 |
 |
 |
|
|
|||
|
|
||||
|
||||
Re: alternative hysterectomy for fibroid uterusFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Tue, 22 Jul 1997 11:32:16 -0500 (CDT)
At Mon, 21 Jul 1997, Mita wrote: I am looking for >somebody who has experienced myomectomy,or experience in performing it, >and share it with me.I have a large (8.9cm) intramural fibroid in the >posterior wall of the uterus.I think I am going into menopause (52 yrs), >andthe complain I have is the pressure on my bladder,sometimes if I have >been sitting too long I have low back pain which will subside after >excercise. Uterine fibroids, which are smooth muscle growths within the wall of the uterine muscle, are a common and usually asymptomatic condition. In some women, however, symptoms may develop and may even worsen over time. If the fibroids are located within the lining of the uterus there may be heavy bleeding, which at the extreme may lead to blood transfusion and emergency surgery. Other symptoms may include rectal or bladder pressure, uterine prolapse (where the uterus falls partly or all the way out of the vagina), constipation, pressure and swelling of the kidney tubes (ureters), or abdominal pain. In some cases fibroids grow so slowly that treatment is not necessary. When symptoms are severe, however, and treatment is necessary, there are a number of methods that may help. One non-surgical treatment is an "anti-hormone" called a GnRH agonist. We use it to decrease the estrogen in the body for 6 months or so which often shrinks the fibroids. In a patient approaching menopause, as you are, this may help significantly. On the other hand, the fibroids may re-grow. Plus, in your case, a 9cm fibroid is about the size of a grapefruit, which is pretty large (fibroids range from pinpoint to watermelon size)! Finally, GnRH agonists may cause significant side-effects such as hot flushes, headaches, joint pain, etc. But, for many these potential side-effects outweigh the risks of surgery. Another option is to remove the fibroids but leave the uterus, called a myomectomy. This has the obvious advantage of leaving the uterus, but of course is not risk-free. There may be bleeding (although recent evidence suggests no more than a hysterectomy) and scar tissue formation, and in 1/4 of cases the fibroids come back. Most gynecologists are a little reluctant to do this in perimenopausal women such as yourself, since you are done with childbearing and there is a risk of the fibroids returning and of scar tissue formation. In all honesty, very few of my patients in your age group opt for myomectomy , but of course I would perform it after discussing the risks and benefits of each procedure if they wished. Younger women, however, tend to choose myomectomy over hysterectomy to conserve childbearing potential. Finally, there is hysterectomy, which is removal of the uterus. There is no chance of recurrence or future bleeding, but there are risks inherent to this (and all) surgical procedures. Most myomectomies are performed by a larger abdominal incision, or a laparoscopic procedure, but many hysterectomies can be performed through the vagina, which has a relatively rapid healing time compared to abdominal incisions. Possible risks with hysterectomy include bleeding, infection, bladder damage, and perhaps future urinary troubles such as incontinence. (As an aside, I have not seen the alleged "sexual problems" that some claim are caused by hysterectomies. In fact, my experience, and that of the medical literature, is the opposite). Hysterectomy is a large surgery (although not necessarily "smaller" than many myomectomies), and as with all major surgeries requires careful consideration. As you can see, there are many decisions when treating fibroids. This requires a lot of discussion with a doctor you trust, and an open mind on the part of the patient (and doctor). *You* make the ultimate choice, but should do so only after becoming comfortable with all of your options. Best of luck to you with your decision. Ashley
-- Ashley Hill D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL dahmd@gate.net
|
|
Return to ![[ Women's Health Forum ]](http://www.obgyn.net/images_women/wh-forum.gif)
Report TECHNICAL Problems ONLY to: webmaster@obgyn.net
Last Updated: Wed Dec 2 06:58:35 2009
Women's Insurance Checklist from Auto Insurance Quote
home | medical professionals | women | industry | forums | international