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Fibroids: anemia and treatment options/ Micronor pills

I am a 36 year old female with a 7cm uterine fibroid that has caused me to have anemia from having heavy (also painful) menstrual cycles. My hemoglobin has gone from 9.8 to 12.5 in one month. My gynecologist wants me to start Ponstel and Micronor pills (progesterone) to help with my symptoms and in 3 months repeat an ultrasound to see if the fibroid has changed in size.

My question is will progesterone only Micronor pills help to decrease or increase the size of the fibroid. I have done research online and found out that the Micronor might increase the size of the fibroid, is this true? I am factor 5 Leiden positive (increased risk of blood clotting) so I can’t take estrogen-containing pills.

What would be the least invasive type surgery option for me if fertility is not an issue? Is uterine fibroid embolization or the new MRI focused ultrasound an option?  I prefer non-surgical safe options if available but would consider surgery if it is the best thing for me.

Can one just live with a 7cm size fibroid with corrected anemia or can the fibroid increase in size or anemia get worse?  Can one live with fibroids this size for a long time?  Is 7 cm considered small, medium, or large in size?

Thank you.

A.

A,

Studies show that most women can take birth control pills without any increase size of the fibroids.  The studies have been done for combination (estrogen and progesterone) pills, but not specifically for Micronor.  Since Micronor contains a similar progestin to other pills, it is likely to be OK, but checking your uterus with an ultrasound in a few months is a reasonable way to know if it is staying the same size.

From what you say here, you should be a candidate for embolization.  However, we do not recommend this for women who wish to maintain their fertility.   Focused ultrasound might be an option, but we do not have any studies to tell us whether this works well for bleeding or not.

7 cm is medium size and could likely be removed laparoscopically by a gynecologist trained to do this.  If you continue to take iron and maintain your hemoglobin, then you could live with the fibroid.  We cannot predict fibroid growth, so if you chose to just observe your situation you should see a gynecologist a few times a year to check on the size and check on your hemoglobin.

I hope this is helpful,

Bill Parker, MD

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in Los Angeles, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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