uterine fibroid- i am confused

hi i m a 52 year female , 2 months back i started getting heavy periods , when i consulted my gynecologist , she ordered for a ultrasound ,report of which reads
.uterus is enlarged and bulky with lobulated outline ,it measures 9.4*5.0 cms in size .
a large hypoechoic fibroid is seen along fundus of uterus , easuring 6.2*4.7 cmsin size.
another large fibroid is also seen in lower uterine segment ,measuring 6.o cms in size .
few other smaller ,hypoechoic myometrial fibroids also noted,abutting endometrial echo,measuring only 1.0- 2.0 cms .
endometrial echo appears to be displaced and measures 8.0 mm in thickness .

my gynecologist says that surgery may not be needed at this age because fibroids shrink , another gynecologist says that get the uterus removed . i m totally confused , please help

[Elaine Brown, MD]

HI!

No wonder you're confused!  Was the first a woman and the second a man?  Just a guess.  If my patient had your findings, I would discuss surgery with her, but basically leave it up to her what to do.  Here are some facts:  The average age of menopause is 51-52 (it IS hereditary, so mom, sister, can predict your age). After menopause periods stop and fibroids shrink.  (You have some pretty good sized fibroids!)

Here are the options for treatment of fibroids:
1) conserative management with follow up ultrasounds
2)medical therapy with Lupron or contraceptives to control bleeding problems
3)MRI guided ultrasonic ablation
4)Uterine artery embolization
5)myomectomy
6)hysterectomy.

If it were ME with the fibroids, I would decide based on how bad the periods were--If they were stopping me from doing the things I wanted to do, I would go for surgery, and would probably choose a hysterectomy and keep my ovaries.  If the periods weren't too bad, I would tough it out till menopause, or try pills.  (You can't take them if you smoke though)

Hope this is helpful--you could ask your doctor which of the options is available in your area and to give you a little more detail on what each entails.

Good luck!
Dr B
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