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Re: Advice needed for fibroid uterusFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Fri, 30 May 1997 22:59:40 -0500 (CDT)
At Thu, 29 May 1997, S. wrote: > >I am 52 yrs still having menstruation until this month.I was diagnosed >fibroid tumor since 6 yrs ago. the >myoma is now 90 mm in diam. A 9cm fibroid is quite large (about grapefruit size) but despite this size, it may or may not cause any symptoms. In your case it sounds like the size of the fibroid and uterus are causing bladder pressure. I approach these cases as follows: I explain that fibroids are very rarely malignant (certainly much less than 1%) and that they may, or may not, continue to grow over the next few years. After menopause they tend to shrink, but, unfortunatley, not all will decrease in size. There are a number of options. If there are no symptoms, then "expectant management" with annual pelvic exams is the way to go. If there are symptoms, and they are bothersome enough to the patient, then medical treatments such as non-narcotic pain medications, or GnRH agonists (these medications are "anti-hormone" meds that shrink the fibroids by removing much of the female hormones from the body during treatment) may help. GnRH agonists are often quite helpful, and you may be an excellent candidate for this since you are approaching menopause. The fibroids may shrink enough to decrease the symptoms, and may stay "shrunk" after menopause. Of course, if you don't go in to menopause for another 8 years then the fibroids may come back! GnRH agonists are powerful medications with many potential side effects. Some of my patients take them, whereas others refuse and opt for surgery. To each his or her own. A myomectomy may also be helpful. This is a surgical procedure where the fibroid is removed, but not the uterus. In general, most gyn's I know (myself included) are a little reluctant to do this on someone your age, but will do so after discussing the risks:benefits. About 1/4 fibroids come back after myomectomy. The major problem, in my opinion, is that myomectomies can lead to severe scar tissue formation between surrounding organs (intestines, omentum, tubes, ovaries) and the uterus, which may cause a lot of pain. It is not really a better or worse procedure than a hysterectomy, as both can have complications. It's simply a matter of patient choice. Finally, if GnRH agonists don't work, or if the fibroids get very large and start causing many symptoms, then a hysterectomy may be the only way to relieve the symptoms. A hysterectomy is certainly a major operation, but, despite what you may read in various women's magazines or on the Internet, most women are happy with the results of this surgery. After all, in order to undergo a major operation like this the patient's symptoms must be pretty severe. It stands to reason that removing the source of these symptoms will improve the quality of life. The trick is to not do this surgery until you have made an effort to attack the symptoms via less extreme measures. If the symptoms are controlled with medications or minor surgery, then that's great. If not, once these measures have been exhausted, then in most cases a hysterectomy will alleviate the symptoms. Best of luck to you,
-- Ashley Hill D. Ashley Hill, M.D. Assistant Director, Department of Ob/Gyn Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
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