Uterine Fibroids: Treatment Options and Surgical Considerations

Uterine fibroids

Hello Dr.
Lin: I would like to ask you about my uterine fibroid, which was originally 2.6 cm.
Due to prolonged episodes of heavy bleeding, my hemoglobin level dropped to only 7.
At that time, I was 27 years old.
I have been receiving treatment at the clinic for twenty years.
The doctor administered injections in an attempt to shrink the fibroid, but for someone like me who menstruates, will the uterine fibroid shrink? After about three years of treatment, the fibroid grew to 4 x 5 cm, and I experienced continuous heavy bleeding.
Fifteen years later, the fibroid has grown to 6.5 x 5 x 1.0 cm, and the bleeding has not stopped, leading the doctor to insert a vaginal pack.
I would like to ask you a few questions: 1.
Should the uterine fibroid be surgically removed? 2.
Given the long duration of treatment, should alternative treatment options be considered?

Xiao Qiu, 40~49 year old female. Ask Date: 2012/06/28

Dr. Lin Wenbin reply Obstetrics and Gynecology

Hello.
Your treatment history for uterine fibroids has spanned 20 years, from your reproductive years to now, approaching menopause.
During this time, medical advancements in Taiwan have made significant progress.
Each stage of treatment has its own unique circumstances and context, and different physicians may have varying judgments, making it impossible to reach a definitive conclusion.
Should uterine fibroids be surgically removed? Even if surgery is indicated, what type should be chosen? (Laparoscopic myomectomy, traditional open myomectomy, hysteroscopic myomectomy, uterine artery embolization, or hysterectomy, etc.) The decision must be based on the specific circumstances at that time.
Given that you are currently 47 years old and experiencing significant bleeding leading to anemia, and if you do not plan to conceive again, a hysterectomy may be considered.
If you are concerned about how a cervical removal might affect your sexual life, laparoscopic removal of the uterine body while preserving the cervix could be an option.
I recommend that you visit a hospital for a thorough examination and discussion, so that the physician can make a decision based on your individual circumstances and determine which treatment best meets your needs.

Reply Date: 2012/06/28

More Info

When it comes to managing uterine fibroids, particularly in your case where you've experienced significant growth and symptoms such as heavy bleeding and anemia, it's essential to consider various treatment options and their implications. Uterine fibroids, also known as leiomyomas, are benign tumors that can cause a range of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. Given your history and the size of your fibroids, let's address your questions.

1. Should you consider surgery for your uterine fibroids?
Based on your description, the size of your fibroids has increased significantly over the years, and you are experiencing severe symptoms, including heavy bleeding that has led to anemia (with a hemoglobin level of 7, which is quite low). In cases where fibroids cause debilitating symptoms and do not respond to medical management, surgical intervention may be warranted. The surgical options include:
- Myomectomy: This procedure involves the removal of fibroids while preserving the uterus. It can be performed through various approaches, including abdominal, laparoscopic, or hysteroscopic methods, depending on the size and location of the fibroids.

- Hysterectomy: If you are certain that you do not wish to have children in the future, a hysterectomy (removal of the uterus) may be a more definitive solution. This would eliminate the fibroids and prevent any future complications related to them.

The decision to proceed with surgery should be made in consultation with your gynecologist, who can evaluate your specific situation, including the size and location of the fibroids, your overall health, and your personal preferences.

2. Is it time to consider alternative treatment options?
Given the duration of your symptoms and the ineffectiveness of previous treatments, it may be time to explore more aggressive treatment options. While hormonal treatments (like GnRH agonists) can sometimes help shrink fibroids temporarily, they are not a permanent solution and may not be effective for everyone. Additionally, the long-term use of these medications can lead to side effects, including bone density loss.

Other treatment options to consider include:
- Uterine Artery Embolization (UAE): This is a minimally invasive procedure that blocks the blood supply to the fibroids, causing them to shrink. It is effective for many women and has a shorter recovery time compared to traditional surgery.

- MRI-guided focused ultrasound: This is a non-invasive treatment that uses ultrasound waves to destroy fibroid tissue. It is suitable for certain types of fibroids and may be an option if you prefer to avoid surgery.

In conclusion, your situation warrants a thorough evaluation by a gynecologist who specializes in fibroid management. They can provide you with a comprehensive assessment and discuss the risks and benefits of each treatment option, including surgery, to help you make an informed decision. Given your history of significant symptoms and the growth of your fibroids, it may be advisable to consider surgical options sooner rather than later to alleviate your symptoms and improve your quality of life.

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