Is surgery the solution?

Part 4 of a five-part series on “Fibroids: what every woman should know”

January 06, 2010 04:05 pm | Updated 04:05 pm IST

Do all fibroids need a hysterectomy?

Tasleem is 42. She has regular periods. The flow is not heavy and she uses 2-3 pads per day. She has mild, bearable pain during her periods. She occasionally takes a painkiller tablet for this. When she went to see her family physician for diarrhoea and lower abdominal pain, an ultrasound was ordered. The uterus was incidentally found to contain a fibroid measuring 5 x 4 centimetres.Tasleem was then asked to see a gynaecologist who advised a hysterectomy. Does Tasleem really need surgery?

Thamarai is 56. She reached her menopause 6 years ago. She went for a regular check-up and was told she had a lump in the lower abdomen. An ultrasound confirmed the presence of two large fibroids, the larger one measuring 6 x 6 centimetres. She was asked to have a hysterectomy. Is surgery essential for Thamarai?

When is surgery needed for fibroids?

The mere presence of fibroids is not reason enough to have a hysterectomy. Even large fibroids need no surgery unless they are causing problems. Fibroids cannot ‘burst' as they become larger. At the same time, there are no medicines that can make fibroids shrink permanently. Just remember, fibroids will shrink after menopause.

Uncontrolled bleeding

It is common for women between 35 and 45 years of age to have some irregularity in their periods. This may be in the form of missed periods or frequent periods, scanty or heavy flow. This is usually due to not forming an egg, leading to a hormonal imbalance. This becomes more frequent as a woman gets closer to her menopause. In the 3-4 years leading up to menopause, this irregularity can become worse. If at this time, an ultrasound scan reveals a fibroid, there is no need to immediately blame the fibroid.

All efforts must be made to control the heavy bleeding with hormonal tablets, if indicated, or with medications like tranexamic acid or mefenamic acid which, taken at the right dose, can reduce bleeding by as much as 60-80 per cent.

Surgery is only indicated if you have heavy bleeding that is persistent and causes severe anemia. Fibroids may be the cause ofbleeding if:

* They are lying in close contact to the lining of the uterus

* They are lying inside the cavity (fibroid polyp)

* They are so large and numerous that they distort the uterine cavity

Pressure symptoms

Fibroids may cause pressure on the bladder, making you want to pass urine very frequently. If large enough, fibroids may also press on the rectum, making it painful or difficult to pass motion. If very distressing, these symptoms may be a reason to have a hysterectomy.

Sometimes a large fibroid may be present on the back wall of the uterus. This may tend to make the uterus tilt back. This may lead to severe difficulty in passing urine. This may be more obvious early in the morning. In this case a hysterectomy may be the only answer.

It is sometimes mentioned that large fibroids can cause pressure and lead to damage to the kidneys. Through many years of practice, I have never seen a woman experience kidney damage due to fibroids.

“Will my fibroid turn into cancer?”

This is probably the commonest question a woman will ask when diagnosed as having fibroids. The chance for a fibroid turning into cancer is so rare that it should not be the reason for undergoing a hysterectomy.

Questions to ask your doctor when hysterectomy is suggested

A hysterectomy for fibroids is almost never an emergency and you can take some time to make up your mind. You can also seek a second opinion if you are not convinced that you need a hysterectomy.

Remember that it is your body and you have every right to ask questions.

1. Are there any non-surgical options? If the surgery is being suggested for heavy bleeding, are there any medications that may help instead?

2. Will the surgery be done vaginally or abdominally? Can the hysterectomy be done laparoscopically?

3. Do the ovaries need to be removed? Remember that if you are younger than 45, every effort must be made to retain the ovaries. Ovaries need not be removed even if you are older. The decision to remove the ovaries should be made only with your consent.

Treatment options other than hysterectomy will be discussed in my next column.

The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

www.passport2health.in

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