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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:  Anemia and Hereditary

My stomach is the size of a 4 to 6 month fetus, and the fibroid or cluster of fibroids feel like melon size.  The major problem is because I have been anemic all my life, the heavier menses or the fibroids have really affected me.  For example, 6 months ago, my iron count was 5.6 and I was given iron infusions.  I later checked my records, and my iron count had been 5.6 for 3 years; 7.5 for a couple of years and maybe never higher than 9.0 since my 20s, even though I had very light menses up until about 7 years ago. Every doctor I have gone to since I was 21 years old have put me on major iron pills, however, it never seemed to help. My mother and my sister have the same problems.  In the past, a very good internist said that it was hereditary and that I should not worry about it, however, it has gotten much lower over the past 7 years.

Analysis:  You seem to have two separate problems:

  1. Chronic anemia
  2. Uterine Fibroids.

The anemia seems to be hereditary.  Most likely it is Thalissemia.  This may best be evaluated and treated by a hematologist or a “good” internist. 

Since you have no symptoms from the fibroids treatment would not appear to be necessary.  I am very interested to know what the outcome of a hematology evaluation shows.  Such tests as hemoglobin electrophoresis will give the answer.   -  Francis Hutchins, Jr., M.D.


 

Case Example:  Weight and hysterectomy

Is there a situation when a hysterectomy for uterine cancer couldn't be performed because of a weight problem (obese)?

Analysis:  Rarely would obesity preclude the surgery but it always makes it more dangerous.  I am thinking about 250+ pounds.   -  Francis Hutchins, Jr., M.D.

 

Case Example:  Subserous fibroid and Zoladex

I am in my early 30’s and I was diagnosed with subserous uterine fibroid of 28 weeks in size.   I have been told to take 2 doses of Zoladex injection in order to decrease the size and vascularity of the tumor.  I am wondering why did I bleed because I was not suppose to bleed while being on Zoladex?

Analysis:  What you are experiencing is a very well known side effect that occurs depending on the time in the menstrual cycle that the Zoladex (GnRH analogue) is given. You appear to have had an 'estrogen surge'.  This class of drugs is capable of not only suppressing the ovaries but also may stimulate the ovaries.   All this is dependant on the dose and the part of the menstrual cycle in which it is given.  It is unlikely to persist into your next cycle.  -  Francis Hutchins, Jr., M.D.

 

Case Example:  Pedunculated Fibroids and Embolization

I have large pedunculated fibroid tumors, and I also have other types of fibroids in my uterus.   I want to know if the embolization process is effective for large tumors?  I have heard different stories from women about the embolization success rate.

Analysis:  Options could include: 

1.   Remove the pedunculated tumors by laparoscopic surgery. Whether the tumors in the uterus need to be removed will depend on their size and location.

2.   Embolization – even though it has less probability of shrinking the pedunculated tumors it still might do that.  The uterine tumors would also be treated.   If unsatisfactory shrinkage of the pedunculated tumors occurs, surgery still could be done and it might be made easier because the blood supply to the fibroids will be reduced. 

UAE has a success rate of @ 80%+ for symptoms of fibroids.  By and large this does not,  in my experience, vary greatly from radiologist to radiologist.  (Training Standards for Interventional Radiologist who perform UAE.) 

I would caution your rather quick acceptance of anecdotal evidence from limited personal experience such as you quote.  To determine the effectiveness of any treatment you should rely primarily on science based statistics rather than gossip.  You have many questions that reflect a need for in depth knowledge.

If you opt for laparoscopic surgery you will need an experienced laparoscopic surgeon.    -  Francis Hutchins, Jr., M.D.

Pedunculated fibroid photo - caution it is graphic in nature.  Questions to 'Ask The Doctor' Lists
 

 

Case Example:  BRCA2, Fibroid, Menopause

I found out last week I have the BRCA2 breast cancer/ovarian cancer gene.  The Doctor is removing the ovaries.  With the BRCA2 gene I have up to a 50% chance of also getting ovarian cancer.  He said that he could remove the ovaries (and fallopian tubes) laparoscopically, and by removing the ovaries the uterine fibroids would shrink on their own.  I am so grateful I found this Doctor just like you were to find the Fibroid Doctor.  If I was doing something with my regular OB/Gyn I know it would be a full hysterectomy.  The Doctor can look around better to see if I have cancer with the laparoscope than if he opened me up abdominally.  I cannot take hormone replacement because I want to save my other breast.  I am open to suggestions on how to cope with the instant menopause.  I am going to be 51 next month so maybe I am almost through menopause.  Maybe the changes (dryness etc.) won't bother me.  I think one of the options is an anti-depression medicine and I am not crazy about that option. 

Analysis:  Replens vaginal suppositories for vaginal dryness.  Black Cohosh (Remifemin), Dong Quai are useful.  St John's Wart has been used for mood problems.   -  Francis Hutchins, Jr., M.D.

