Deborah, a 54 year old woman from the Midwest, called stating that her uterus had multiple fibroids which have grown over the last two years, and she wanted to avoid a hysterectomy for personal reasons. She was having regular menstrual periods and lab work (FSH) showed that she was not yet menopausal, and was quite uncomfortable from the pressure of her huge uterus and heavy menstrual bleeding. An MRI was ordered, in which over 30 fibroids were identified. The MRI is shown below:
When she came to see me her uterus was almost to her ribcage. I did an office hysteroscopy which showed a large submucous fibroidin addition to the fibroids in the wall. This was important to know about beforehand, as it would have caused continued heavy bleeding if it was left behind. We talked about all treatment options, including embolization (UFE) and hysterectomy. Since she chose to have an abdominal myomectomy, we agreed that a hysterectomy would only be done in the very unlikely event of an unexpected finding that would threaten her life.
Here is a photo of Deborah’s uterus during her myomectomy. A horizontal incision was made, and her uterus containing the fibroids is shown below. Her legs are to the left of the photo.
A total of 89 fibroids were removed, which are shown below.
Comment: A number of treatment options were possible for Deborah. Embolization (UFE) would have avoided an incision, but even if it decreased significantly in size it still would be huge. She also had a submucous myoma, which could cause problems after emboliztion. I had suggested that because of the large number of fibroids hysterectomy would be simpler than a myomectomy, and require less surgical time. She could still keep her overies and her cervix. (Hysterectomy would not be an option for someone desiring pregnancy.) I feel my job is to present as objectively as I can the advantages and disadvantages of all the options. Since women have different needs and beliefs, what is best for one person may not be the same as what is best for another.Deborah chose an abdominal myomectomy, and was able to go home with her uterus intact. — Paul Indman, M.D.
Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.