Over the years, a number of women have come to my office with extreme symptoms due to uterine fibroids. Some of these women had fibroids that were very large (the size of a full-term pregnancy), some had severe bleeding that caused a very low blood count (hemoglobin of 4- 6, when 12 is normal), and some had fibroids that blocked the bladder and required a visit to the emergency room for a urinary catheter to be inserted.
All of these intelligent women were aware that they had fibroids. However, they had put off treatment after having been told by numerous doctors (as many as 7 in one woman’s case) that the only remedy was a hysterectomy. Some of the women had not yet had children and wanted a family. Many felt strongly about keeping the body parts they were born with, and others feared a hysterectomy. Since they didn’t want or medically need a hysterectomy, they just stopped seeing doctors.
However, these women tolerated terrible symptoms and allowed fibroids to control their lives. Some were unable to leave the house every month when the bleeding was heavy. Some were weak and tired and weren’t able to function at work or at home. Some reported having strangers asking them “when the baby is due”. Most were consumed with worry about their health and about what was going to happen to them.
My sense is that these women accommodated to their symptoms over time. “Well, I am bleeding heavily but not much heavier than last month.” “Well, the fibroids are larger but not that much larger than 6 months ago.” The problem is that “normal” had been forgotten, and slow growth or a slow increase in bleeding can be deceptive. Following a myomectomy, these women often say “I forgot how good it feels to have a fibroid-free life” or “I feel like a new person”.
However, treatment options may be limited when the fibroids are very large, or if a woman has a very low blood count. For instance, laparoscopic or robotic myomectomy is not possible if the uterus is so large that there is not enough room to place the instruments of the robot in the abdomen. Some interventional radiologists do not recommend uterine artery embolization for very large fibroids because they think the procedure is not likely to be successful. Severe anemia may require either iron infusions or even, rarely, a blood transfusion before anesthesia and surgery can proceed safely.
Watchful waiting is an excellent solution for many women with fibroids. Some fibroids don’t grow, and some even shrink before menopause. After menopause most fibroids will shrink and bleeding will stop. My advice though is to continue to search for a gynecologist who has experience with managing fibroids on a regular basis, who can help you with the “watching” and who is experienced at treatment options including myomectomy in case surgery becomes necessary.
In my practice, I like to see women with bothersome fibroids on a regular, usually every 3- 6 months, basis. On these visits, I review their symptoms and examine them. We monitor blood counts when bleeding gets heavier, and re-discuss treatment options if symptoms get worse, or if the patient has reached the end of her rope. So, watchful waiting is fine, but have someone help you “watch”.
