I am glad you found some guidance from my website and I absolutely agree that hysterectomy is not necessary for you. You only would need treatment if the symptoms were significantly bothersome and then a laparoscopic myomectomy should be straight-forward in the hands of someone who does this procedure on a regular basis.

I hope all goes well,

Bill Parker, MD

Dear Dr. Parker,

In 2009, I discovered that like many Black women I was afflicted with fibroids. The last ultra sound result in June 2010 revealed that I had “an anteverted 10cm uterus with a 5.2cm intramural fibroid, causing distortion of the endometrium, suggesting submucous extension. A 9.0mm subserosal fibroid is in the anterior fundus. The endometrium is 6.5mm and thick.” Two separate attempts were made to perform a biopsy and curettage but it would seem the fibroid’s position and the fact that I was bleeding at the time prevented a conclusive determination. I was immediately told that I should have a hysterectomy, but resisted the idea of losing my womb. I sought several ‘second opinions’ and was constantly told the same thing.

In the meantime, during my periods, which could last anywhere from 12-20 days, I suffered extremely heavy bleeding (saturating super Tampax tampons and pads every 2-30 minutes for several hours and accompanied by glass coaster-sized clots) and pain severe enough to require morphine drip treatment at medical facilities on a few occasions (have since been prescribed Ponstan Forte 500mg for the pain, which I must take 3 days before period begins). Attempts were made to stop my periods altogether (Depro Provera and various contraceptive pill regimes) all to no avail. I also tried alternative treatments (acupuncture and various herbs, including Dong quai, Red raspberry leaf, Shepherd’s purse, Lady’s mantle, Yarrow, etc, as well as the enzymes Fibrovera and Neprinol – which I took together) in an attempt to find a treatment that would allow me to keep my womb, but it was all for nought. So finally, I have thrown in the towel and partially accepted that I may have to lose my womb. Due to all the heavy bleeding, my haemoglobin levels are low – 6.5 in November 2011 – and so once again, my gynaecologist tried to stop my periods in an attempt to raise my iron levels by putting me on the pill, Yasmin, with the ultimate goal of performing a hysterectomy this year (Trihemic makes me vomit, so that’s a no-no). Only thing is, I started Yasmin in early November 2011 and after initially retarding my period for a week or two, my flow has now been going nonstop (now 2nd week January 2012). The pill has had some effect as I no longer suffer the ‘deluge’ I had before, but it’s still there. Volume fluctuates, sometimes moderate with some clotting and pain and sometimes very light). So, I’m due to start Zolodex this week to see if that will prove more successful.

The problem is that I live in a country where treatment options for fibroids are very limited, with hysterectomies and myomectomies being the only two procedures and the laproscropic versions of those only being introduced 2-4 years ago. Is there really nothing else that can be done for me? I have tried to be as thorough as I can in presenting my case to you in order that you may best suggest a solution without actually having examined me.

I am really looking forward to your response.

Best regards,

Joy

Joy,
I totally understand your dilemma – it is a story I hear all the time from women I see for second, third, fourth opinions. You do have options, but you will need to find qualified doctors to provide them for you.

One option is an endometrial ablation; cauterization of the uterine lining cells to stop the bleeding. See more about this here: http://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

A similar technique, hysteroscopic myomectomy, may be used to remove part of the fibroid in order to gain access to the uterine cavity so that the ablation can be performed.

Another option is uterine artery embolization. This procedure is performed by interventional radiologists and has excellent results for heavy bleeding, around 90% success rates. You can see more about this here: http://www.fibroidsecondopinion.com/uterine-artery-embolization/

And, as you mention, myomectomy can remove the fibroid and also eliminate the heavy bleeding without a hysterectomy. Based on the size of the fibroid, this should be very straight-forward in the hands of a gynecologist who regularly performs this procedure.

Hopefully, you can find someone to provide you these other options. Hysterectomy should not be necessary.

