Fibroids: you never need a hysterectomy for fibroids

The most common reason hysterectomy is performed is for fibroids. Most fibroids don't cause any symptoms and rarely cause a true medical problem. But if you had symptoms that were more than annoying, if they really impacted your ability to function, there would be no reason to undergo a hysterectomy. If you are told that a hysterectomy is your only choice to treat symptomatic fibroids, find another doctor who has the skill to perform a myomectomy, and who will respect your decision to choose the treatment that you think will be best for you. It's your body, you always have the right to refuse treatment.

Here is basic fibroid information that can help you decide if what you have is a true medical problem or if it's really a nuisance.

Fibroids are benign growths of muscle and connective tissue that grow until you reach menopause. Then they slowly and gradually shrink to a negligible size, at which time they will become small and calcified. Less than 1% of fibroids are cancer, a leiomyosarcoma.

The average size of the uterus including fibroids in the late thirties to early forties is a ten to twelve week pregnancy size (about 13cm in the largest dimension), in the middle forties fourteen to sixteen weeks is average (about 17cm in the largest dimension), and in the late forties to early fifties eighteen to twenty weeks is average (about 21cm in the largest dimension).
Fibroids have two rapid growth spurts that are natural, predictable, and not a cause for alarm. The first rapid growth spurt is in the late thirties to early forties. Then you have a few years of slower growth. Right before you go through menopause, when you have the hormone changes associated with the beginning of menopause, you have the second and last rapid growth spurt. Then the fibroids slowly and gradually shrink to a negligible size.

You develop all of the new fibroids you are going to have in your 30's you do not develop new fibroids in your 40's. Both estrogens and progesterone stimulate fibroid growth. Many women use the so called "natural" progesterone yam cream that promoters claim shrinks fibroids, but in fact it makes them grow.

Fibroids are not a disease, they are your genetic blueprint. If you can live with the symptoms it would probably be better than unnecessary intervention of any kind. If you cannot live with the symptoms a myomectomy, the surgical removal of fibroids leaving the uterus intact, is a reasonable option. Even in the case of leiomyosarcoma, some women choose myomectomy, if the leiomyosarcoma is in the wall of the uterus, and not attached to a ligament.

If a doctor tells you that it can't be done because you have too many fibroids or that your uterus is too large it just means they don't have the skill, and that you need a doctor that does have the skill. Fibroids that cause heavy bleeding with large blood clots are submucosal, they are in the endometrium, the inside layer of the uterus. A submucosal fibroid that is 4cm or cm or smaller can be removed hysteroscopically. A hysteroscope, a long tube, is inserted into the vagina, into the cervix, and into the uterus. A tool is attached to it, and the surgeon chips away at the fibroid until nothing remains but the shell. If the submucosal fibroid is larger than 4cm you would need a myomectomy. A horizontal incision would be made above the pubic bone, and the fibroid would be dissected out of the uterus. Fibroids in other locations do not cause heavy menstrual bleeding or large blood clots.

Although there are many other treatments for fibroids, such as uterine artery embolizaiton (UAE, also called UFE), endometrial ablation, focused ultrasound, myolisis, and Lupron to shrink them, they are all destructive. The only constructive treatment for fibroids is myomectomy, but only if you're in the hands of a skilled gynecologist who has consistently good outcomes. A good outcome from myomectomy means you came out of the operating room with an intact uterus, you were not given a blood transfusion, and you did not have a new medical problem that you did not have before the myomectomy.