In considering treatment for uterine fibroids, I always like to emphasize to my patients that they need to strongly ask themselves, "Why do I need any treatment at all?"  Since the majority of fibroids will pose no threat to your life or well being, the most common and therefore useful approach is what we refer to as observation.  Observation in medicine means “do nothing”.   Simply monitor the process by examinations periodically, once or twice a year, and as long as it doesn't bother you, you don't bother it. 

A second recommendation that I make is what I have come to call “Hutchins' First Law”.  Which goes something like this:  Whenever you are considering surgery always make sure you have a good answer to the question: "How am I going to be better off?" 

This sounds like a very simple concept but you would be amazed at the number of women that I have seen in consultation who do not have an answer to this question.  Many of them have no symptoms whatsoever and the only reason that they are considering treatment is because it has been recommended to them, but they have no clear vision of how they will be better off after they are treated. This is particularly distressing to me when the treatment being considered is major surgery, and most often hysterectomy.  Why would anybody want to undergo a major surgical procedure associated with risks of serious complications, including death, simply to have an organ removed which has a disease that is causing no problems and likely will not cause any problems in the future? 

It is particularly important when considering treatment options, to understand that gynecologists are surgeons and they get paid more for operating on people than anything else that they do.  Now in spite of the fact that they try to be as ethical and honest as possible in making recommendations, nevertheless, this financial incentive has the ability for some, to compromise their thinking.  It is also important to remember that hysterectomy has traditionally been the "big ticket item."  Put another way, hysterectomy is the procedure for which the gynecological surgeon has had the most extensive training and for which he or she gets paid the most.  In thinking about this I am often reminded of the saying, “If the only tool that you have is a hammer, most problems start to look like a nail.” 

Similarly, surgery to the surgeon can begin to look like the solution for all problems.  All of this may be the reason why the hysterectomy rate in the United States is the highest in the world. 

For these reasons, I infrequently perform hysterectomies, looking to the procedure as a last resort for treatment of fibroids. 

There are surgical treatment options as well as drug-based treatment options.  In order to make informed decisions about your reproductive health, it behooves you to familiarize yourself with all of them. – Francis L. Hutchins, Jr., M.D.