What To Do About Fibroids

Fibroids which are causing no symptoms and which are growing slowly can be left alone. Fibroids larger than the size of a grapefruit that are causing pressure symptoms or severe bleeding can be better handled through myomectomy which means removal of the fibroid tumour with preservation, and if necessary, reconstruction of the uterus. These operations can be more complicated, require a longer time, and cause more blood loss than hysterectomies. Usually it will take some research and input from women's groups to find a gynecologist who is skilled at removing fibroids, even in a large city.

Small fibroids under one or two cm in size or that have a stalk or that are protruding into the uterine cavity can be easily removed through the hysteroscope. Fibroids between 2.5 cm and five cm can be removed the same way after they have been shrunk through medication (GNRH drugs, see chapter on endometriosis for more details). Fibroids larger than five cm must be shrunk medically, and then removed in two steps.

In the case of removal of small fibroids causing bleeding, 50 to 87 percent of women return to normal menstruation after the hysteroscopic operation. If the uterus is larger than a 14-week pregnancy size (about the size of a grapefruit), than hysteroscopic removal cannot be done.

Some fibroids can be removed through the laparoscope. In addition, women with disabling bleeding from fibroids may be possible candidates for endometrial ablation.

There is at least a ten percent chance that the fibroids may grow back enough to necessitate surgery. If you are planning to have a myomectomy, you should make sure your iron stores are built up before the operation.

Fibroids will also grow larger if you are taking the hormone estrogen. Fibroids will also shrink after menopause. So if you are approaching menopause, the best course may be to leave them alone until that time.

More About Moderate To Heavy Bleeding

This is a common reason for hysterectomy. When a woman is having periods that are debilitating or interfering with her life, a hysterectomy can seem like an appealing option. However there are many things a woman can do before resorting to the hysterectomy as a last resort.

• Sometimes simple over the counter medications such as anti-inflammatory and pain reliever drugs for painful periods, such as as motrin, or anti-histamines, such as chlortripolon, will bring the bleeding under control. Avoid anti-histamines like seldane or hismanal.

• Make sure you have your blood level of iron and iron stores checked.

If you are anemic, you should work aggressively on keeping your iron levels high (see chapter on iron). Some studies indicate that chronic iron deficiency may itself be a cause of heavy bleeding.

• Make sure your thyroid function has been checked. Even a slightly lowered thyroid function can cause menstrual disturbances including heavy bleeding. Also make sure that you check your basal temperature. (See the chart at the end of the chapter on The Thyroid Gland And Pregnancy).

• Consider going on a hormonal regime, usually Provera, to regulate the bleeding and make it more predictable.

• If you are significantly overweight, your fat tissues will produce extra estrogen, which can increase bleeding.

• Always find out the cause of the bleeding. This can be done through a simple office procedure called endometrial biopsy. A small sample of the lining of the uterus is taken and cancer can be ruled out. If the lining of the uterus is overgrown, short term treatment with Provera will solve the problem.

A D-and-C is sometimes useful and may help the bleeding. However, an office procedure called hysteroscopy, where a lighted tube is introduced through the cervix is a much more sensitive and accurate procedure than a D-and-C for both diagnosis and treatment.

• Consider seeking natural solutions for your bleeding problems. Consider seeing a skilled acupuncturists who will give Chinese herbs as well as acupuncture to bring the body into balance. The Chinese herb dong quai is the foremost of female tonics and can help regulate periods and reduce bleeding.