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    The Reason for the spotting post menopause
    MsSueBowie posted:
    I seen my GYNE yesterday. My Pap Smear was normal and the transvaginal ultra sound was ugly. The fibroids are causing the bleeding. There is one the size of an orange. The choices are hysterectomy or UFE. I prefer the UFE, but my mother and sister suggested having hysterectomy. The both of them had the procedure in the past. I am relieved it was not anything too serious.
    Anon_6061 responded:
    Did your doctor not mention procedures to remove JUST the fibroids sort of like doing a lumpectomy for the breasts? Small fibroids can be removed via hysteroscopy and larger ones via myomectomy. But not all doctors have these skills and insurance reimbursement rates may favor hysterectomy or UFE (also known as UAE).

    And if it's just the fibroids and the spotting isn't that bothersome, it seems you could forego doing anything. As time goes on, it's possible the fibroids will shrink or the spotting will stop. And if not, you can always pursue treatment then.

    At any rate, be sure to do your homework on any procedure you're considering. I've found that many women (including myself) weren't given all the potential risks of various treatment options. And with procedures (unlike with meds) there's no turning back. What's done is done. Hope it all goes well whatever you decide!
    Mary Jane Minkin, MD replied to Anon_6061's response:
    Good points: but I'll differ on one. If fibroids can be resected through the cervix, that's terrific-it is a reasonably minor procedure, and often will help bleeding. In general, though, if you need an abdominal procedure to take out fibroids, in general, I recommend a hysterectomy and not a myomectomy (as long as one is done having kids-if child bearing is in the future, then of course one needs to keep the uterus in place.) I just suggest this for a few reasons: I have lost far more blood taking out fibroids than taking out uteri; and if you leave a uterus in place, you need to remember, once a fibroid former, always a potential fibroid former-so you may end up with more fibroids. And let me tell everyone, as a surgeon, the scar tissue that a myomectomy (fibroid removal) leaves can be amazing: some of my toughest hysterectomies have been on women who had previous myomectomies, they formed new fibroids, and I needed to go back and take out the uterus: and the pelves were disasters full of scar tissue. So I usually say that if I have to go in abdominally, and a fibroid needs to be removed in a woman who has no plans for any future childbearing, at least consider taking out the uterus for these reasons.
    Of course, if one is clearly perimenopausal, and the bleeding is not overwhelming, if you can wait things out and go through menopause, that's great-the fibroid almost always shrinks with menopause. Just today I reviewed an ultrasound of one of my patients who premenopausally had a 6 cm fibroid; she is now one year after her last menstrual period, and the fibroid is less than 2 cm-so she cured herself!

    Good luck,
    Mary Jane

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