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Legislation Reform Needed Update:

NOTE:  The new section is not intended to take the place of seeing a physician for a consultation.  

Case Example:  Urinary Tract Infections 

I have fibroids and get Urinary Tract Infections (UTI).   Can fibroids cause Urinary Tract Infections?

Analysis:  I have seen fibroids cause increased UTIs because the fibroids can obstruct the outlet of the bladder and cause some urinary retention.  If the urine sits in the bladder, it becomes a reservoir for infection. - William Parker, M.D.

   

Case Example:  DCIS Breast Cancer – Fibroid, Uterus, and Ovary removal  

My Gyn would like to remove my uterus and ovaries in light of the fact that I was just diagnosed with DCIS non-invasive breast cancer...stage o.   I chose the mastectomy - no radiation, no chemo, no Tamoxifen.  If the lymph glands are clear and they find no invasive sites after the mastectomy I will be cured the doctor said.  This is the only type they can cure.  What kind of doctor should I go to for a second opinion about my fibroids, uterus, and ovaries being removed? 

Analysis:  The patient should consider getting a second doctor opinion from a medical oncologist who deals with breast cancer.  DCIS is not as aggressive as breast cancer and you may be disease free after the mastectomy.  I see no reason to remove the uterus unless you are having symptoms that YOU wish to resolve with surgery.  This all seems a bit drastic to me. – William Parker, M.D.

 

Case Example:  A fibroid patient looking at pregnancy options

History:  Diagnosed with fibroids 2001 during a routine Ob/Gyn visit.  I wasn’t experiencing any symptoms other than frequent urination and some heavy bleeding during my period.  Had ultrasound which showed one fibroid, 6 cm, on front posterior of uterus.  Fibroids in my family - Mother had them.

Started fertility treatments the fall of 2002.  I think this is when the second fibroid was spotted – another one outside the uterus pressing on my bladder.  My Reproductive Endocrinologist (RE) could see them on the ultrasound during cycles. 

Had two cancelled cycles due to follicle issues.  The doctor noticed fibroids were enlarging as expected from the hormones and thought they could block egg retrieval.  The doctor had me undergo an MRI which uncovered many small fibroids in the walls of my uterus.  Not sure how many, but I remember my uterus looking like a bag of golf balls and a reference to it being the size of a 12 week pregnancy.   

My Reproductive Endocrinologist (RE) thought that UAE was best option due to the number of fibroids, which could result in a hysterectomy if a myomectomy was performed. 

January 2003 I underwent UAE performed by an Interventional Radiologist.  There were no complications from the procedure. 

November 2003, had another IVF cycle which resulted in 7 frozen embryos but they weren’t implanted because the Interventional Radiologist said my uterus wasn’t ready. 

January 2004, I had a repeat MRI and a consultation.  He gave me the go ahead to implant the frozen embryos. 

When starting FET cycle, Reproductive Endocrinologist (RE) noticed what looked like another fibroid inside my uterus which was the first interior one found.  Since the doctor couldn’t get surgery time quickly we setup surgery to have my OB/Gyn remove it.  During this surgery my doctor saw that my uterus was filled with cotton candy like tissue which the doctor couldn’t identify.  I don’t think much was removed during this surgery. 

RE referred me to another specialist.   He said the cotton candy like substance was dead fibroid tissue and in April 2004 he performed surgery to remove it.  There might have been another live fibroid in with the dead tissue. 

At this point I stopped having periods.  During office exams the doctor diagnosed me with Asherman’s Syndrome, which was scarring over my cervix and preventing me from having periods.  He removed the scarring several times in his office and in July we started a FET cycle since my lining was looking healthy.   

At the start of this cycle the doctor found another live fibroid in my uterus and performed another surgery in October to remove it.  He wasn’t able to remove all the live fibroid.

At this point I had another MRI done which showed quite a bit of dead tissue still in my uterus walls.  During a January 2005 appointment, the doctor said a myomectomy to remove that tissue wouldn’t be successful since the tissue is very spongy and harder to remove than a live fibroid.  He also didn’t want to perform any other type of surgery on me at this point.  His advice was for us to either use a gestational surrogate (GS) or pursue adoption as we had discussed.  If we adopted, he agreed to continue treating me but didn’t know whether my uterus would ever get better. 

This past May I started having a regular discharge.  I hesitate to call it a period because its very light and brown but it does come on a 26/27 day cycle.  At first it was just a day or two but this past month it lasted several days.  It also includes some clots that are dark brown and very sticky – like when I’ve ovulated.  Having intercourse during this time sometimes produces a little bright red spotting right after. 

