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“WHAT IS
THE ANSWER TO MY UTERINE FIBROID QUESTION?” A
PATIENT ASKS HER INTERVENTIONAL RADIOLOGIST AND GYNECOLOGIST "As far as I am
concerned there is no reason to avoid HRT in women who have had UAE
(although there may be such a reason in women with untreated fibroids).
In women who have had UAE the residual 'fibroids' aren't myomas, but scar
- and should not be responsive to HRT. HRT after UAE has not,
to my knowledge, been formally studied."
"Fibroids after the menopause are not generally found to be sensitive to HRT because of the very low dose of estrogen complained in the medication. In a woman who has just entered the menopause the fibroids may be sensitive to HRT for the first few months of menopause. UAE on the other hand kills the fibroids and dead (degenerated) fibroids are not sensitive to HRT. Bottom line - women who have undergone UAE can take HRT without concern that those fibroids treated by UAE will grow. The following article is a reference for your edification although if you wish to use it you certainly can. Women with fibroids have been treated with HRT for many years now." - Francis Hutchins, Jr., M.D. The three-year HRT study for postmenopausal women.
A three-year clinical study was performed to examine the effect of hormone replacement therapy (HRT) on uterine fibroid growth among postmenopausal women. For the study, the women did not have previous treatment of their fibroids.
Thirty-seven postmenopausal women with solitary fibroids were involved in this study. All of the women received conjugated equine estrogen (CEE) and medroxyprogesterone (MPA) daily.
Another thirty-five postmenopausal women were involved in the study, but they did not take HRT.
The final outcome from this study
was HRT does increase uterine fibroid volume in the first two years of
use. The fibroid volume decreased at the third year in both HRT
users and non-users.
It is very unusual for fibroids to grow after menopause. Whenever they do it is mandatory to rule out "neoplasm" (malignancy). This should be thoroughly evaluated by a gynecologist. – Francis Hutchins, Jr., M.D.
Many fibroids undergo spontaneous degeneration over time. If this is extensive then when menopause occurs they will no longer shrink because they are mostly scar tissue not fibroid tissue any longer. - Francis Hutchins, Jr., M.D. There have been isolated reports, but no prospective series
supporting the routine use of the UAE procedure in the menopause for 'bulk
symptoms' and therefore it might be tried.
The cause of this needs to be determined. If you are menopausal then you need to be sure there is no cancer. You should see a competent gynecologist right away! - Paul D. Indman, M.D.
UAE is a specific treatment for fibroid disease. In the absence of fibroids, it probably would not work to control abnormal bleeding.UAE (embolization)
can help after childbirth if a torn vessel is bleeding.
Dysfunctional uterine bleeding is a diffuse process that is usually
hormonally mediated.
Can UAE or Myomectomy cause premature menopause? Menopause can occur at any age after 35. There is evidence that women 45 and older may never have a period after UAE (15-20% of the time), and about half of these develop menopausal symptoms. - Dr. Worthington-Kirsch Myomectomy does not cause premature menopause, as it doesn't interfere with the blood supply of the ovary. - Paul D. Indman, M.D. The amount of shrinkage varies from woman to woman. It is not necessary to do anything unless you have symptoms that you desire remedy. Your options are limited. It is likely that most or all of the shrinkage that you will experience has occurred. This eliminates everything but surgery. – Francis Hutchins, Jr., M.D. "Patients with very high performance levels tend to de-condition fairly rapidly. Their recovery to 'regular' activity levels (i.e. - the same level as we couch potatoes) is often a bit faster than usual. However their recovery to what they perceive as 'normal' for them (high performance) takes a while - typically 5-6 weeks after UAE.
Recovery
after abdominal surgery is typically harder and longer. Women who are very
high performance athletes have often found that the disruption of the
abdominal wall muscles needed for an abdominal incision are enough for
them to lose their competitive edge."
“Recovery from
hysteroscopic surgery, which does not require an incision, is usually just
a few days, although strenuous activity may be limited for several weeks.
Yes, this has happened to several patients.
Since you get overall decrease in uterine size, the wall between the
endometrium and the the fibroid thins. The fibroid doesn't 'migrate'.
The problem with infection is that when the fibroid starts to slough
the cervix opens and the tissue is exposed to the outside world.
An
elevated white count can come from dead tissues as well as an infection,
but that determination can only be made by a doctor after a careful
evaluation. It is important to have a doctor determine if it
is an inflammation or infection so it can be treated properly. - Paul
Indman, M.D.
Sometimes the uterine lining cells extend way down toward the cervix and remain after the top of the cervix is removed with supra-cervical hysterectomy. These cells continue to respond to the ovarian hormones and can bleed monthly. This occurs in about 5% of women who have this procedure. Often, this can be treated in the office by applying silver nitrate to the cervical cells. But, this is not a worrisome problem and you can chose to do nothing about it as well. – William Parker, M.D.
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