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07 Feb 2004

Leiomyoma - Fibroid Degeneration
Dear Doctor C,
I am 48 years old and have 2 children , age 21 and 18. January 2003, detected fibroid , measuring 5cm. This February 2004, experienced a bit of swelling on lower part of abdomen, and found out fibroid has grown to 6cm. Doctor has advised me to remove my fibroid together with the whole womb through laser treatment. Should I try other options, like taking drugs? Right now I feel fine, and at a loss as to what to do, because nowadays we read so much of doctors who want to make money, more so because I am covered by insurance. I don't want to lose my womb , and would like to experience natural menopause. Will my fibroid turn malignant? Will worse symptoms occur if I leave it alone and wait for menopause, because after that it may shrink itself? Thank you very much and please advise.

Yours sincerely,
Jwen
Answer 498 views
Expert
GynaeDoc
gynaedoc

01 Jan 0001

If the fibroid is degenerating, it is likely to cause more symptoms later. 6 cm is quite large. A very small percentage of fibroids do become malignant, but this is not a major concern. Symptoms and pressure on adjacent structures are more likely. Having the uterus removed will not change your experience of menopause unless your ovaries were removed as well. Medication wll not really help. If you do not have the surgery, it would be a question of weighing up the risks of symptoms getting worse and the small chance of malignancy.

Ntha, You are correct that hysterectomy is not the only option. The treatment has to be individualised. For, example, if the fibroids are very large and obstructing the bowel or kidneys, then hysterectomy is the best way to treat them. If they are smaller and causing bleeding preoblems, the options are 1. to live with the symptoms 2. to try medications such as cyclokapron to lessen the bleeding. This sometimes works, but not always, 3. To try and resect the fibroids together with the uterine lining - this would depend on the number of fibroids and where in the uterus they are. I have already answered your question about uterine artery embolisation. This is a very new procedure and carries its own risks, especially when few people have experience with it in this country.

Best wishes
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