Journal: Journal of Clinical Endocrinology and Metabolism. 2011;96:412-21.

Authors: Sinclair DC, Mastroyannis A, Taylor HS.

Study from: Yale University School of Medicine

Problem: Women with submucous fibroids have decreased fertility, increased miscarriage rates, and heavy menstrual bleeding. Why this happens has not been well understood. The authors tested to see if proteins that interfere with fertility and/or cause heavy bleeding were produced by fibroids.

Study: Sophisticated laboratory tests were performed on fibroids and normal uterine muscle to see if the cells made proteins that could cause infertility or heavy bleeding.

Results: Fibroids make different amounts of proteins than normal uterine muscle and these proteins make it more difficult for a fertilized egg to stick to the uterine lining. Fibroids also make other proteins that interfere with the blood clotting in the uterine lining which causes heavy bleeding.

Dr. Parker’s Comments: This is cutting edge science from the fertility group at Yale. Using techniques from molecular biology, the authors showed that fibroids make proteins that both decrease fertility and increase menstrual bleeding. We knew these effects existed, but now we have a better idea as to why.

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