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.

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
 

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)

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
 

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

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

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

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? 

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