Difficult decisions between hysterectomy, myomectomy, mrgfus, morcellator

Hello! I am new here. I am 40 years old and I was diagnosed with fibroids in 2013. Three main ones- two at 6 cm, one around 11 cm- plus smaller ones- uterus at 20 wks. I suffered from really heavy bleeding for years until last year, maybe due to help from Chinese medicine-never been anemic. My symptoms now are primarily bulk: back pain, frequent urination, occasional pain/ constant pressure in pelvic area, bowel pressure, fullness after small meals, intense fatigue off-and-on, need for elastic waistband pants, tenderness in abdominal area. I am on birth control now to suppress periods, which cause fatigue, migraines, cramps, large clots. I have seen six doctors. Most suggested hysterectomy. I would prefer not to have a hysterectomy because of concerns that even a partial one can lead to early menopause and changes in sexual functioning. I am interested in MRI focused ultrasound but the price/possibility of regrowth are concerning. Basically, as far as what my insurance covers, the remedy seems worse than just staying with my current symptoms: laparoscopic surgery is great in terms of healing/recovery, but the use of the morcellator could lead to the spread of occult cancer (I've already had occult cancer in thyroid); an open myomectomy means potential serious blood loss, 4-6 weeks away from work, potential complications, adhesions, infections, etc. Oh, and with both procedures regrowth is a significant possibility. I'm just really down today and I've pretty much resigned myself to living with this until menopause. That makes me sad but I would rather not risk something even worse than what I have! Any advice would be much appreciated. I could use some reassurance.

Have you looked into Uterine Artery Embolization / Uterine Fibroid Embolization? If not, ask your doctor for a referral to an interventional radiologist. UAE/UFE is not done by gynecologists. It will shrink your fibroids over time (much like MRGFUS, but UAE/UFE is covered by most insurance). It is fast, easy, and very low risk.

Yes, with any fibroid intervention short of hysterectomy, there is always a risk that new fibroids can grow. Most women never have another regrowth, but some do. It's hard to know whether regrowth would happen to you.... but at that point you could decide whether to do a more invasive treatment. Or who knows... maybe by then there will be even better treatment options out there!

If you need immediate relief from your symptoms, you should consider myomectomy. Even with laparoscopic myomectomies, no one morcellates anymore (check to be sure your doctor is on board with the latest recommendations)... or if they do morcellate, it's in a bag (or the surgeon dices up the fibroid inside the bag, with a scalpel versus morcellator ... either way, the fibroid is fully contained in a bag, so there is less risk that any tissue would be spread in your abdominal cavity). Watch online videos of the procedure... it's actually quite fascinating and you can see them do the work in the bag. It might help allay your fears.

Good luck and be sure to let us all know what you decide and how you're doing.

I've had two vaginal myomectomies and one laparoscopic myomectomy for an abdominal fibroid. I'm having more fibroids treated shortly and will most likely opt for a partial hysterectomy. If I were going to do another myomectomy, I would do it vaginally again and go to the same doctor who did my second surgery - he was a fertility specialist dedicated to doing everything possible to preserve my fertility. One consult for my first myomectomy shrugged and said (of my uterus) just get rid of it if you don't think you're going to have kids - I wouldn't let him anywhere near me surgically. I found the recovery from the vaginal myomectomy was shorter and less painful than from the laparoscopy.