Bill Parker, MD

Before my family and I moved to Germany from North Carolina, I was diagnosed with a 1-2 cm posterior fibroid per pelvic exam. Over a year later, it had increased to 4-5 cm per an ultrasound that my German gynecologist performed. Six months after that it had increased to about 7 cm. She told me that laparoscopic hysterectomy was my only option because the fibroid was intramural and would continue to grow until menopause. She did mention that some of her patients had seen a reduction in growth rates with diet and exercise. I believe that because I’m 44 (with no plans to have more children) she was not concerned with offering me other alternatives. After thoroughly reading your website, I have decided to cancel my surgery and talk to my German physician about “watchful waiting” since you commented that smaller fibroids are likely to grow quickly. It may be that my fibroid growth slows or stops now that it is 7 cm. Additionally, I am having no significant symptoms. I have some mild pressure in my lower back with moderate to heavy bleeding for 2 days during my menstrual cycle. It does not seem to affect my quality of life (I take iron during that time). I plan to ask my gynecologist about the option to perform an MRI for a more accurate diagnosis as well.

Thank you again for providing this information for the many women out there, like me, who have been given no serious alternatives to hysterectomy. I hope that I can go without surgery indefinitely or until we return to the states.

Sincerely,

Marlo C. Powell

I’m 46 years old. 13 years ago I had a myomectomy removing a grapefruit sized fibroid. The fibroid was too large to remove laproscopically so they did a c-section cut to remove the fibroid. Over the past year I have been experiencing very, very heavy periods and large blood clots (very unmanageable at times). I had an internal ultrasound yesterday and have two fibroids, one is 2.1 and the other 3.3. A small cyst on one of my ovaries was also discovered. A hysterectomy with removal of the cervix has been recommended. After all I have read, I don’t know if I want to do a hysterectomy. Would another myomectomy be recommended due to my age and if there is a chance the fibroids can return?

Usually, fibroids that cause heavy bleeding are those that bulge into the uterine cavity. These are hard to see on a regular vaginal ultrasound and are better seen with MRI or with an ultrasound after sterile saline is inserted through the cervix to fill the uterine cavity.

If there are fibroids bulging into the cavity, they can be shaved out – hysteroscopic myomectomy. If the fibroids don’t bulge into the cavity, bleeding can often be controlled with either a progesterone containing IUD (Mirena) or with an endometrial ablation. See more about hysteroscopic myomectomy or endometrial ablation here:
http://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

Also, for the size fibroids you mention, a laparoscopic myomectomy should be very feasible:
http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

In addition, uterine artery embolization is very effective to treat heavy bleeding from fibroids: http://www.fibroidsecondopinion.com/uterine-artery-embolization/

A small clear cyst on your ovary should not require any surgery at all – these usually go away, but clear cysts do not change into cancer: http://www.ovaryresearch.com/ovarian_cysts.htm

Lastly, you are about 5 years away from menopause when bleeding will stop and no new fibroids will grow and virtually all the above treatments should work.

So, you should have lots of options other than hysterectomy, which should be a last resort rather than first resort.

Bill Parker, MD

Bill Parker, MD

i didn’t mention a couple of other things because i didn’t think they were related.

shortly before i was diagnosed w/ the fibroid, i was experiencing other symptoms (leg numbness + strange heat sensations) and my new doctor pretty much told me i was gaining weight with age suggested i buy a book about hormones. i also asked her whether i could have a food sensitivity or IBS and she said possibly, but that there’s not much that i could do about the IBS and to exercise more.

i’m always bloated. would IBS cause someone to look pregnant 24/7 and always look pregnant even if i haven’t eaten (although slightly better than if i ate). my periods are heavy, need to pee often (embarrassing but i’ve had accidents outside home), constipated, and i’m often very irritated easily.

i also took a food sensitivity test and found out that i don’t have celiac. i asked my family doctor about IBS before and she said it’s likely, but there’s no way to test it. she hasn’t been very helpful with anything and just told me to take probiotics.

she told me i was gaining weight with age and suggested a buy a naturopathic book written by her friend about hormones (which i did), but i didn’t believe her it was all that as it didn’t feel correct.

Since the fibroid is in the back of the uterus (posterior) and only 6 cm (tennis ball size), it is unlikely that it would make you look pregnant. Abdominal bloating and constipation may be the result of irritable bowel syndrome (IBS), so you might ask a GI doctor about this. Obviously, without me being able to examine you, I cannot really tell what is going on, so you should also discuss this with your gynecologist.

Bill Parker, MD

I hope this is helpful,

Bill Parker, MD

Bill Parker, MD