Hello Dr. Parker,

I get directed to your site every time I search for information on fibroids. I live in India, but I was hoping to get an opinion from you about the possibility of removal of my very large subserosal fibroid. On MRI it measures 12.3cm x 13cm. There are two small intramural fibroids (3 cm each).

I would be very obliged if you could give me some advice if the fibroids can be removed laparoscopically. I want to retain fertility and I am 32 years of age (unmarried).

Thanks,

A

A,

Yes, this fibroid can be removed laparoscopically by an experienced laparoscopic surgeon.  One other fibroid is subserosal and could also be removed. Also see:http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

I hope this is helpful.

Bill Parker, MD

I am 25 and am getting married this August. Last week I was diagnosed with 3 fibroids – 10cm, 3cm and 4cms (submucosal). I have fairly heavy periods but don’t get severe cramps. My periods are always on time. I am getting married soon and am too scared to have surgery. However I do want children in a couple of years.

Also, fibroids run in my family: my grandmother, mother and aunts all have them. My mother had to have it removed three times as it always grew back after surgery. I am worried the same thing may happen to me too

What advice do you have for me?

S.

S,

Surgery would only be necessary if the symptoms are very bothersome, or when you are ready to have children.  The submucous fibroid may decrease your fertility, but it may not and you should discuss the size and position of the fibroid with your doctor or a fertility specialist. Also see:  http://www.fibroidsecondopinion.com/fibroids-and-pregnancy/

The risk of needing another surgery for new fibroid growth after a myomectomy is about 25%, but genetics do have something to do with this.  I usually recommend surgery, if necessary, about 3-4 months before you are ready to get pregnant, so that no new fibroids will grow before you try to conceive.

If you do need surgery, you should get an opinion from a gynecologist who takes care of women with fibroids on a regular basis.

I hope this is helpful,

Bill Parker, MD

Dear Dr. Parker:

I am a 49 year old female recently diagnosed with multiple fibroids.  The largest is 17.0 x 10.6 cm. I also have several uterine masses “compatible with additional subserosal fibroids” and a thickened uterine wall compatible with numerous fibroids.

I consulted with three doctors, all of whom recommended hysterectomy as my only option.  I specifically asked about myomectomy but this was dismissed as “very bloody surgery” and not appropriate to my situation due to the size of my fibroids.  It was not until I saw your website that I realized any other option might be possible.

I am scheduled for surgery this Thursday morning. I would very much like to meet with you if this could be done quickly.  I am hesitant to cancel my surgery because the past two months have been utter hell.  The second doctor spoke at length about cancer, and since then I’ve been a nervous wreck.  I can’t stand the waiting and the uncertainty.

My mother is a breast cancer survivor, and my father is a colon cancer survivor and has prostate cancer.  After reading your website, I wonder if I should have some genetic testing done to decide whether or not it is advisable to keep my ovaries.  I wish I had seen all this sooner!

By the way, from the bottom of my heart, thank you for posting all this information and helping women educate themselves about their options.

Kind regards,

G.

Note: I called G and reviewed her situation and felt that myomectomy was very possible.  She cancelled her surgery and came to the office for a consultation.  Following an MRI and blood tests, I was very confident that cancer was not present and we scheduled her for surgery. I performed a laparoscopic myomectomy, the fibroid was benign and she has done extremely well following surgery.

See this page: http://www.fibroidsecondopinion.com/fibroids-and-cancer/

Bill Parker, MD

I have a large fibroid, about the size of a grapefruit. I am in my late forties. I haven’t been to see my gynecologist in well over a year. He has recommended a hysterectomy. I wouldn’t be too bothered by this but have had 2 c-sections in the past and dread the thought of additional scarring. However, I have a lot of discomfort such as stinging pains like pin pricks, and an enlarged uterus. Should I toughen up and just get the surgery or go for a pap smear and try to hold off for menopause. Any help you could offer would be appreciated. Also, I wish in the future that more research could be done for a medication for fibroids to help other women. Thank You.

T.

T,

The fibroid will shrink about 50% once you get to menopause (average age is 52).  A skilled laparoscopic surgeon should be able to remove either the fibroid (laparoscopic myomectomy) or the uterus (laparoscopic hysterectomy) if that is what you want. Either of these procedures involves a 0-1 night hospital stay and a 2 week recovery to normal activity. If your symptoms are bothersome, you should consider getting a second opinion.  I agree – a lot more research is needed in every aspect of taking care of women with fibroids.

Bill Parker, MD

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

I am a 45 year woman who has never had a child (I have been pregnant several times but never full-term) I am very active and very healthy. I live in the US Virgin Islands and I swim and do yoga daily.

For the past 6 months I have been bleeding very, very heavy – with large blood clots. Once I drove myself to the hospital because the bleeding was so severe. For the past 4-5 moths I have been taking 5-6 birth control pills a day to control the bleeding. My GYN says that taking these many BC pills is very bad and I have been diagnosed with a fairly large fibroid.

It has been suggested that I have a hysterectomy to control and stop the bleeding. I DO NOT WANT a hysterectomy – I checked on having the UAE procedure (blocking the blood supply to the fibroids) but was told the fibroid in my uterus is too large. I do not want to lose my uterus. Every woman that I know that has had a hysterectomy is overweight and has a large stomach. I know that sounds vain but having a large stomach and being overweight are unhealthy.

I just want to die right now! I feel so old and so horrible I cannot stop crying. My other half is 17 years older than me and he is a surgeon in St. Thomas and he wants me to have a hysterectomy – I DO NOT- I would rather bleed everyday than take my uterus out. Plus I have heard that Drs. just sometimes go ahead and take the ovaries also. I don’t know what to do – I want to just die – I feel old and I have nothing to look forward to. This feels like the end. I need some advice. What are my alternatives? Please.

