Experiences with hystorectomy, fibroids and IUD.... oh my?

Your PCP said they like to wait 3-6 months with an IUD. Does that mean wait 3-6 months to see how your body eventually adjusts? If so, you will have an adequate picture by the 4 month mark. A string check is helpful, but perhaps an ultrasound to check on the location/orientation in the uterus might be helpful, especially if you have a 3rd bad month.

The decision between abdominal, vaginal and lap-assisted vaginal approaches is one that your doctor can best discuss with you. It will depend on the size of your uterus and the previous surgeries. You had a myomectomy, so you've had previous abdominal surgery. If you had a c/section for the twins, there can be other issues. These 2 possibilities may very well eliminate a vaginal hyst from the possibilities. Depending on the size of the uterus and the size of the fibroids, lap-assisted may be the best choice as it is less invasive, so easier recovery. Of course, the size of your uterus and fibroids can make it so that isn't even a possibility today.

At 47, unless there is a reason, the ovaries would be left intact. However, today, I would ask that the tubes go with the uterus. They will serve no function and there is a growing body of evidence that, at least in some cases, the fallopian tubes may actually be the origin for ovarian cancer.