Case Example:  Asherman's Syndrome - losing periods while ovulating 

Does this problem, Asherman's Syndrome,  need corrected?  If yes, how is this problem treated? 

Analysis:   In Asherman’s syndrome, the endometrium is largely destroyed and replaced with scar tissue.  If pregnancy is desired treatment is necessary.  The treatment is performed by using a hysteroscope to cut away the scar followed by estrogen administration. - Francis Hutchins, M.D.

Case Example:  20-Week Size

I’m in my late 30’s and I am suffering from fibroids equivalent to a 20-week pregnancy.  Are there any other alternatives to hysterectomy besides UAE?  My major symptoms include bladder pressure, which causes frequent urination.  I am uncomfortable from the size, and they interfere with my previous yoga practice, which I no longer do because of the flooding at the beginning of my menstrual cycle (usually the first 2-3 days and my cycle doesn’t completely stop until almost 14 days).  The fibroids are really causing me great physical as well as psychological strain at this time.  My goals are to minimize them as much as possible without hysterectomy or UAE as I have read other women’s accounts of some of the horrible side effects for both procedures.

Analysis:  Yes.  In summary, you have a 20-week fibroid uterus with symptoms of bladder pressure and heavy/prolonged periods and you wish to avoid hysterectomy or UAE.  With the combination of symptoms, you have a number of options not only hysterectomy and UAE but also resection of any submucous fibroids that may be causing your bleeding, intermittent treatment with medications or, of course, doing nothing.  It is very important that your decisions be based on sound understanding of the pros and cons of the various options/treatments.  There are several ways to accomplish this:

• You can review the extensive material on www.hopeforfibroids.org or similar websites
   
• You can read a book such as I have authored for this express purpose The Fibroid Book, or
   
• You can make an appointment for a consultation.

One of my concerns is that you may, like many, be hampered by false or misleading information that you have received from unreliable sources.  That may unnecessarily limit your options.  Your most obvious option is to do nothing but if you want to resolve symptoms compromise may be necessary.  There are no treatments for fibroids that are completely without undesirable side effects.  Remember the old saying: “Everybody wants to go to heaven but nobody wants to die.”  The advantage of a consultation and other objective educational resources are objective knowledge and understanding.  -  Francis Hutchins, M.D.

Case Example:  Uterus removed 

Five (5) years ago my uterus was removed and now I want to know is there a way for it to be replaced again.  I would like to have another baby.

Analysis:  I believe this has been done experimentally but I know of no program performing this.  If your ovaries were left then it is possible for you to arrange for a surrogate to carry a pregnancy after your eggs have been used for in vitro fertilization.  And of course adoption is an option.  -  Francis Hutchins, M.D.

Case Example:  Fibroids cause fatigue  

I have been putting off going to the doctor.   I am afraid of what I will be told.  I am afraid of the major surgery, and what if the fibroids grow back and I don’t get relief from the pressure they are causing me?  What would I have gained from the surgery?   I am wondering how my life would change if the fibroid was removed?  Also, can a fibroid cause fatigue? 

Analysis:  A consultation with a Gyn knowledgeable about fibroids should answer all these questions and more pertaining to options.  Often fears are not well founded.  And anyway, you don't have to take the doctors recommendation if you don't agree with it. 

Your exhaustion could be due to anemia caused by the heavy bleeding, which by the way tends to get worse with time.

Your best question concerns what I have referred to in my book by saying, "Never have surgery unless you have a very good answer to the question 'How will I be better off?"

Depending on the type of treatment you have you should expect the pressure to improve and your bleeding to resolve. 

You might find it helpful to read “The Fibroid Book”.  You are why it was written.  – Francis Hutchins, M.D.

Case Example:  How long after UAE should a woman wait before deciding the UAE didn’t work? 

I had a lot of large fibroids and I had a lot of heavy bleeding until I had the procedure done (UAE).  I'm in my mid-40’s and I wanted to have another child.  I still have quite a few large fibroids, and my uterus was still so high even after 5 months. 

My questions are do you think at my age I should have a second UAE performed?  Is it too late for me to try having a baby?  What do you think would be my success rate for the second time around (my doctor told me my fibroids have grown right thorough the walls of my uterus)?

My measurements:  Pre UAE my uterus is 18x15x8, and fibroid is 5.8x6 5x4.5 5x4.5.   Post UAE my uterus is 14.3x10.1x5.6, and fibroid is 1.7x1.8 5.1x4.3

Analysis:  There are several observations that can be made: 

1.      You have had a substantial reduction in the size of your fibroid uterus (>50% decrease in volume). 

2.      Many women will continue to have reduction as long as 12 months after UAE. 

3.      Five (5) months is too short a time to judge fertility.  Usually 9-12 months in normal couples is used.   

4.      In this case the effect of the UAE may not be over as well. 

Thus it is too soon to tell what effect the UAE may have had on fertility and too soon to consider any other treatment. – Francis Hutchins, M.D.

Case Example: Menstruation after UAE – irregular or no periods  

Before UAE many women experience regular 28-30 day menstruation cycles.  The first 3-6 months post UAE it may not be unusual for a woman’s menses cycle to be irregular, experience spotting, and fibroid tissue sloughing/discharge.   I am keeping my Interventional Radiologist informed about my UAE recovery.  Is there anything else I should do?

Analysis: The answer to this question will depend on whether or not the woman is having intercourse and using contraception. This type of question is why women should be monitored by a gynecologist after UAE and be able to freely communicate with her/him.  As the accountants and lawyers often answer, “It depends (on many things).” - Francis Hutchins, M.D.

Case Example: Hyperthyroidism & Fibroids