There are two (2) genes, BRCA 1 and BRCA 2, that get mutations and then can lead to a higher rate of breast and ovarian cancer.  Both genes are more common among women of Eastern European Jewish descent (about 2% will have the gene, while only 0.2% of other women have the gene).  These two (2) genes account for about 90% of all known genetic breast and ovarian cancers.  However, only 10% of all women with breast or ovarian cancer have an inheritable cause of the disease. - William Parker, M.D.


 

Case Example:  Hormone Imbalance and Fibroids

Have you heard of any link between uterine fibroids and strange behavior due to hormone levels?  I found out that I have two close relatives (one on each side of my family) that have uterine fibroids.  One of them exhibits illogical, hateful, paranoid behavior that began with the discovery and removal of the fibroids 16 years ago. The behavior continues to this day. 

Analysis:  Fibroids are not caused by hormone imbalances except in those instances where a woman is taking large doses of hormones. I am unaware of any psychiatric abnormalities attributed to fibroids. The relative in this case may represent either: 

1.    A coincidence or

2.   a genetic predisposition in the family that has nothing to do with fibroids. 

In either case, concern would not appear to be justified.  - Francis Hutchins, Jr., M.D.


 

Case Example:  Nabothian Cysts and Photo

I had an ultrasound done and nabothian cysts were diagnosed.  When the Doctor did the internal examination the cervix appears to be clear and the slight bleeding is from the uterus.  Are nabothian cysts serious?

Analysis:  A nabothian cyst is a blocked mucus gland in the cervix (mouth) of the uterus.  It is very similar to pimples you get on the face.  It generally does not cause symptoms and is not serious.  If your problem is abnormal periods, it is not due to a nabothian cyst. Francis Hutchins, Jr., M.D.

Follow this link to a very good discussion with pictures. http://www.nlm.nih.gov/medlineplus/ency/article/001514.htm
 


 

Case Example:  Bartholin Cyst Surgery

The doctor informed me that he thought it was my Nabothian gland. He then proceeded to cut this "lump" in his office.  I was bleeding very heavy after the incision.  He then inserted a catheter to blow the balloon up to get a closer look and it "popped" inside my vagina.  I stood up and could feel the blood just pouring out of me.  I just recently went for a pelvic and transvaginal ultrasound and they found a left ovarian cyst, fibroid within the Uterus, 2 small right ovarian cysts and Nabothian cyst of the cervix.

Analysis: What you were originally treated for in your doctor’s office was, in all likelihood, a “bartholin cyst”. The usual treatment is to incise it and insert a Word Catheter to promote drainage and healing. 

The heavy menses are possibly due to a submucus fibroid which could be evaluated and possibly treated by hysteroscopy. It also sounds like you may have a recurrence of the bartholin cyst, which is common and may require treatment again. - Francis L. Hutchins, Jr., MD

Reference:  The pathomorphology of Bartholin's gland. Analysis of surgical data. Sośnik H, Sośnik K, Hałoń A Pol J Pathol. 2007;58(2):99-103. (pubmed)


 

Case Example:  Fast Growing Fibroids (age 36)

Almost two years ago I was diagnosed with uterine fibroids. We watched them with ultrasounds for a year, but my gynecologist was concerned that they couldn't see everything.  So we followed up with an MRI about 6 months ago (and they did that procedure where they inject the dye). 

We did another MRI recently, and my gyno says both fibroids have grown by about 2 cm each.  The Doctor said they can't rule out cancer, and is referring me to a gynecologist-oncologist.  But the Doctor also said that in order to determine if the fibroids are cancerous, they will have to be removed, and that probably means a hysterectomy.  That seems very extreme...to have my uterus removed at the age of 36, just to determine if the growths are cancerous, when probably they aren't.  I don't have many symptoms from the fibroids.  Some pressure. Occasional pain.  But they do seem to be growing quickly.

Analysis:
1. The rarest thing that happens to fibroids in women prior to the menopause is for them to become cancerous.  In fact, many/most do not believe that fibroids become cancerous. Instead, is likely that a benign fibroid and “cancerous” fibroid are two different tumors.

2. Change in size of fibroids is natural.  They grow over time.  It was falsely thought in the past that “rapid change in size” of a fibroid was a sign that it possibly had become cancerous. 

It is correct that there is no way to tell if a fibroid is cancerous except by taking it out.  However, the overwhelming probability is that any fibroid that has been in a woman prior to menopause that grows is not cancer. If we were to assume that any fibroid that changed in size was malignant, huge numbers of women would either be developing sarcoma or undergoing hysterectomy to a far greater degree than is currently happening. 

Finally, if these are the same fibroids identified by MRI 6 months ago, it is highly unlikely that they represent cancer. 

