Symptom-free but fast-growing fibroids?

43 years old, child-free, 7-8 fast-growing intramural fibroids (one has grown an inch in the past year-- what's that in CM?) but mostly normal periods -- other than some small changes attributable to perimenopause as much as the fibroids. Only "symptom" is vague but increasing feeling of presence in my lower abdomen -- discomfort is too strong a word for it (although in certain yoga poses they DO cause minor discomfort).

When my previous gyno started to use the "h" word two years ago I switched to a reproductive endocrinologist who performs many myomectomies but does not herself do hysterectomies -- feeling that she would have no vested interested in performing one on me.

But she has just recommended that I have a hysterectomy, citing number and rate of growth, saying I am not a candidate for myomectomy because I have too many, and I have too many good years of estrogen to make myomectomy more than a short-term solution (i.e., I will grow a new crop in due course).

She does not like UAE, particularly in my case because I have so many tumors. My reading has also made me skeptical of UAE.

I have several friends who've said hysterectomy was "the best thing I've ever done," but they had a lot of bleeding and anemia beforehand.

I'm not inclined to change my diet and lifestyle and become one of those people who turn their their obsession with dietary restrictions into a subsitute for religious proscriptions, in the hopes that it MAY make my fibroids shrink. (I tried chaste berry/vitex for a half a year, but while some say that shrinks fibroids, some say it makes them grow. WHO KNOWS?)

But still... I don't really have symptoms that affect my lifestyle.... YET...

I'm looking for signposts out of this gray area...

Hi, Liz,

I can relate to at least some of your situation. I have a couple of fibroids that aren't causing any discomfort (except for probably increased gas pains during my more swollen times of the month), just bleeding. So I was motivated to avoid hysterectomy. I went down the dietary change road for 4 months and saw only an increase in my bleeding, so I gave most of that up (I actually think it was a good overall diet, but I just DO like to eat meats, dairy, and chocolate once in a while). Luckily for me there seems to be an option that at least might work for the bleeding (endometrial ablation) but it wouldn't help you.

What I wanted to pass along was what the IR (interventional radiologist) at my Kaiser facility told me about UAE: namely, that OB/Gyns seem to be generally opposed to UAEs since they have always been exclusively the treaters of fibroids, and this is a method that does not involve them. That said, he acknowledged that there have been problems with UAEs but his view is that nearly all of those have been when small particles are used, as opposed to large particles (which he uses) - that the small particles more easily move to where you don't necessarily want them, thus causing unwanted effects. I don't know anything about whether this is true or not, but he did impress me as a very straightforward guy who wasn't trying to talk me into anything. My concerns about the procedure were some reports I've heard of women who've had a loss of sexual sensation following a UAE. He felt that there are many other factors among the population of women having UAEs that could also cause that (like we're generally nearing menopause, that we are stressed in a way that could dampen things a bit, etc.) which makes sense but it did not reassure me entirely, and I am still not sure if the ablation does not work that I would want a UAE.

So if you're opposed to the idea of a hyst, you might want to speak to an IR who does UAEs and ask them about their views - and see how you feel about their answers, whether they sound "hollow" or not! Good luck in your decision - it's a tough one, and one I still may have to make down the road. Keep me posted-

Debbie

Thanks, Debbie. Interesting that your bleeding worsened when your diet improved. I'm actually toying with the idea of giving a vegan diet a 6-month trial, but the idea of life without eggs and cheese really disheartens me. Plus my husband was a pesco-vegan for several years, and I've only just rediscovered the joy and ease of throwing chicken breast in the oven instead of chop-chop-chop-chop-chop-chop-chopping vegetables. Vegetarian is definitely more prep.

Re: UAE, my doc gave me the impression that gynos ARE heavily involved in the procedure, required for managing the post-procedural recover, especially if there are complications.

I had 7 or 8 fibroids and have many good years of estrogen ahead of me--more than you have and my surgeon performed myomectomies on me out of respect for my wishes. She's a highly skilled surgeon, so while the surgery was challenging, it was not impossible and I didn't lose that much blood. (I was on Lupron beforehand to shrink the fibroids.) I know that there is a 10% chance of the fibroids recurring, and that's a chance I don't mind taking.

Ten years ago I started out with one tiny fibroid my ob/gyn couldn't even feel. Five years ago, it had grown considerably, and by the end of last year it was 12 cm...plus unbeknownst to me, it had multiplied.

Several years ago, a friend of mine tried diet and herbs to shrink her fibroids and they just kept growing--she ended up with myomectomies, too--she describes the number and amount of fibroids her surgeon removed as a whole fruit basket, ranging from a fibroid the size of a cantalope on down to a grape. She also didn't lose much blood during her surgery.

Another friend of mine swears progesterone cream and castor oil helped her tiny fibroids disappear...at least they didn't show up on the ultrasound the second time around.

Whatever you decide, I hope it goes well for you.

