Hi, It's Dr. C. Board certified Ob-gyne. I can help you today.
I'm sorry to hear about your symptoms and findings. A fibroid as big as that can contribute to a hiatal hernia. There is pressure upwards from the fibroid and if there is any weakness at all in the diaphragm, that pressure will push the abdominal contents upwards and contribute to a hernia.
Options for the fibroids are several but best option depends on your age and overall medical health. If fairly close to menopausal age a medication called Depo-Lupron can be used for 6 months to shrink the fibroid. But in the meantime, we hope that the woman becomes menopausal because if not, the fibroid will regrow after treatment. So this is the least often used option. But it can sometimes be helpful if a woman is very close to menopause and has some medical conditions that make the other options too risky.
The second option is a UAE (uterine artery embolization). This can be used at any age but works better the closer a woman is to menopause. It can be a good option and causes the fibroids to shrink by about 50%. Recovery is pretty fast, most women are back to work within 1 week. But if a woman is still far away from menopause, there is a risk that the fibroids will grow back.
The third option is hysterectomy. The ovaries can be left behind so the surgery would not cause immediate menopause in most women. In my experience, women with a size of fibroid as you have and are not close to menopause, are happiest with this option in the long run. The 100% guarantee that a woman will never bleed again and never have fibroids again is hard to beat. But if a woman really wants to avoid hysterectomy or can't afford the time off, the UAE is a good 2nd choice.
The best person to give you an opinion about whether repair of the hiatal hernia should be done at the same time or wait to see if the hysterectomy or other treatment of the fibroid helps is a gastrointestinal surgeon (GI surgeon). If they think you'd benefit from repair, the procedures usually could be done at the same time. It would require coordination between the surgeons.
Most women get a lot of relief in GI symptoms from removal of a fibroid of that size.The relief may be good enough that hiatal hernia repair may not be needed at all.
I hope this information was reassuring and helpful. Let me know if I can clarify anything or add details. I want to be sure you get the most helpful information for your situation.