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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:  Fibroids, UAE, and Menopause

I'm in my late 50's and my last menstrual period was 6 years ago. Due to heavy bleeding secondary to large fibroids I had a UAE in 1998. However, due to the size of the fibroids I believe the procedure was not successful but did allow me relief from the excessive bleeding. Currently I'm having pelvic pain that feels like menstrual cramping. I had a pelvic exam today and the doctor is ordering a ct scan which has to be authorized by my insurance. The concern is that the fibroids area feels hard.  Would this be due to calcification?  The other concern is that they may be malignant but I won't know until the cat scan is performed.

Analysis: 

1 - You should discuss this with the IR who treated you.

2 - Calcification of fibroids is an expected and positive outcome of UAE.

3 - It sounds as if you had very large fibroids and unrealistic expectations of how much volume reduction you expected.

4 - UAE is not the final answer for everyone. There are some people who do go on for other treatment, including hysterectomy. If you go on for hysterectomy now, after natural menopause, it seems that the UAE allowed you to defer surgery for 10 years, which is hardly a failure. - Robert Worthington-Kirsch, MD



Case Example:  Fibroids growing after menopause  

I have a large (grapefruit or larger) size fibroid imbedded to the right side of my uterus.   I am searching for both information on the origin and development of fibroids in women who are over 50 and post-menopausal and the recommended treatments available. 

Analysis:  It is NOT normal for fibroids to develop or grow after menopause.  It should be determined if this is new or something that you had before menopause, but were not aware of.  

It is EXTREMELY important that you have a doctor consultation and/or second opinion to evaluate this situation in detail.  -  Francis Hutchins, M.D.


 

Case Example:  Menopause after UAE 

I was using vitamin E to help with my sore breasts during ovulation (I am starting to experience menopause symptoms after my UAE, age 48), but recently I saw a controversial article on Vitamin E and heart disease.  What other herb/vitamin can I use to relieve sore breasts/PMS symptoms? 

Analysis:   Evening Primrose oil.  Remember, however that pain relievers such as Tylenol may also be useful. - Francis Hutchins, M.D.

 

Case Example:  Fibroid, Ovarian Cyst, Menopause at 65 Years Old

I have a large fibroid and also a large mass on the ovaries.  One doctor recommends a hysterectomy, and another doctor recommends a myomectomy.  I am 65 years old and wonder if the embolization technique would work on both problems?

Analysis:   At age 65, I assume your have entered menopause. Fibroids normally do not grow after the menopause and they tend to reduce in size.   Embolization would not be expected to have any effect on a fibroid after menopause.  Why has treatment of the fibroid been recommended? 

The mass on you ovary is much more concerning because you are in the age group where cancer of the ovaries tends to occur.  No one can assure you that a large ovarian mass at your age is non cancerous.

Having said all that, my last comment is to urge you to have something done sooner rather than later.  You will only know what this ovarian mass is when it can be surgically examined.  - Francis Hutchins, M.D. 

 

Case Example:  62 Years Old - Menopausal Bleeding

I am almost 62.  I started bleeding again last month. Had an ultrasound -"multiple fibroids" - the largest one is about 1" x 1".  The doctor has educated me about them, & says her preference is a hysterectomy.  I still use estrogen patch & prometrium.  She says continued use isn't good for me.  I had one ovary removed almost 20 yrs ago because it was mangled by a uterine fibroid.  I have never been pregnant.  Doctor says I don't need my uterus anymore.  I could just continue to take small amounts of estrogen after removal.  I am worried about having my uterus out -- it seems like overkill & too invasive.

Analysis:  You have what is referred to as 'postmenopausal bleeding'.  This is likely secondary to the hormones you are taking but should be evaluated by a biopsy of the endometrial lining of your uterus (an office procedure). 

The fibroids are probably inactive at this point.  I tell patients with fibroids that they are in a race to menopause.  If they get there before symptoms require treatment of their tumors they have won because the fibroids stop growing and shrink. 