There is by the way a wealth of information in current gyn literature to support the above.  Your analysis has served you well.  Keep reading. - Francis Hutchins, Jr., M.D. 


 

Case Example:  Ginette

I don’t have any symptoms except for a lot of lower back pain. My periods are just heavy on the first 2 or 3 days.  My Doctor has prescribed Ginette for the next 6 months - to cease my monthly menstrual periods.  I read that there are some pro and cons of this tablet and I am just doubtful.  I was advised that taking this would reduce the growth of the fibroids and cysts.  Is this true?  Would you be able to elaborate on this drug?  I also had a friend that had cysts and her doctors had prescribed her medication / tablets (don’t know the name) that melts the cysts.  Is this an option?

Analysis:  Ginette, also known as Diane 35, is an oral contraceptive.  It is thought that by using this category of drug that ovarian cysts can be suppressed.  I am not personally familiar with this drug since it is not available in the U.S.A.  However there have been some papers in the European literature suggesting that one of the components in Ginette may be useful in shrinking fibroids in women after the menopause. 

In Canada there has been some concern over formation of blood clots in women on this drug but that is a concern with all oral contraceptives. 

It may be more in formative for you to address your questions to the doctor who prescribed this for you. - Francis L. Hutchins, Jr., MD
 


 

Case Example:  Ablation, UAE, Hysterectomy?

I have been given the option of Endometrial Ablation or Hysterectomy.  I have 2 questions. The first being, is there any advantage of having one or the other, a UAE or the Novasure?  I just found out about the UAE through research, it wasn’t mentioned to me. Second question, is it standard for my OBGYN to request the diagnostic hysteroscopy prior to the procedure or does that mean he thinks something else could be wrong?  He said ablation will not work for my situation.

Analysis:  If the primary goal is to treat abnormal bleeding associated with fibroids, endometrial ablation is a good option since it is essentially an office procedure with minimal risk.  It also has the potential for eliminating your period for the future.  

Diagnostic hysteroscopy with endometrial biopsy or equivalent evaluation of the endometrial cavity is a standard way to evaluate the multiple possible causes for your bleeding and to rule out cancer.

It seems to me that you should ask your doctor what he found that makes him pessimistic about ablations for you. 

UAE is also an excellent treatment especially if the size of the uterus and pressure symptoms are a concern. 

In the final analysis, there are multiple factors that should be considered in making this decision including your age, size of the uterus, pressure symptoms, etc.  -  Francis L. Hutchins, Jr., MD
 


 

Case Example:  Observation

For years I have had periods with extreme pain and bleeding.  Recently my abdomen has increased about 2 inches and the pain is constant, not just during menstruation.  Some spotting after intercourse.  These symptoms are the reason for the ultrasound.  My doctor recommends a hysterectomy but I would rather not.

Analysis:  The most obvious observation that I can make is that the fibroid is not the problem in all likelihood. Chronic pain is an atypical symptom with fibroids.  Acute pain lasting days or at most a week or two is more typical of fibroids.  Adenomyosis or endometriosis is typically associate with chronic pain and adenomyosis is associated with excessive bleeding as well.

Bleeding with intercourse is also not typical of fibroids but more likely with associated with an abnormality of the cervix. 

In summation, you do not have a clear diagnosis(es) for your symptoms.  To better evaluate consideration should be given for an MRI, pap smear, laparoscopy and possibly hysteroscopy.  With out definitive diagnosis, the full range of treatment options cannot be entertained leaving the shot gun approach of hysterectomy as the only option.   - Francis L. Hutchins, Jr., MD


 

Case Example:   Natural, Organic

Do you think using treatments like natural drugs or organic drugs can help treat fibroids?  What sort of treatment do you think is safe for someone who doesn't have kids?  Do you think surgery is safe?

Analysis:  There have been many claims some of which appear quite logical regarding "natural/herbal" therapies for fibroids.  None have ever been substantiated.  This is in spite of the fact that intense study is going on at the National Institutes of Health.

In answer to your second question, the best treatment depends on what symptoms the fibroids are causing. Certainly myomectomy, abdominal, laparoscopic or hysteroscopic are surgical procedures performed to preserve or improve fertility.  Hormone therapy can be used to reduce symptoms.  Uterine artery embolization has been shown by some studies to be useful in women who wish future pregnancy but there are others who question this and feel that this has not been satisfactorily studied to make sure it does not interfere with future pregnancy.  This is also true for the very new procedure MRI FOCUSED ULTRASOUND.  -  Francis L. Hutchins, Jr., MD


 

Case Example:   Kidneys

I have a large degenerated fibroid.  The uterus is exerting pressure on the ureters.

