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Re: How does a utrerine fibroid shrink?From: William D. McIntosh, MD (anonymous@obgyn.net)Sat, 29 May 1999 13:56:53 -0500 (CDT)
At Sat, 29 May 1999, Hilary wrote: > >I am 46. I have 3 large (grapefruit size) fibroids which are growing >steadily but have no other symptoms. I have been considering myomectomy >for a while but have recently read a lot about fibroid embolization. >To avoid major surgery I have been trying to understand how a fibroid >shrinks. >Everyone says fibroids shrink at menopause. Also, drugs like Lupron >make them shrink. And now, fibroid embolization is said to make them >shrink 40-60%. >My question is how are they shrinking? Are they losing liquid and the >'matter' remains - what is it that is left after 'shrinkage'? I read >that after embolization what remains is a hard lump. Do each of these >methods of 'shrinking' leave the same shrunken fibroid still in place? >If I am to wait for menopause will they shrink to nothing (a pea-sized >lump)? >THANK YOU > >-- >Hilary M. Joy > Fibroids can shrink in one of two ways that I can think of off the top of my head. The first is a gradual reduction in the size of the individual cells of the fibroid, typically associated with a low estrogen state, such as menopause or GnRH agonist use like Lupron. The second is when the fibroid infarcts, loses blood supply suddenly, where chunks of the fibroid die over a relatively short period of time, such as with overgrowth during high estrogen states, like pregnancy, or with arterial embolization. This typically leaves some "normal" fibroid like cells, with lots of associated scar tissue, much like what happens to cardiac muscle from a myocardial infarction. Fibroid embolization is a promising therapy that remains incompletely studied, especially in long range follow-up. The biggest obstacle is the extremely limited access. It is being performed in very few centers nationwide, and even the most experienced practitioners of this technique have only done a few hundred. We are a long way from this being a readily available option, assuming that the long term results are good. If you have 3 grapefruit sized fibroids, I can guarantee that they will not shrink to pea sized. You would be lucky indeed it they were to shrink to orange sized. I really cannot recomend a myomectomy for you, as you describe yourself. The presumption behind a myomectomy is that there is something approaching a normal uterus somewhere in there that removing one large or several small fibroids will reveal. What you have described is something that is supposed to be the size of an apple with 3 grapefruits growing in it or on it. I doubt even Julia Child could operate on such an apple, and have it look something like an apple when she was done. When you factor in the heavy blood loss that such a case would entail, this cannot be considered to be a reasonable option. If you have to go with surgery, a hysterectomy, with or without removal of the cervix, is a much less morbid option. On the other hand, if you don't have any symptoms, the real question is whether or not you need ANY therapy. My only concern is the continued growth, despite the steady decline in your natural estrogen levels. Traditionally, this has been considered a risk factor for the extremely rare leioyomyosarcoma, the malignant version of the uterine fibroid, but recent reports suggest that this is not really the case.
-- William D. McIntosh, MD Clarksville, TN
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