision, without increasing regret.

What if the two opinions differ?

Differing opinions are common, more often about the choice of treatment than about the diagnosis. In this case:

• ask each doctor to explain what evidence their proposal is based on;
• check that both have had the same tests;
• ask whether your case can be discussed at an RCP or with an expert centre (endometriosis, cancer care);
• take time to think: except in an emergency, a delay of a few weeks does not generally change the prognosis of a benign condition.

You are the one who decides. You can choose to be operated on by the first or the second surgeon, or not to be operated on.

How to ask for a second opinion at the practice?

Arrangements: book via Doctolib or on 01 43 79 59 79. Usual waiting time: one week to 10 days on average, except during holiday periods. Teleconsultation: possible, via Doctolib. Fees: €120 to €150 (doctor contracted in sector 2 with unrestricted fees, not a member of OPTAM) per consultation; students are seen at the national health insurance rate; patients covered by C2S or AME are accepted with no extra fees.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.