Analysis:  Injury to the kidneys by an enlarging fibroid uterus, though often spoken about is actually quite rare. Mild caliectasis is not significant unless it were to progress to hydronephrosis.  Caliectasis is simply dilatation of the collecting system if the kidneys due to pressure on the ureter.  A similar thing happens in pregnancy and does not result in injury.  This finding is often related to position and the fact that the bladder has been maintained full for the ultrasound.  It is quite possible that doing a renal ultrasound or other imaging study of the kidneys with bladder empty will cause this finding to disappear. 

If there are concerns about kidney function, renal function studies may be ordered. 

Assuming that the original findings are confirmed, shrinking the uterus is one way to treat this, i.e., embolization.  I am surprised that the radiologist has recommended hysterectomy.  I have seen this treated successfully by UAE on multiple occasions over the years.  -  Francis L. Hutchins, Jr., MD, FACOG


 

Case Example:  Blood transfusions/Sexual positions

I don't have energy because of my excessive bleeding, which is caused by a 25 cm fibroid.  I would like to have children.  There are many sites that offer info on this subject if you are pregnant and wish to have sex, but are there any positions that are best for a woman with fibroids that make it less painful? 

Analysis:   Hysterectomy is the most radical treatment for fibroids and it is contraindicated when fertility is desired.  Your fibroids have reduced your energy because of the bleeding they cause you.  That constitutes an urgent need to do something.  Blood transfusions are not desirable and they have significant risks. 

Myomectomy is the standard approach to this kind of problem.  UAE is less standard only because of your desire for future fertility.  Drugs that are currently available are not appropriate by themselves because they would have to be given very likely for years and they are not recommended for chronic administration because of their side effects. 

Your fibroid is not as startling or unusual as you may think. There is a picture of a very large fibroid uterus that I operated on some years ago on the Hope For Fibroids website. 

With such large tumors you may find rear entry or woman on top positions more comfortable because you can control the depth of penetration more easily.  -  Francis L. Hutchins, Jr., MD


 

Case Example:  Subtotal Hysterectomy and bleeding

My doctors think that I have a Fibroid that bleeds easily to the touch in my cervix and it has my cervix dilated 2 1/2 centimeters.  My doctor did a biopsy, which stated that it was not a fibroid.  The biopsy test stated that this small golf ball or marble size flesh was my cervix.  My doctor sent me to a cancer specialist for a second opinion, whom stated it was fibroid.  He could see it very well from observation during my pap smear.  They suggest moving this 2 1\2 piece of flesh in diameter by surgery.  I'm unsure if I want to do this, because I'm not sure that they are sure.  I had surgery a year ago to remove my uterus and one ovary, in which another doctor performed this surgery.  I still have my cervix and one ovary left. I menstruate monthly the same time each month since this partial hysterectomy, but my bleeding has slowed down very much.  I only bleed seven days lightly now.  Yet, I still have the problem of the brown yucky stuff that comes with the menstruation every month also.  What is this brown yucky stuff mixed with the blood?  I had the partial hysterectomy to stop the bleeding and the brown yucky stuff, which lasted about 3 weeks every month.  Since the partial hysterectomy, I only bleed the blood and brown yucky stuff one week out of the month.  I was supposed to of had fibroids inside my uterus, because the doctor could never detect them or saw them, so this was also the reason she thought I bleed so much of the blood and brown stuff before my hysterectomy, so this was the reason we decided to do the partial (removal of my uterus and one ovary).  What is going on, and what should I do about what ever this piece of flesh is in my uterus?

Analysis: I understand your problem.  If there is no suspicion of cancer then of course you don’t have to do anything.  The procedure for removing it should be fairly simple and it may be possible for them to cauterize the remainder of the lower uterine cavity, which is what is causing you cyclic bleeding, etc.  This is not an unusual problem after subtotal hysterectomy.  -  Francis L. Hutchins, Jr., MD


 

Case Example: Polyps coming back and pregnancy

I was recently diagnosed with a polyp in my uterus after bleeding for over 3 months.  I just had a D & C and had the polyp removed.  My gynecologist is recommending we have children as soon as possible now. My mother was diagnosed when she was young with the same problems I have recently been having and hers have continued to grow back every year. 

Analysis:  From what you describe I can see no reason to encourage you to have children other than when you want to.  I am unaware of polyps frequently growing back once removed.  -  Francis L. Hutchins, Jr., MD

 


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

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


CASE
EXAMPLES (#5) 

Anemia and Hereditary Thalassemia

Weight and Hysterectomy
Subserous fibroid and Zoladex

Pedunculated Fibroids

BRCA2, Fibroid, Menopause
Hormone Imbalance and Fibroids
Nabothian Cysts
Bartholin Cyst
Fast Growing Fibroids (age 36)
Ginette medication
Ablation
Observation
Natural, Organic
Kidneys
Blood transfusions/sex
Subtotal Hysterectomy and bleeding
Polyps and pregnancy


Case: #1
Case: #2
Case: #3 | 3b
Fertility
Case: #4 Menopause

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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