1)   About 18% of African-American women and 8% of white women have fibroids during pregnancy.

2)   Only 30% of women have fibroids grow during pregnancy and most of the growth is within first three months.

3)   The risk of fibroid degeneration that leads to pain and early contractions is very small (5%).

4)   There is a small increased risk of early delivery (3 weeks or more) in women with fibroids (19% v 13% of women without fibroids).

5)   There is a small increased risk of heavy bleeding after delivery of the baby in women with fibroids (8% v 3% of women without fibroids).

6)   There is an increased risk of breech (13% v 8% of women without fibroids).

7)   There is a greater risk of having a Cesarean Section (49% v 21% of women without fibroids)

8)   There is essentially no risk of fibroids injuring the baby.

Also see this webpage: www.fibroidsecondopinion.com/fibroids-and-pregnancy

I will be seeing yet another gynecologist (third opinion) for menorrhagia and severe anemia supposedly due to one large submucosal fibroid. However, my last sonogram showed two smaller growths with one ulcerated and the endometrial biopsy showed polyp tissue so I really don’t know what is going on. All previous doctors have offered me only one option – total hysterectomy with ovary removal. They are not interested in further diagnostics, I guess because of my age. I am 55 and have skipped a number of periods. In the last year however when I do have one it is extremely heavy. I really don’t want a hysterectomy and feel that I always have to fight to even get my thoughts heard by doctors.  I need to know what specific questions to ask the new doctor so that I might be offered some other options?

G.

G,

I agree that hysterectomy should be a last resort. First, you need to know exactly where the fibroid is. An MRI or saline-infusion sonogram is much better than regular ultrasound at this diagnosis. If the fibroid is mostly in the cavity and less than 5 cm, it can probably be removed by hysteroscopic myomectomy: see http://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

If this is not possible, then a myomectomy, either laparoscopic or abdominal, should then be possible. See: http://www.fibroidsecondopinion.com/abdominal-myomectomy/

Unless you have a family or personal history of ovarian or breast cancer, the current thinking is that the ovaries may provide long-term health benefits.

Bill Parker, MD

Hello!

I have a fibroid that is uncomfortable due to bulk and extends length of menstruation (7-9 days at least).  I recently saw a fertility specialist who did an exam and recommended a “mini” laparoscopy to remove the fibroid. The doctor said the “mini-lap” would involve a three inch (approx) incision at the bikini line.

Can you explain the difference between the mini-lap and regular laparoscopy?  Including the typical size of a bikini line incision (if one is involved)?

Thank you in advance.

G.

G,

A mini-lap is the term used for mini-laparotomy. As you describe, a mini-laparotomy involves a 2-3 inch incision above the pubic bone and uses standard surgical instruments and technique. Laparoscopy uses 3 or 4 much smaller incisions (1/2 inch each) and uses long instruments passed through these incisions to perform the surgery, which is viewed on a large video monitor. See the illustrations here: http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/ compared to here: http://www.fibroidsecondopinion.com/abdominal-myomectomy/

I hope this is helpful,
Bill Parker, MD

Dear Dr Parker,

I am a forty year old female living in Australia and recently tests have shown that I have a very large fibroid growing on the Uterus Muscle. The fibroid is 17.5cm X 16.3cm X 6.8cm. I am worried that so far most have the notion that I would require a full hysterectomy in order to remove the mass. About four years ago I had GBS and now suffer from chronic fatigue and I am scared about having a hysterectomy. Have you removed fibroids this large from woman without the need of a full hysterectomy? I look forward to your reply…

Kind Regards

D.

D.

Yes, a fibroid this size can be removed by abdominal myomectomy with a bikini type incision. I have removed even larger fibroids this way. A hysterectomy is not necessary.

Bill Parker, MD

I was diagnosed with a 8-cm fibroid only today (13 Jan), after doing an ultrasound, and my gynecologist whom I was seeing for the first time, has scheduled my surgery to be done 13 days later without telling me much about the surgery.