Currently I’m doing acupuncture and herbal treatments along with massage therapy.  I’ve taken a Mind Body Class during my fertility treatments, and I have changed my job to lower my stress level. 

I try to exercise regularly and maintain a healthy diet (I'm slightly overweight) I am in my early 40's.

Analysis:  As far as losing periods while ovulating, Gaylene Pron in Toronto has reported a number of cases of Asherman's syndrome (intrauterine adhesions) after UFE, which can cause amenorrhea. - Paul Indman, M.D.

Analysis (Patient):  At this point of research - questions to ask the doctor.

1.      Can I expect the remaining dead tissue in my uterus to be reabsorbed or expelled?

2.      Can I do anything to keep new live fibroids from forming?  Would hormone therapy of any kind be helpful at this point?

3.      Is there anything I can do to encourage the ‘periods’ I have to become stronger and more productive?  Any medication that can do this?

4.      Have you even known a woman in my situation to have a successful pregnancy?  If so, how long after UAE?

5.      Can I carry a pregnancy even with the dead tissue in the walls of my uterus as long as my lining looks good and the interior is fibroid free? 

Medical Article:  “Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy”, Paulus et al., Fertility and Sterility 2002, Vol 77,  p. 721, Elsevier. [Entrez PubMed]   A 2002 German study, published in the reproductive journal 'Fertility & Sterility', recounts how adding acupuncture to vitro fertilization treatment substantially increased pregnancy success. 

One group of 80 patients underwent embryo transfer with no acupuncture.  The second group of 80 patients received two (2) 25-minute acupuncture treatments, one prior to having fertilized embryos transfer and one after the transfer. 

RESULTS:  Clinical pregnancies were documented in 34 of 80 patients (42. 5%) in the acupuncture group, whereas pregnancy rate was only 26. 3% (21 out of 80 patients) in the control group. 

 

Case Example:  Robot Assisted Myomectomy for Uterine Fibroids

The largest of my multiple tumors were around 8 cm and boy were they painful!   My OB/GYN removed 3 of them during my C-section in 2003, while leaving the other fibroids behind.  I had UAE done in 2004 and had minimal results with it.  At my last GYN visit my uterus measured around a 14-week pregnancy.  I am researching the following: Robotic Assisted Myomectomy and  Laparoscopic Myomectomy.

Analysis:  Robot assisted myomectomy:  It is a device to simplify laparoscopic surgery.  When the bugs are worked out it promises to allow laparoscopic treatment of some fibroids that otherwise would require an incision.  I played with one last year and it's nice.  It is very slow to gain acceptance because it's extremely expensive to buy and use, and GREATLY extends OR time.  I gather a few hospitals that bought one are no longer using it because it takes so long.

I think this, or a laparoscopic approach may be good for one or a few fibroids relatively near the surface.  But if there are multiple or deep fibroids I still would like to have the uterus in my hands in order to feel and manipulate the deep and the small fibroids.  No point in taking out the tip of the iceberg and leaving the rest.  Recovery from an abdominal myomectomy is somewhat longer than through a scope, but not as much as you'd think.  More importantly is the question of how to do the best procedure on the uterus.  If it can be done with a scope or robot (which is a scope) great, but it's not worth compromising the procedure to use it.

Laparoscopic myomectomy is a procedure where a doctor inserts a small device, laparoscope, through an incision in the abdomen to remove the uterine fibroids.  – Paul Indman, M.D.

Refer to Dr. Indman's web site URL: http://www.myomectomy.net/laparoscopic_myomectomy.htm.
 

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Legal Note:
  The material presented on Hope For Fibroids Inc. web site is for informational purposes only.  It is not meant to be a substitute for physician care. 
If you need medical advice on uterine fibroid disease or other medical conditions you should discuss them with a physician.

Last modified:  Monday January 01, 2007
Copyright  2005-2007  Hope For Fibroids Inc.
 (web site designed & developed by Hope)  

 


Paul Indman, M.D. is a Gynecologist in Los Gatos, CA.
Paul Indman, M.D.

William Parker, M.D. is a Gynecologist in Santa Monica, CA.
William Parker, M.D.


CASE
EXAMPLES (#2)  

UTI

DCIS, Fibroid, Uterus, Ovaries
Fibroids & Pregnancy (patient)

A
cupuncture
Robot Assisted Myomectomy

Case: #1

Case: #3 | 3b Fertility
Case: #4 Menopause
Case: #5

Case Listing

Fibroids and Ovarian Cyst Photos
 
Medical Terms
Notes On Insurance