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Fibroids
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marfelix posted:
I just turned 48 and two years ago (2011) I had an ablation procedure done due to irregular and heavy bleeding. In 2010 I started to have hot flashes, then followed by all of the other symptoms of perimenopause.

October 2012, I had lab work done to check my hormone levels and I was told I was in menopause and I went ahead and had the hormone replacement (pellets) done. Since I still had my uterus I have to take progesterone. I feel great and back to normal, but about two and half weeks ago I started spotting, nothing heavy, but I have been experiencing some cramping and mild stomach discomforts.

I called my OB/GYN and they were to get me in right away. I had an ultrasound done and I was told that I had fibroids and a lot of them and with the hormone treatments it has caused the fibroids to bleed?

I was told that I needed a hysterectomy!?! How do I know if this is really necessary? they also took some tissue to do a biopsy but this just came a surprise! I was also told that I had to double my dosage of the progesterone and this would cause me to have my period again and it would be heavy!

I do not know what i am facing here and I am concerned because I do not know what to do?
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georgiagail responded:
Attached is a good article on uterine fibroids, including various treatment methods, including those that do not include a hysterectomy:

http://www.mayoclinic.com/health/uterine-fibroids/DS00078

You can, of course, do absolutely nothing and take what is known as a "watchful waiting" course with these. If they are not bothering you significantly and you can live with their current symptoms, there is certainly no rush to do anything.

In the meantime, this will give you some time to research the subject and perhaps feel more comfortable coming up with a decision should these symptoms worsen. Keep in mind though that because you were told you have "a lot" of them (as opposed to, say, just one), you may eventually find that if several increase in size, your discomfort and perhaps bleeding will also increase IF they should expand into blood vessels in the uterus.

Gail
 
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Anon_6061 responded:
It can be hard to get the right amount of progesterone to offset the estrogen to keep from bleeding, fibroids or not. And if you're getting estrogen pellets (or too much of the testosterone pellets are converting to estrogen), then estrogen levels can get fairly high which will tend to stimulate fibroids. Some women just tend to spot with progesterone. If that's the case, it may be easier to cycle the progesterone and have a "scheduled" bleed. Another option is to try a progestin.

If you have a surgeon with the right skills, the fibroids can be removed (via hysteroscopic resection or myomectomy) leaving your uterus and its anatomical and sexual functions intact. It's possible too that the fibroids aren't even the cause of the bleeding. Ablation oftentimes stops periods but then they can start up again. So you may not even be in menopause. A one-time FSH test isn't considered completely reliable to diagnose menopause because the FSH can be elevated during perimenopause when hormones fluctuate wildly. (You didn't mention how you were diagnosed menopausal.)

Another option that may work better to protect your uterus without bleeding is a progestin. These can be prescribed separately or you could switch to an estrogen/progestin pill or patch such as Combipatch or ClimaraPro.

Hysterectomy is the most overused surgery after c-section. According to this study
http://www.ncbi.nlm.nih.gov/pubmed/10674580 , 76% don't even meet ACOG criteria. Only about 2% are done for cancer.
 
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skinchic123 responded:
Fibroids are a pain but usually not cancerous. I had severe fibroids (over 20 golf ball size) so my abdomen was distended (I looked 4 months pregnant), had extremely painful periods with heavy bleeding and often they would shift and put pressure on my urethra so it was like a kink in a hose - full bladder but couldn't pee.

The doctor advised a hysterectomy. At that point I was ready for anything that would resolve my issues. They removed my uterus and part of my cervix but left both ovaries. The surgery was done using the Divinci Robot and took about 4 1/2 hours. I was under general anesthesia. The scars were minimal and now, almost 4 years later, are barely visible.

There was some pain following surgery (I don't take pain meds due to an extreme nausea reaction so just took Tylenol & Advil) and I felt most comfortable sleeping propped up on pillows on my back. Full recovery depends upon the person, but for me it took about a month before I felt really good. In 6 weeks I was cleared to go back to the gym and yoga and have sex.

I feel like the hysterectomy was the best decision and have enjoyed a pain-free, period free 4 years. I use a topical progesterone cream to keep hormones in balance and feel great!

I know a lot of people are against hysterectomies but I'm not sure why. Myself, sister and several friends who've had them say it was a good decision and have no regrets. No periods, no pregnancy, it's all good!

I hope this helps in your decision making process.


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