Fibroid and irregular bleeding

[RunningL8]

Hi -- I’m 44 and ½, and I plan to be married at the end of August. My fiancé and I have been planning to try to have a baby and also to pursue adoption. My periods have been very regular for the past several years:  i.e., 10 months of the year I have a 27-day cycle, and I’ll have one 26-day cycle and one 28-day cycle in the course of a given year.  In the past few years, I’ve experienced very heavy bleeding for the first 2 days of each period, then just a little spotting for a few more days; this heavy bleeding was a change from when I was younger.  I’ve also had an increasing problem with bladder urgency, and at times I have a constant sensation of needing to urinate, despite the fact that I’ve just done so.

In early January of this year, I began 5 days of heavy bleeding on day 16 of my cycle.  My ob-gyn ordered an ultrasound of my uterus, and I was told that I have a tangerine-sized fibroid on the back of the uterine wall.  I’ve got the ultrasound report, and it says: uterus L 89 mm; H 59 mm; and W 61 MM; VOL 167.71 cc; “uterus slightly enlarged.”  It also says: endometrium H 9 mm; “endometrium is impinged by fibroid.” And it says “post fibroid”:  L 49 mm; H 39 mm; W 47 mm; VOL 47.03 cc.

My ob-gyn thinks this fibroid explains why my periods have become heavier and also the sensation that my bladder is full (i.e., she said the fibroid is causing my uterus to press on my bladder).  She isn’t sure, however, whether my 5 days of bleeding on day 16 of my regular cycle was the beginning of irregular periods generally or whether it was the fibroid bleeding. She also said that if I want to try to have a baby, I should have the fibroid removed surgically.  I’m considering having the surgery in another state (where my fiancé lives), and I have interviews with two well-respected gynecological surgeons set up next week.  

My question: I’m wondering if you have an opinion on whether this irregular bleeding would be due to the beginning of menopause, or whether the fibroid could have caused so much bleeding.  After the 5 days of mid-cycle bleeding, I started a new 27-day cycle, which perhaps suggests it was a period (?).  Also possibly relevant is that I had a FSH exactly a year ago due to some heat spells (kind of like flushing); my FSH was normal (3.4), and it turned out the heat spells were a side effect of a medication I tried (and they went away after I discontinued it). Should I now have another FSH test? I've never been pregnant, and if I'm now too old to conceive, I might decide to postpone the surgery; are there other tests that would indicate my fertility?

Thank you!

[Machelle Seibel, MD]

A. Age is probably the best indicator of one’s ability to conceive.  At 44 ½ the chances of conceiving are <5% so I would not advise having a major operation that will take a month to schedule, 3 – 6 months to recover from before trying to conceive if getting pregnant is your only goal.  However, if a fibroid is in the muscle of the uterus and comes in contact with the lining, it can be a cause of bleeding, especially if it is 50 mm or more. Yours is just about that big.  Make sure to check your blood count and perhaps a blood test to measure your iron level. Anemia and low iron are sometimes causes of increased bleeding. It is a good idea to take an iron supplement anyway so you don’t become anemic from the bleeding. The best test for fertility is FSH (Follicle Stimulating Hormone).  It rises and the ovaries approach menopause and is the best single test.  At 44, if the FSH is at all elevated, pregnancy is possible but very unlikely.