Do I Need Surgery for Uterine Fibroids? Exploring Medication Options

Do uterine fibroids require surgery? Is there a medication treatment available?

I am 45 years old this year.
Last year, an ultrasound examination revealed that I had a uterine fibroid measuring about 3 cm.
This year, during a follow-up examination, it has grown to 6 cm.
My doctor has suggested a hysterectomy, but I am wondering if it is severe enough to warrant a complete removal.
The doctor also mentioned that after the age of 50, I will enter menopause, and the uterus will atrophy, which may cause the fibroid to shrink on its own, so it might not require intervention.

I am experiencing symptoms such as palpitations, hot flashes, and heavy menstrual bleeding.
I follow a vegetarian diet, primarily consuming legumes and mushrooms.
I have heard that soy isoflavones can help alleviate symptoms of menopause, and I have taken them occasionally—60 capsules over the course of a year.
The doctor insists on a hysterectomy because the fibroid has grown from 3 cm to 6 cm.
I am unsure if taking these supplements has contributed to the growth.

I would like to inquire if it is possible to avoid surgery and if there are any medications available to manage this condition.

lolo, 40~49 year old female. Ask Date: 2009/09/10

Dr. Dong Yuhong reply Obstetrics and Gynecology

Whether a 6 cm uterine fibroid requires surgery depends on a comprehensive evaluation of multiple factors, such as the location of the fibroid, its impact on menstrual flow, whether it causes anemia, proximity to menopause, and the risks associated with surgery.
It is advisable for you to communicate further with your attending physician to determine the best treatment approach that you can understand and comply with.

The soy isoflavones mentioned in your question are plant-based hormones, and their effects on the body can vary from person to person.
Since you have issues with heavy menstrual bleeding, it is important to consider whether there are any endometrial pathologies.
After ruling out the possibility of malignant endometrial changes, medications or intrauterine devices (such as Mirena) can be used to reduce menstrual flow and maintain your health.

My response may only address some of your concerns, but the questions you raised are very important.
It would be beneficial to inform your attending physician about your concerns, as they can provide medical advice tailored to your specific situation based on the actual clinical assessment.

Reply Date: 2009/09/10

More Info

When it comes to managing uterine fibroids, particularly in your case where the fibroid has grown from 3 cm to 6 cm, the decision to undergo surgery or pursue medication is complex and should be tailored to your individual circumstances, symptoms, and overall health.

Uterine fibroids, also known as leiomyomas, are non-cancerous growths of the uterus that can cause a variety of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. The growth of fibroids can be influenced by hormonal changes, particularly estrogen, which is why they often shrink after menopause when estrogen levels decline. Given that you are 45 years old and approaching menopause, it is indeed possible that your fibroids may shrink on their own in the coming years.

Your doctor’s recommendation for a hysterectomy (removal of the uterus) is typically considered when fibroids cause significant symptoms that affect quality of life, or if there are concerns about the size and growth of the fibroids. A hysterectomy is a definitive solution, as it removes the source of the problem entirely. However, it is a major surgical procedure with its own risks and implications, including the loss of fertility if that is a concern for you.

Before making a decision, it is essential to consider the following:
1. Symptom Severity: You mentioned experiencing heart palpitations, hot flashes, and heavy menstrual bleeding. These symptoms can significantly impact your quality of life. If they are severe and not manageable with medication, surgery may be warranted.

2. Medication Options: There are several medication options available for managing fibroids and their symptoms. Hormonal treatments, such as birth control pills or hormonal IUDs, can help regulate menstrual bleeding. GnRH agonists can temporarily shrink fibroids by lowering estrogen levels, but they are not a long-term solution. Additionally, medications like Tranexamic acid can help reduce heavy bleeding. However, these medications may not be suitable for everyone and can have side effects.

3. Alternative Treatments: Some patients explore alternative treatments, including dietary changes, supplements (like soy isoflavones), and lifestyle modifications. While some studies suggest that certain dietary changes may help alleviate symptoms, the evidence is not robust enough to replace conventional treatments.

4. Monitoring: If your symptoms are manageable and not severely affecting your daily life, your doctor may suggest a watchful waiting approach, especially considering your age and the potential for fibroids to shrink after menopause.

5. Second Opinion: If you are uncertain about the recommendation for surgery, seeking a second opinion from another gynecologist can provide additional insights and options.

In conclusion, while surgery is a definitive treatment for uterine fibroids, it is not the only option. Medication can effectively manage symptoms for some patients, and lifestyle changes may also play a role in symptom relief. It is crucial to have an open discussion with your healthcare provider about your symptoms, treatment options, and personal preferences to make an informed decision that aligns with your health goals and lifestyle.

Similar Q&A

Should You Consider Hysterectomy for Uterine Fibroids?

Hello Doctor: In 2011, I underwent a minor surgery to address a large uterine fibroid, which was successful. However, since 2012, it has recurred, and medication has not alleviated the pain. I would like to inquire whether I can undergo a hysterectomy or if there are other method...

Dr. Lü Lizheng reply Obstetrics and Gynecology
1. Generally, fibroids are mostly benign, so surgery is not absolutely necessary. The reasons for treatment primarily focus on the symptoms caused by the fibroids, including pain, heavy menstrual bleeding, and urinary frequency due to bladder pressure. Some individuals may opt fo...

Managing Uterine Fibroids: IUD vs. Surgery Options Explained

Hello: I have uterine fibroids and adenomyosis, experiencing prolonged menstrual periods with heavy bleeding and pain that can only be managed with painkillers. Since I do not plan to have children, I am considering a hysterectomy. The doctor has suggested the insertion of a Mire...

Dr. Xu Junrui reply Obstetrics and Gynecology
Ms. Li, given your situation, I would recommend that if you do not have any fertility needs, it may be worth considering a hysterectomy. Your concerns are valid, especially if you have previously experienced multiple instances of intrauterine device displacement; it is indeed pos...

Uterine Fibroids: Surgical Options and Risks for Women Over 40

Hello, doctor. My younger sister is 41 years old, unmarried, and has never had children. Recently, she was diagnosed with a uterine fibroid measuring approximately 8 cm, accompanied by periodic pain. The doctor has recommended surgery. Should she opt for tumor removal or a hyster...

Dr. Lin Wenbin reply Obstetrics and Gynecology
Please go to the hospital for an examination. In addition to surgery, there are now medications available to treat uterine fibroids. Treatment options should be discussed based on individual circumstances.

Understanding Surgical Options for Uterine Fibroids: What You Need to Know

Hello, Doctor: I have been very worried about a tumor in my uterus recently! Two years ago, it was only 6-7 cm! In the past two months, I have experienced abdominal distension, especially after meals or during ovulation, along with dizziness and other discomfort. After a CT scan ...

Dr. Mao Yikun reply Obstetrics and Gynecology
Hello: Uterine fibroids do not always require surgery, but if they grow too quickly or cause discomfort, surgery may be necessary. Whether to use laparoscopic surgery depends on the hospital's equipment. Some medications may help shrink the fibroids.