Question: I had the embolization about four years ago. An MRI reveals that I experienced significant shrinkage after one year but the fibroid are most definitely not gone. My doctor told me that's about the most I can expect to see. My period stopped after the procedure, and I was expecting to see even more shrinkage; I heard that some fibroids disappear after menopause. Though I have no discomfort, my stomach is still rather bloated and I can feel the remaining fibroids. Acupuncture has helped but it is extremely slow going and pricey. Do you have any suggestions - barring surgery - that may help me realize further shrinkage? 

Dr. Rundback:  On average, fibroids shrink by about 40-50% in volume after UFE, which is similar to what would occur after natural menopause, and is enough to completely or largely eliminate symptoms in about 9 out of 10 cases. Since this patients fibroids diminished in size after the procedure but have now remained stable, it is likely that she will have no further change in her fibroids. However, it would be useful to consider a current MRI with and without gadolinium injection. This will help determine if her current symptoms are still fibroid related, and will show if she has any remaining or new viable fibroids that could benefit from a repeat UFE!  Thanks for the opportunity to help.
JHR

Question:  I am post menopausal for 4 years. I started having breakthrough bleeding weeks ago which lead to an endometrial biopsy, ultra sound and sonohysterography. No cancer was found but several fibroids and polyps. The doctor said to wait 3 months and if I am still bleeding to come back. I am concerned about this.

Dr. Rundback:  Most gynecologic bleeding is minor and not a major health risk. She should follow her blood count to determine if she is developing anemia. Otherwise, waiting until the Ibuprofen is stopped and some time has passed is not unreasonable. If bleeding persists, a hysterectomy is probably the best option in a postmenopausal woman.

Question:  I was diagnosed with a uterine fibroid back in 2006.  A nurse practitioner found it while doing an ultra sound. She said it was very hidden and hard to find but it was quite small- however, I had had symptoms since 2004. What exactly would mimic having a fibroid?

Dr. Rundback:  As you know, the diagnosis of symptomatic fibroids and differentiation from other potential causes of similar symptoms can be difficult on ultasound or physical examination. In these instances I usually recommend a pelvic MRI with and without gadolinium. This is often much more specific and diagnostic so that the best care plan can be developed.

Question:  I am a 19 year old and I was diagnosed with fibroids and I have excessive bleeding and clots.

Dr. Rundback: Would need to review MRI but suggest that this patient may be a good candidate for either hysteroscopic myomectomy or robotic-assisted myomectomy.

Question:  I have a nabothian cyst and I have small fibroids. I would like to know if a total hysterectomy is needed to remove this cyst or keep it away? My age is 44.

Dr. Rundback:  Nabothian and small ovarian cysts are entirely benign and have no malignant potential. No procedure is needed for these or for the small fibroid described by the patient in the absence of fibroid related symptoms.

Send questions to Dr. Rundback:  drinfo@hopeforfibroids.org

Contact Information:

John H. Rundback, MD, FAHA, FSVM, FSIR
Medical Director, Interventional Institute, Holy Name Medical Center, Teaneck, NJ
Managing Partner, Advanced Interventional Radiology Services LLP
Telephone: 212. 838.4243 | Fax: 212. 838.7370
Dr. John Rundback Bio and CV:  http://www.hopeforfibroids.org/md/john_rundback_md.htm