W.

W,

A myomectomy is always possible and a hysterectomy should not be your only option from what you describe here. You should get a second opinion from a gynecologist who is comfortable with myomectomy surgery. A myomectomy sounds like a very good solution for your symptoms.

Bill Parker, MD

I am 25 and am getting married this August. Last week I was diagnosed with 3 fibroids being 10cm, 3cm and 4cms (submucosal). I have fairly heavy periods but don’t get severe cramps. My periods are always on time. I am getting married in August and am too scared to have surgery. However I do want children in a couple of years. What advice do you have for me?

S.

S,

Surgery would only be necessary if the symptoms are very bothersome, or when you are ready to have children. The submucous fibroid may decrease your fertility, but it may not and you should discuss the size and position of the fibroid with your doctor or a fertility specialist. When it is time for surgery, you should get an opinion from a gynecologist who takes care of women with fibroids on a regular basis.

I hope this is helpful,

Bill Parker, MD

Dear Dr. Parker:

I am a 49 year old female recently diagnosed with multiple fibroids. The largest is 17.0 x 10.6 cm transverse and 14.6 cranial/caudal. Also several uterine masses “compatible w/ additional subserosal fibroids” and a thickened uterine wall compatible w/ numerous leiomyomata.

I consulted w/ three doctors, all of whom recommended hysterectomy as my only option. I specifically asked about myomectomy but this was dismissed as “very bloody surgery” and not appropriate to my situation due to the size of my fibroids. It was not until I saw your website that I realized any other option might be possible.

I am scheduled for surgery this Thursday morning. I would very much like to meet with you if this could be done quickly. I am hesitant to cancel my surgery because the past two months have been utter hell. The second doctor spoke at length about cancer, and since then I’ve been a nervous wreck. I can’t stand the waiting and the uncertainty.

My mother is a breast cancer (post-menopausal) survivor, and my father is a colon cancer survivor and has prostate cancer. (My sister has a uterine fibroid.) After reading your website, I wonder if I should have some genetic testing done to decide whether or not it is advisable to keep my ovaries. I wish I had seen all this sooner!
By the way, from the bottom of my heart, thank you for posting all this information, and helping women educate themselves about their options.

Kind regards,
GS

Note: GS came to see me in Santa Monica about 2 weeks ago and we determined with an MRI that she had a pedunculated external fibroid and a fibroid inside her uterine cavity, causing heavy bleeding. A blood test for LDH was normal, making uterine sarcoma extremely unlikely. Therefore, one week ago GS had an abdominal myomectomy with removal of 4 fibroids. The pathology report showed typical, benign fibroids. Her recovery is going well.

Bill Parker, MD

I am a 46 year old women who has had fibroids about 15 years. They now have disrupted my life significantly. My uterus measures 13.0 x 6.7 x 9, I have approx. 12-16 fibroids from very small to 7 being 2.4 cm or larger. I have anemia and have been on prescription iron for 2 years. I have significant pain for 2-4 days a month, but my worst symptom is the excessive bleeding. For 72 hours, I cannot leave my home. My pad plus super tampon fill immediately and when I stand up, I gush.

One gynecologist recommended hysterectomy and my current gynecologist has recommended 6 months of a depo-lupron shots or embolization. I am considering the depo shots as I have a long-planned cruise w/ my family the beginning of April and worry that I will be cabin-bound for 1/2 of the trip – I am worried that the menopausal reactions to these shots will also interfere w/ my quality of life. I am scheduled to meet w/ the radiologist next week to consult about the embolization, but worried that the 5 weeks from now until vacation will not be enough recovery. I just don’t know what to do – the bleeding is consuming how I live.

R.

R,

Embolization certainly sounds like a reasonable option and most women recover in a few weeks. But, discuss this with the interventional radiologist.

The Lupron will cause heavy bleeding about two weeks after the shot, but then bleeding should stop. There are definitely side-effects: hot flashes, trouble sleeping, vaginal dryness, and they will last until a month after the last injection. The interventional radiologist will not want you to take the Lupron, since it makes the UAE procedure more difficult to do. So, discuss this with him as well. Abdominal myomectomy is also an option to remove all the fibroids.

I hope this is helpful,

Bill Parker, MD

I am a 47 year old woman who has never had children. I have recently been told I needed a hysterectomy after being seen by a oncolgist/gyn. I have a 2.5- 3 cm cyst on each ovary- neither are considered simple- one has some solid material and both are septated.

The MD seems to think they are benign. I have had 4 u/s’s since last July and the cysts have remained basically the same. On the last one 1 week ago, it was noted that my uterine lining was also thickened- no fibroids that I know of. I have not had a period since last September and blood work has shown me to be menopausal. I am not taking any hormones, but am taking Remifemin for hot flashes. My Past medical history includes taking infertility drugs (Clomid) X 3 cycles, with no pregnancies. My mother died of breast cancer at age 46- no other relatives with breast or gyn cancers.

If I have the surgery, it will have to be soon due to work issues. Can you please give me any advice as to other options? Thanks so much!

M

M,

Most ovarian cysts are benign and it would be highly unusual for ovarian cancer to remain unchanged on ultrasound over 7 months. Uterine lining thickening is also usually benign and can be easily evaluated in the office with an endometrial biopsy.

I cannot give medical advice over the internet, but I think you should consider getting a second opinion from someone knowledgeable about ovarian cysts.

Bill Parker, MD