Uterine Fibroids: When to Consider Surgery and Manage Symptoms

Uterine fibroids and blood clots during menstruation?

Dear Doctor,
My last menstrual period was on April 25.
Since I did not get my period in May, I went to the obstetrics and gynecology department for a check-up (pregnancy test) and confirmed that I am not pregnant.
However, during an abdominal ultrasound, I was found to have uterine fibroids, approximately 7 cm in size, with 2 fibroids.
I was then advised to return to Zhongli for further examination.
After returning to Zhongli, I visited a maternal and child hospital, where a transvaginal ultrasound confirmed the presence of three fibroids measuring 8 cm, 6 cm, and 2 cm.
The doctor recommended surgical removal (traditional open surgery) due to their size, but since they do not affect my daily activities and I have no discomfort, I would like to know if surgery is necessary, or if I should just monitor the situation or consider medication for management.
Additionally, I took medication to induce menstruation on June 17 (for 3 days), and my period started around June 23.
However, during these 5 days, I have experienced more discomfort than usual during my period, and there are quite a few blood clots.
Is this normal, or should I wait until my period is over to return to the hospital for further examination? Thank you for your response.

Ms. Chen, 30~39 year old female. Ask Date: 2016/06/27

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, for general tumors (such as uterine fibroids), surgery is typically considered when the size is over 5 centimeters.
However, if there are no symptoms or discomfort, observation and regular monitoring can also be considered.
Therefore, you should have a thorough discussion with your obstetrician-gynecologist before making a decision.
This month, if your menstrual period is more uncomfortable than usual, it may be due to taking menstrual induction medication; observation is sufficient.
Wishing you good health.

Reply Date: 2016/06/27

More Info

When it comes to understanding uterine fibroids, also known as leiomyomas, it is essential to consider several factors before deciding on surgery or other management options. Uterine fibroids are benign tumors that develop in the muscular wall of the uterus and can vary in size, number, and location. In your case, you have been diagnosed with three fibroids measuring approximately 8 cm, 6 cm, and 2 cm.
The decision to undergo surgery for fibroids often depends on various factors, including the size and number of fibroids, symptoms experienced, and the impact on your quality of life. Since you mentioned that the fibroids have not affected your daily activities and you are not experiencing any discomfort, it may not be immediately necessary to proceed with surgery. Many women with fibroids remain asymptomatic and can manage their condition through regular monitoring.

However, it is crucial to keep in mind that fibroids can sometimes lead to complications, such as heavy menstrual bleeding, pelvic pain, or pressure symptoms affecting the bladder or bowel. If you start experiencing any of these symptoms, it would be advisable to consult your healthcare provider for further evaluation.
Regarding your recent experience with menstrual discomfort after taking medication to induce your period, it is not uncommon for women to experience increased cramping and heavier bleeding after such treatments. The presence of blood clots during menstruation can also be normal, especially if the fibroids are causing changes in your menstrual flow. However, if the discomfort is severe or if you notice any unusual symptoms, such as excessive bleeding or signs of anemia (like fatigue or dizziness), it would be prudent to seek medical attention.

In terms of management options, if surgery is recommended, it is typically because the fibroids are large or causing significant symptoms. Surgical options include myomectomy (removal of fibroids while preserving the uterus) or hysterectomy (removal of the uterus), depending on your future reproductive plans and the severity of your symptoms. If surgery is not immediately necessary, your doctor may suggest a watchful waiting approach, where you would have regular follow-ups to monitor the fibroids' size and any potential symptoms.

Medications can also be used to manage symptoms associated with fibroids. Hormonal treatments, such as birth control pills or hormonal IUDs, can help regulate menstrual cycles and reduce heavy bleeding. Additionally, medications like GnRH agonists can shrink fibroids temporarily but are typically used for short-term management due to potential side effects.

Ultimately, the decision regarding surgery or other management strategies should be made collaboratively with your healthcare provider, considering your personal circumstances, preferences, and any changes in your symptoms. Regular follow-up appointments are essential to monitor the fibroids and ensure that any changes in your condition are addressed promptly. If you have any concerns or if your symptoms change, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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