I have never understood what "need" in this context is supposed to mean.  But it is insensitive and ludicrous to recommend major surgery with all its risk based not on symptoms but rather lack of "need" for an organ. 

It is probable that adjusting or stopping your hormones will resolve the bleeding.  Nevertheless an endometrial biopsy is recommendable.  Isn't that a lot simpler and safer than a hysterectomy?  – Francis Hutchins, M.D.


 

Case Example:  Subserosal Fibroid at Age 45

I have a subserosal fibroid.  I have no pain, pressure, or abnormal bleeding.  I am 45 years old.  What kind of fibroid treatments or diet should I look at for this situation?   

Analysis:  " I have no pain, pressure, or abnormal bleeding."  This means you have no symptoms and apparently no indication to be treated.  You are approaching what I consider the "finish line" for fibroids, i.e., menopause.  Fibroids stop growing after menopause and tend to shrink. 

I know of no diet that has been proven to effect fibroids one way or another. Francis Hutchins, M.D.

 

Case Example:  Myomectomy and Menopause

I know that UAE can send 5% of women straight into menopause, and I wonder if this can also happen with a myomectomy.   I am in my early 30's, and I should probably be happy with the reduced bleeding, but I am worried that it may be a symptom of something else (menopause, scarring in the uterus, sterility)?

Analysis:  As long as the period is occurring regularly you are not in menopause and the endometrial lining of the uterus is present and responding.  Nevertheless you should let your gyn know about this in case he knows of any difficulty during the surgery which may cause him concern about the endometrium.  There are women who normally have such light periods through out their reproductive lives and have no fertility problems.  Francis Hutchins, M.D.


 

Case Example:  Depo provera

Hi, I have just been to the doctor for anemia, and they told me I have a large fibroid the size of an 18 week pregnancy.  They want to start me on Depo provera for 6 to 9 months.  Maybe then hysterectomy.  I am 51 and have not had any menopause symptoms.  Does the Depo provera work in shrinking the fibroid enough to do the new laparoscope hysterectomy?  Thanks for any info. 

Analysis:  If laparoscopic hysterectomy is desired, Lupron or a similar drug would be the preferred drug.  Depo provera has little potential for shrinking fibroids. - Francis L. Hutchins, Jr., MD


 

Case Example: Abdominal Myomectomy Incision

I underwent an abdominal myomectomy. The doctor removed a 6 centimeter fibroid from my uterus, and she said it was apx. 3 times the size of my uterus. As far as I can tell I seem to be recovering fine (I experienced some "twinges" of pain on occasion).  However,  there is a "pouch" of skin (for lack of a better description) that is above the horizontal 4 inch incision and yet below where my stomach is. Further, prior to the surgery, this area was completely flat. From a side angle/profile, this "pouch" extends approximately 1 inch. It is very tough to the touch.

Analysis:  What you describe commonly occurs after “bikini” type transverse incisions. It does not represent type of scarring that you likely have been cautioned against. That type is internal. The one you have is of cosmetic concern only and will tend to improve with time.  - Francis L. Hutchins, Jr., MD

 


Francis L. Hutchins, Jr. is a Gynecologist - Plymouth Meeting, PA (Philadelphia).
 Francis Hutchins, Jr.,  M.D.

Robert Worthington-Kirsch, MD - Interventional Radiologist in Philadelphia, PA.
Robert Worthington-Kirsch, M.D.
 


CASE
EXAMPLES (#4) 
Menopause 

Fibroid, UAE, Menopause

Fibroid Growth After Menopause

Menopause After UAE
Fibroid, Ovarian Cyst, Menopause at 65 Years Old

Menopausal Bleeding 62 Years Old


Subserosal Fibroid at Age 45
Myomectomy and Menopause
Depo provera
Abdominal Myomectomy Incision


Case: #1
Case: #2
Case: #3 | 3b Fertility
Case: #5

Case Listing

Pedunculated Fibroid Photo


Medical Terms
Notes On Insurance

 

 

 

 

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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.
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