Is this too rushed? Do I need to consult another Doctor before deciding on the surgery?  I found out from the staff of the hospital which my gynecologist is working at that she has 8 years of experience and has just been promoted to have her own clinic in the hospital. So, I feel a bit uneasy.

Please kindly advise.

M.

M.

Yes, you need more explanation from the doctor. First of all, the fibroid may not need to be removed at all unless you are having bothersome symptoms. Second, most of the time an 8 cm fibroid can be removed laparoscopically in the hands of an experienced surgeon. See this page: http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

Laparoscopic myomectomy has the advantage of outpatient surgery and a fast recovery. I always think a second opinion is a good idea if you are recommended to have surgery.

Bill Parker, MD

I was diagnosed with adenomyosis and my Dr. suggested to do a partial hysterctomy.. Is this the right thing to do.. I’m worried of what to feel after, if it will affect my sex life, will it really make a difference and if not what can happen if I don’t get the hysterectomy done?

Thank You,

N.

N.

The best way to diagnose adenomyosis is with MRI, so hopefully you have had this done to be sure. Unfortunately, hysterectomy is the only 100% cure for painful periods and irregular bleeding associated with adenomyosis. The progesterone IUD has about a 60% success rate and embolization has about a 50% success rate, so those are also options.

If you do not have a hysterectomy and other treatments fail, then you will continue to have whatever symptoms you have now. You can read more about hysterectomy and sexuality here: http://www.fibroidsecondopinion.com/hysterectomy-for-fibroids/ under the heading “Is There Any Benefit to Leaving the Cervix in Place?”

I hope this is helpful,
Bill Parker, MD

Dr. Bill Catherino, head of a fibroid research group at the NIH, presented new findings about what causes fibroids to grow and what possible treatments, diets, environmental changes might be used to reduce the health impact of fibroids.  The less-than-good-news is that none of the following research was performed in humans, so the results are very preliminary.

Hormonal Influences

Women with fibroids have normal blood levels of estrogen and progesterone.  Estrogen dominance does not cause fibroids.

Fibroid cells can make their own estrogen, so the level of estrogen inside fibroids is higher than in blood or other tissues.

Estrogen and progesterone receptors, parts of the fibroid cells that cause them to respond to estrogen and progesterone, are more prevalent in fibroid cells than normal uterine muscle cells.

Fibroids have more collagen than normal uterine muscle cells and more glycosaminoglycans (GAG).  GAGs draw water into the cells and make them swell.  Lupron causes a decrease in GAGs, which dehydrates the fibroid cells and causes shrinking of the fibroids.  When Lupron is stopped, the cells take on water again and swell again.

Dietary Factors

Vitamin D – decreases fibroid cell size and disrupt the formation of fibroid muscle cells.

Resveratrol (found in grapes) – decreases growth and increases death of fibroid cells in a test tube.

Curcumin (spice) – decreases growth and increases death of fibroid cells in a test tube.

Licorice (isoliquiritigenin) – decreases growth and increases death of fibroid cells in a test tube.

Green Tea (epigallocatechin gallate) – decreases growth of fibroid cells in a test tube.

“I am just so pleased with the live telesurgery demonstration,” said the Conference Program Chair C.Y. Liu, MD.  “Dr. Parker did such a wonderful job – he mesmerized the entire audience with his fluid and skillful live demonstration of how the laparoscopic myomectomy could be used and should be done. I am thankful for his willingness to share his expert surgical technique with us.”

During the procedure, Dr. Parker explained what he was doing as he operated, and he answered questions from the audience as well as for the doctors watching over the Internet around the world. This surgery was the first time the American Association of Gynecologic Laparoscopists had used the Internet to transmit a live surgery. A short, edited video of the procedure may be viewed at http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/.

“Minimally invasive fibroid surgery offers the benefit of outpatient surgery with minimal discomfort and seven to 10 days to full recovery,” Dr. Parker said about the procedure. “Women really benefit from these advantages and they appreciate a quick return to their daily lives.”

Authors: Bagaria M, Suneja A, Vaid NB, Guleria K, Mishra K.

