I am 46 years old. History of fibroids. Married with three teenage children. Husband does not want any more children. I do, but don’t have the energy for another small one. I am in moderate constant pain from the fibroids. It’s like walking around with a dull ache inside my abdomen. I also have painful ovulations. My doctor told me today that a hysterectomy is my only alternative as I already had fibroid surgery five years ago. Are there any other options for me? A hysterectomy seems so final. Thanks!
Ann
ANSWER:
Thank you for your question. It is often stated that after a myomectomy the only choice is hysterectomy, but this is not the case. I have on several occasions performed a second or even a third myomectomy for patients either eager to get pregnant, possibly ambivalent about getting pregnant, or just wanting to keep the uterus they came into this world with intact. There are studies showing that myomectomy is not surgically riskier than hysterectomy, is not associated with greater blood loss than hysterectomy, and only in very rare instances can result in very good outcomes. There are rare cases of fibromatosis (where the uterus has over 100 tiny fibroids) that are not very successful, but this condition is not common. Since fibroids are benign and since they stop growing at menopause and actually shrink, I would recommend another myomectomy to any woman not ready or interested in hysterectomy. The benefits of hysterectomy are that no further fibroids can grow, there will be no further menstrual bleeding at all, and estrogen replacement if desired will not need to be balanced with progesterone. Still, if uterine preservation is necessary or desirable, myomectomy is the way to go.
There are other options for fibroids if bleeding is the problem such as resectoscope myomectomy and ablation but this will not treat the pain. There are drugs that put you into temporary menopause and stop the growth and bleeding of fibroids, but not always the pain.
If you cannot find a doctor to take care of this near you, we have many patients who come for care here in Santa Monica from all over the country. Best of luck in your quest.
Amy Rosenman, MD
