Journal: American Journal of Obstetrics and Gynecology (in press, available now on-line for subscribers)

Authors: William Parker

From: UCLA School of Medicine, Los Angeles, CA.

Problem: Fibroids can usually be diagnosed by pelvic examination and ultrasound, but neither gives us exact information about the sizes, number, and positions of all fibroids present. Excellent studies show that MRI is the most accurate way to get all this information, but most gynecologists do not order MRIs or know how to interpret them.

Clinical Opinion: This article describes how MRI works, illustrates normal pelvic anatomy and the appearance of fibroids (and adenomyosis) on MRI and discusses the ways to limit the number of images and, therefore, the cost of an MRI. Three actual cases from my practice are presented to show how MRI can change the treatment options available to women with fibroids.

Authors’ (Dr. Parker’s) Conclusions: If your gynecologist is able to perform only a hysterectomy, then precise imaging of fibroids is not necessary since they will all be removed with the uterus. However, with many other treatment options now available, magnetic resonance imaging (MRI) can help tell us which options may be best. If your gynecologist does not offer the available, often less invasive, treatment options, accurate information allows you to find a gynecologist who has the skills to take care of you.

Hi Dr. Parker

Im about to have surgery to remove 3 fibroids , the biggest one being 9cm and 2 small ones.

the large one is on the anterior wall and the other two are on the posterior wall. My question is should I have them removed if I plan on getting pregnant or leave well enough alone. You see Im scared to death of the myomectomy turning into a full hysterectomy and my sister said its a paper I can sign so that they can not do a hysterectomy if i have a problem during surgery.

Please help

having surgery soon

want to have more kids

L,

The only fibroids that interfere with fertility are those that bulge into the uterine cavity (submucous).

See more about this here: http://www.fibroidsecondopinion.com/fibroids-and-pregnancy/

A hysterectomy should not be necessary and you should consider a second opinion with a doctor who does myomectomies on a regular basis and who will not ask you to sign a consent for hysterectomy.

Bill Parker, MD

Dear Dr Parker

I found your site while researching the possible treatment for my fibroids.  Thank you for creating such an informative resource.

I am 50 this year and have had fibroids for some time which recently began to grow.  This week I had a uterine ultrasound and my doctor has told me I have about “a pound and a half” of fibroids in my uterus.  I’m afraid I don’t have specifics as he called me last night to just go through the test results.  He seems keen on surgery (hysterectomy) and I am not keen on that for the following reasons:

I have only recently started having minor discomfort in association with the fibroids, some heaviness and some changes in the need to urinate but nothing drastic.  My periods have become lighter recently with far less pain than in the past when the fibroids were probably smaller.

What would be an alternate choice of action to surgery at this point?   My doctor says they fibroids don’t seem to be interfering with urine flow but I would be happy to have my kidneys checked out to make sure all is well there.  I am worried that some doctors are just too prepared to perform major surgery when this may resolve itself after menopause.  Of course, if things get worse then I would reconsider the surgery option.Any advice?   Thanks so much again for offering your views on this issue to women who are looking for a balanced view.

T.S.

Hi T.S.,

It is very, very rare for fibroids to block the flow of urine from the kidneys to the bladder and the fibroids would have to huge to do this.  I cannot give medical advice over the internet, but since you are close to menopause you should ask your doctor about watchful waiting.  Myomectomy, removal of just the fibroids is always an option if the symptoms increase.  If the doctor persists with talk of a hysterectomy, then get a second opinion.  Thanks for the kind words about the website.

Bill Parker, MD

For more information about fibroids and surgery, please see:

http://www.fibroidsecondopinion.com/surgery-for-fibroids/