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Medical Forum / General / General / May 2005OBGYN: Fibroids and their Treatment
I noticed the OBGYN arm of sci.med was not active, so I hope you don't mind my posting my questions here. I received my pelvic US results with findings of a suspected hemorrhagic follicle in my left ovary and and two discrete fibroids. I had the scan due to bleeding between periods. Many moons ago I read about thermal uterine ablation as a way to stop periods all together and treat other gyno problems. I didn't have any problems at the time, but since I had my tubes tied, I longed for a way to "stop the plumbing" entirely. Now that I *do* have problems, I'm wondering if there is a possibility of achieving the cessation of menses without scarring or prematurely wrecking the biology of it all. I know the type and location of the fibroids would have a lot to do with the treatment, if any, but what can I say or ask for to steer my ObGyn in the direction something that would both physically mentally make me quite happy? Don't Pay ~ ! >I noticed the OBGYN arm of sci.med was not active, so I hope you don't > mind my posting my questions here. [quoted text clipped - 13 lines] > ObGyn in the direction something that would both physically mentally > make me quite happy? It depends on whether your dysfunctional uterine bleeding is due to degeneration of the fibroids, or abnormalities of your menses. It's also important to be certain that the bleeding is not related to endometrial cancer. Fibroids can be removed laparoscopically. The lining of the uterus can be ablated (endometrial ablation). The former will stop your bleeding if the the fibroids are the cause, the latter can be done in addition if it's due to menstrual abnormalities. Other options include laparoscopic hysterectomy (LAVH vs supracervical hysterectomy). HMc Howard McCollister <nospam@nospam.net> wrote in sci.med: > It depends on whether your dysfunctional uterine bleeding is due > to degeneration of the fibroids, or abnormalities of your menses. [quoted text clipped - 9 lines] > > HMc Thanks for the information. This is only the beginning of the process, but I was told not to worry and to have a follow-up US in three months. I'm sure if there was suspect endometrial cancer she would not have been so blase. This only came up recently in my yearly PAP, which was normal. Last year she said I had a benign polyp that *could* cause bleeding and asked if I had a problem with that. I didn't. But a few months after she said that I did, and I attributed it to that. But when I told her at this appointment she said the polyp was no longer there. Then she ordered the US because she "felt something" on the left ovary, which I guess turned out to be the hemorrhagic follicle (16mm). The US also revealed the fibroids and the presumption is the fibroids are what is causing the spotting. Can't they do most of the procedures transvaginally? Call me vain, but I prefer not to have any little scars. My tubal was even done transvaginally. There's something ot be said for having an internal cavity providing a great deal of abdominal access (isn't that a sexy and appealing way to put it. LOL!) > Howard McCollister <nospam@nospam.net> wrote in sci.med: > [quoted text clipped - 32 lines] > cavity providing a great deal of abdominal access (isn't that a sexy > and appealing way to put it. LOL!) Methods of resecting a uterine fibroid will depend on the size and type of fibroid. If it is on the inside lining (submucosal) and small enough, they can be removed from the inside of the uterine cavity via a hysteroscope. In some cases, the arterial supply to the fibroid can be interrupted by arterial embolization, which may cause it to shrink and stop bleeding. Bear in mind that larger fibroids, or those that are full-thickness and/or subserosal may only be amenable to laparoscopic excision, or perhaps even require open surgery. Perhaps even a hysterectomy if they are problematic enough (pain or excessive bleeding) and can't be removed by simpler means. If endometrial cancer is ruled out, fibroids don't have to be removed if the patient is willing to put up with the symptoms that they are causing. In cases where a woman presents with dysfunctional bleeding, endometrial cancer must be ruled out. That can't be done with ultrasound with certainty. In your case, dysfunctional uterine bleeding, a history of an endometrial polyp, and ultrasound evidence of fibroids, hysteroscopy is indicated to a) look for and remove endometrial polyps b) evaluate and sample the uterine lining to rule out endometrial cancer and c) determine the nature and resectability of the fibroids if they are submucosal. If the gynecologist is capable enough, hysteroscopy can be done in the office. HMc Howard McCollister <nospam@nospam.net> wrote in sci.med: > Methods of resecting a uterine fibroid will depend on the size and > type of fibroid. If it is on the inside lining (submucosal) and > small enough, they can be removed from the inside of the uterine > cavity via a hysteroscope. I understand that. Just trying to think of best case scenario to get both what I need and what I want. > In some cases, the arterial supply to > the fibroid can be interrupted by arterial embolization, which may > cause it to shrink and stop bleeding. I read a little on that. Ick. > Bear in mind that larger > fibroids, or those that are full-thickness and/or subserosal may [quoted text clipped - 4 lines] > have to be removed if the patient is willing to put up with the > symptoms that they are causing. I'm actually not willing to put up with the symptoms. Periods are supposed to be one week on, three weeks off, not the other way around. Luckily, I'm very tuned to what my body is up to in that regard. I rarely need a calendar because I can feel when I ovulate and I can feel when my period is about to start. I don't cramp up, but I recognize the various twinges, even when I'm about to have a day of bleeding. Now, if this is going to turn into severe cramping I'd rather do something sooner than later. Not much into "girl pains." FYI, I'm a 40-year-old female and had bleeding back in 1998 that was "treated" (HMO style) by putting me on birth control pills. I had an abnormal PAP in 1999 treated with cryo and clean PAPs ever since. > In cases where a woman presents with dysfunctional bleeding, > endometrial cancer must be ruled out. That can't be done with [quoted text clipped - 6 lines] > gynecologist is capable enough, hysteroscopy can be done in the > office. The polyp was cervical and she said it was a common one. Anyway, I'll wait to pursue the issue until I go back home in about three weeks. I've been on assignment in my old stomping grounds, so I went to my old doctor. Why not? I hadn't chosen a new one yet and I only moved a year ago. Gee, I'm glad I finally broke down and got individual health insurance 6 months ago. I gave them my whole history and they chose to exclude my panic disorder. Hehehe! They picked the wrong one. |
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