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Re: FIBROID TUMORSFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Mon, 9 Aug 1999 18:44:42 -0500 (CDT)
At Mon, 9 Aug 1999, JOANNE wrote: > >I am a 46 year old woman. I was diagnosed with a large fibroid tumor -- >equivalent to a 23 week pregnanc. My uterus measures 18.5 cm. My >periods are 2-3 times heavier than a year ago. This is a very large fibroid. There are alternatives to hysterectomy, even with a fibroid this large. The final decision depends on many factors, the most important probably being how much you like your uterus. I say this because I have learned that no two patients share the same thoughts on hysterectomy. I have some patients with fibroids as large as yours (above the belly button) that beg for a hysterectomy, while others would do anything other than surgery. Each person is different. There is a procedure called a myomectomy (my-oh-mect-oh-me) where the fibroid or fibroids are removed but the uterus is left in place. Women who still desire children, or who are fond of their uterus, often choose this option. With a uterus your size it would require a large bikini cut or even a vertical incision. You could expect to have 1-2 hours of surgery, a 2-4 day stay, and 4-6 weeks recuperation. About 1/4 of women who have this will later need a hysterectomy due to recurrence of fibroids, and the procedure itself commonly leads to scar tissue around the uterus. Another option is to take 6 months of a medication called a GnRH agonist, which removes the estrogen and progesterone from your body and hopefully shrinks the fibroid(s). The problem with this medication is that while it works, it may have significant side effects, it's very expensive (about $400 per month) and the fibroids commonly regrow after the medication is finished. I do not usually recommend it to my patients with fibroids as large as yours. The last real option is hysterectomy. The benefit of a hysterectomy is that the fibroids will never recur, nor will you ever have periods. However, it is a major operation (however, so is a myomectomy). And, some women have very serious issues with removing the uterus. Again, this is a personal issue. In my practice I actually turn away patients who want a hysterectomy, because they have reasons that I do not consider worth the surgical risk (for example, someone who has completely normal periods but does not want the inconvience of them, or someone who wants birth control and wants something more than a tubal ligation). Others, even women with a very large uterus like yours, will try just about anything but hysterectomy. You are on the right track by asking questions. Please discuss this with your doctor, who can best answer them, as he or she has the advantage of having done a physical exam. Best of luck,
-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd
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