WOMENS-HEALTH Messages for July, 1999: Can AUB be caused by a slight increase in fibroid size?

Can AUB be caused by a slight increase in fibroid size?

From: Maryam (anonymous@obgyn.net)
Tue, 13 Jul 1999 19:22:34 -0500 (CDT)

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I am 38 yrs old,nulliparous,no past pregnancies.Last year a pelvic ultrasoundrelvealed the presence oftwo relatively small submucosal fibroids,one 3 cm, and the other 2.8 cm in size.My menstrual flow been heavy for the past two years,but not unbearable. 17 days ago,I had a sudden onset of bleeding which was not accompanied by any pain whatsoever.The bleeding was accompanied by the passing of several extremely large size blood clots.After the first "gush"of blood and clots,the bleeding tuned to spotting for several hours,then there was another incident of "gushing" and several large blood clots. Over the next five days,the gushing/clots/spotting cycle continued,but now the gushing was occuring several times each day.Each time the amount of blood was enough to completely saturate a large overnight sized pad. I saw the GYN after five days of this.She said that my uterus was enlarged,and she thought that my fibroids were the cause of the heavy bleeding.She prescribed Methergine o.2 mg q4h to help control the bleeding,and it did slow the bleeding down a bit for a few days.However,the bleeding picked up again,despite the Methergine.She advised doubling the dose as needed. This past Saturday morning,despite the double dose of Methergine, I awakened with my night clothes,bedding and husband's night clothes saturated in blood. The bleeding continued heavily through Saturday evening,and into Sunday,where it came to a rather abrupt halt in the early evening. Total days of this cycle of bleeding were 16. I had a pelvic ultrasound today which showed the same two fibroids mentioned previously.One of the fibroids had increased in size from 3cm to 4 cm, the other had decreased in size from 2.8 cm to 1 cm.The radiologist also said that the back of the uterus looked thickened and irregular,which might indicate the prescence of another fibroid in the uterine wall. My questions are: Can such a small increase in the size of fibroid cause such a bout of AUB? Also, on ultrasound,are all types of fibroids identifiable,or only some? My GYN thinks that the best option for me is hysterectomy,and I am seriously considering this.I have an endometrial biopsy scheduled for next Friday,however, I am wondering if it would be a better option to have hysteroscopy and biopsy together? Thank you in advance for any information/informed opinions.

--
Maryam

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