((Liz)),
Good for you for doing your research A Hysterectomy is a major surgery and while there are many positive outcomes there are also negatives, as with any surgery. IMO, it should be left as a last resort when all less invasive procedures have been tried, when this is done as an elective surgery-Quality of life issues. Here are some links on Fibroids and many alternatives to treating them:
Fibroids:
http://www.obgyn.net/displayarticle....broid_symptoms
http://www.drdeljuncojr.com/fibroidtumors.html
http://www.gynalternatives.com/hysterec.htm
http://www.emedicine.com/aaem/topic195.htm
http://health.yahoo.com/health/centers/women/28.html
http://www.uterinefibroids.com
http://www.dyspareunia.org/html/fibroids.htm
http://12.31.13.84/library/healthgui...?HWID=hw183462

Myomectomy for uterine fibroids:
http://12.31.13.84/library/healthgui...ions/topic.asp
?HWID=hw182148
http://www.drdeljuncojr.com/fasvsmyomectomy.html
http://webmd.lycos.com/encyclopedia/article/1838.50403

Birth control pills (oral contraceptives) for uterine fibroids:
http://12.31.13.84/library/healthgui...?HWID=hw181919

"Laparoscopic Procedures":
http://www.obgyn.net/displayarticle....ures#lap_proc4
Lap for Uterine Fibroids:
http://12.31.13.84/library/healthgui...?HWID=hw182663

Hysteroscopy for uterine fibroids:
http://12.31.13.84/library/healthgui...?HWID=hw182639

Making the decision about treatment for uterine fibroids:
http://12.31.13.84/library/healthgui...sp?HWID=tv6687

Fibroid Treatment Options:
http://health.discovery.com/centers/...t_options.html
http://health.discovery.com/centers/...terectomy.html<---Alternatives to Hyst

MRI for Uterine Fibroids:
http://webmd.lycos.com/encyclopedia/article/1838.50544

http://www.gynsecondopinion.com/home.htm
http://www.nezhat.com/hormther_.htm#c10


Hope this is of some help Liz Good Luck & know we are here to support you with whatever you decide! Please keep us posted...((hugs))

Hi Liz,
Have you considered getting an opinion from another gyn or another endocrinologist?

You say you are basically symptom-free, so that seems like a good reason to do nothing since fibroids seldom are cancerous. But you also point out that they are fast growing. Is there reason to be concerned in any way about "why" they are so fast growing? I'd be asking about that ... benign fibroids can grow very quickly so it may be just that. But keep asking questions.

Watching and waiting is a viable option if you aren't having symptoms, unless your doc suspects something more serious than benign fibroids. Best of luck. Keep us posted on how you are doing.

Beth

Thanks for all your responses.

My current doc IS my second opinion. She has no reason to suspect it's anything but fast-growing fibroids, or I think she wouldn't have OK'd me going away and coming back in six months as I told her I was doing.

I think a lot of this decision comes down to how many hoops someone is willing to go through to keep my uterus. Part of me feels like if I allow a hysterectomy to happen, I'm caving in to the Patriarchal Medical Hierarchy (insert smily face, which I don't know how to do yet).

It kinda feels un-feminist of me to say "go ahead, take the ****ed thing" but my personality is such that I'll keep obsessing about it (and feeling them there) until I do something. So hysterectomy might be the right decision for me.

I'll also be speaking with my Trusted Famly Care physician (another smiley face). And maybe a third opinion...

Oh, yeah, I also forgot to mention that the OB-gyn doctor who recommended the diet for me advised at the time against myomectomy, for the reason that they generally create adhesions that can be very troublesome if you have to have a second surgery for a hyst - she'd recommend going straight for the hyst if I needed surgery. She herself has fibroids and has (since my appt with her several months ago) had what I believe she said was a resection of the myomas, which I got the impression was different from myomectomy, but maybe not.

Hi there,

Your gray area is really big. I can see no reason for you to have major surgery. If you have one or more fast growning fibroids make sure your doctor does an endo biopsy to rule out cancer.
I have had fibroids since I was 20 and when I reached 46 they started to grow fast. I was on birth control pills to help control break through bleeding and that added hormone plus being perimenopasal, pushed them to grow. I'm 53 and they aren't growing anymore.
Unless there is cancer present or unless you can't work or enjoy life................stay put. Just my two cents. Another way to look at it. Surgery is about 20 to $25,000.00. Say you have no insurance...do you need surgery?
My best to you,

Hi liz,

this is a tough decision. I suffered with fibroids for years and didn't have symptoms at first, but by the time I decided to have a hyst, I was anemic, had awful periods, stress incontinence, sciatica, acid reflux , etc....It was uncomfortable for me to exercise. In less than 2 years, my symptoms worsened severely.

Yes, fibroids can grow very rapidly. My surgeon explained to me it's like blowing up a balloon--at some point, a little more growth can mean a big increase in volume and more intense symptoms as a result. For years, I had been seeing a local ob/gyn who really didn't help me very much or take my symptoms seriously. She kept advising the "watch and wait" philosophy, and I got to the point where I basically had no other options besides the hyst, because my fibroids were too numerous and my uterus too big. I found another doctor who couldn't believe what I was suffering with, I had the surgery, and feel great. I am 48.

But a few things for you to consider: with the hysterectomy, You need to decide about keeping your ovaries; if you don't keep them, you will be faced with the decision to use hormone replacement therapy. Even if you keep your ovaries, they may not function as well or for very long, so you may face menopausal symptoms earlier than you'd wish! So I would really consider the ramifications of being in "surgical menopause." There are also possible long-term problems and complications following this surgery, so I'd be sure to do some reading about them.

I guess, since you are not bothered by symptoms at this point, I would suggest you not have the surgery, but get other opinions regarding UAE and myomectomy.

I don't feel I got good medical advice early on for my problem, when it might have been more treatable. However, I feel that I made the right decision for me personally, given my awful symptoms. I feel really great now . That's because of how miserable I was beforehand.

it sounds like you are on the right track, in doing research and getting advice, so I hope you figure out a course of action that you are comfortable with!