Study from: Department of Obstetrics and Gynaecology, University College of Medical Sciences, Delhi, India.

Problem: So far, no medication has worked to relieve symptoms of fibroids. In early studies, one drug that appeared to be promising was Mefipristone (RU-486).  Progesterone causes fibroid cells to grow and Mefipristone blocks this effect.

Study: The study included 40 women with bothersome symptoms from fibroids; 20 women were taking mifepristone and 20 were taking a placebo. None of the women or their doctors knew what pill they were taking.

Fibroid-related symptoms, the size of the uterus and size of the largest fibroid were measured with ultrasound at the beginning of the study and every month for three months. A biopsy of the uterine lining cells was done at the beginning and again at the end of treatment.

Results: Women who were taking Mefipristone had a 95% decrease in menstrual blood loss after three months   Complete relief of menstrual cramping occurred in 80%, but only 33% patients were free of pelvic pain.  Women taking the placebo pills had no change in any symptoms. Backache, bladder problems and pain with intercourse were not better in either group.

The size of the uterus and size of the largest fibroid were about 30% smaller by the end of the third month of therapy. Women taking Mefipristone had an increase in haemoglobin (red blood cells) from 9.5 to 11.2 . However, 63% of women taking mefipristone had benign overgrowth of the uterine lining cells (endometrial hyperplasia without atypia).

Authors’ Conclusions: A low dose of mifepristone taken for three months is effective in reducing menstrual bleeding and reducing uterine and fibroid sizes, but has the side-effect of causing uterine lining cell overgrowth.

Dr. Parker’s Comments: It would be great if there was a pill available to treat the symptoms of fibroids with few side-effects.  So far, all the tested medications have either not worked or had bothersome side-effects. Mefipristone is given orally and has few side-effects.  It is well-known that progesterone causes fibroids to grow.  Mefipristone works by blocking the action of progesterone and has been shown to shrink fibroids and decrease bleeding.  However, progesterone decreases the growth of the uterine lining cells and since mefipristone blocks this action it allows the lining cells to overgrow.  After just 3 months almost 2/3 of women had benign overgrowth. While benign overgrowth does not turn into precancer or cancer, the worry is that longer treatment with Mefipristone could stimulate actual cancer cells to form.  Further study will be needed, but this study is discouraging.

For more about medical treatment for fibroids see: http://www.fibroidsecondopinion.com/treatment-for-fibroids/

Dr. Parker’s Note: I have summarized most of the information from this paper in a new web page: Caring for Yourself After Surgery.

Authors: Minig, L; Trimble, E; Sarsotti, C; Sebastiani, M; Spong, C.

Journal: Obstetrics & Gynecology:  October 2009 – Volume 114, pp 892-900

Study from: National Institutes of Health, Bethesda, Maryland

Problem:  Following surgery, doctors give fairly standard instructions regarding what activities the patient can, and cannot, do.  Unfortunately, there is little science to back up these recommendations.

Study: The authors reviewed studies related to post-operative instructions from medical journals, medical textbooks in obstetrics, gynecology, and general surgery, the American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions and clinical guidelines of Royal College of Obstetricians and Gynecologists of the United Kingdom in order to evaluate current recommendations.

Authors’ Conclusions: Resumption of usual activities after gynecologic surgery helps integrate women back into their normal life. Available data do not support many of the recommendations previously provided. Restrictions on lifting and climbing stairs should be reconsidered. Guidance on driving should focus on the concern about driving while using narcotic medications rather than concern about opening the wound. Much more study is needed to better define all the above issues.

Dr. Parker’s Comments: As the authors state in the introduction to the article, “recommendations for activity after discharge remain based on tradition and anecdote”.  To the authors’ credit, they investigated current recommendations and came up with little evidence to support what we usually tell women.

The authors suggest that the new recommendations be fully tested by scientific study, but since this is unlikely to happen soon (or ever), it is best to discuss the new recommendations with your doctor.

Patients are often each others’ best resource for finding and sharing information about recovery after surgery. I encourage you to post comments on this post if you have something helpful to share.