FIBROID TUMORS-Followup Question From Dr. Hill's Response
From: Anne (anonymous@obgyn.net)
Tue, 10 Aug 1999 08:28:39 -0500 (CDT)
I was wondering what is the maximum size of fibroid a surgeon would be
comfortable removing during a laparoscopic myomectomy instead of one
performed by laparotomy. Dr. Hill, thanks for your informative
response to the original question.
--
Anne
At Mon, 9 Aug 1999, D. Ashley Hill, M.D. wrote:
>
>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
>
>The above is intended for general medical education,
>and is not for specific medical advice.
>I apologize, but I am unable to answer personal e-mail
>due to time constraints.
>
--
Anne
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