Dr. Parker's Fibroids Blog

Mefipristone, a Medical Treatment for Fibroids, is Not Looking Good

November 1, 2009 – 3:07 pm

Low-dose mifepristone in treatment of uterine leiomyoma: a randomised double-blind placebo-controlled clinical trial.

Authors: Bagaria M, Suneja A, Vaid NB, Guleria K, Mishra K.

Study from: Department of Obstetrics and Gynaecology, University College of Medical Sciences, Delhi, India.

Problem: So far, no medication has worked to relieve symptoms of fibroids. In early studies, one drug that appeared to be promising was Mefipristone (RU-486). Progesterone causes fibroid cells to grow and Mefipristone blocks this effect.

Study: The study included 40 women with bothersome symptoms from fibroids; 20 women were taking mifepristone and 20 were taking a placebo. None of the women or their doctors knew what pill they were taking.

Fibroid-related symptoms, the size of the uterus and size of the largest fibroid were measured with ultrasound at the beginning of the study and every month for three months. A biopsy of the uterine lining cells was done at the beginning and again at the end of treatment.

Results: Women who were taking Mefipristone had a 95% decrease in menstrual blood loss after three months Complete relief of menstrual cramping occurred in 80%, but only 33% patients were free of pelvic pain. Women taking the placebo pills had no change in any symptoms. Backache, bladder problems and pain with intercourse were not better in either group.

The size of the uterus and size of the largest fibroid were about 30% smaller by the end of the third month of therapy. Women taking Mefipristone had an increase in haemoglobin (red blood cells) from 9.5 to 11.2 . However, 63% of women taking mefipristone had benign overgrowth of the uterine lining cells (endometrial hyperplasia without atypia).

Authors’ Conclusions: A low dose of mifepristone taken for three months is effective in reducing menstrual bleeding and reducing uterine and fibroid sizes, but has the side-effect of causing uterine lining cell overgrowth.

Dr. Parker’s Comments: It would be great if there was a pill available to treat the symptoms of fibroids with few side-effects. So far, all the tested medications have either not worked or had bothersome side-effects. Mefipristone is given orally and has few side-effects. It is well-known that progesterone causes fibroids to grow. Mefipristone works by blocking the action of progesterone and has been shown to shrink fibroids and decrease bleeding. However, progesterone decreases the growth of the uterine lining cells and since mefipristone blocks this action it allows the lining cells to overgrow. After just 3 months almost 2/3 of women had benign overgrowth. While benign overgrowth does not turn into precancer or cancer, the worry is that longer treatment with Mefipristone could stimulate actual cancer cells to form. Further study will be needed, but this study is discouraging.

For more about medical treatment for fibroids see: https://www.fibroidsecondopinion.com/treatment-for-fibroids/

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroid bleeding, fibroid medication, fibroid pain, fibroid treatment, mefipristone, shrinking fibroids | Comments (0)

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New Research on the Myths Regarding Instructions Doctors Give Following Surgery

October 25, 2009 – 3:16 pm

Building the Evidence Base for Postoperative (and Postpartum) Advice

Dr. Parker’s Note: I have summarized most of the information from this paper in a new web page: Caring for Yourself After Surgery.

Authors: Minig, L; Trimble, E; Sarsotti, C; Sebastiani, M; Spong, C.

Journal: Obstetrics & Gynecology: October 2009 – Volume 114, pp 892-900

Study from: National Institutes of Health, Bethesda, Maryland

Problem: Following surgery, doctors give fairly standard instructions regarding what activities the patient can, and cannot, do. Unfortunately, there is little science to back up these recommendations.

Study: The authors reviewed studies related to post-operative instructions from medical journals, medical textbooks in obstetrics, gynecology, and general surgery, the American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions and clinical guidelines of Royal College of Obstetricians and Gynecologists of the United Kingdom in order to evaluate current recommendations.

Authors’ Conclusions: Resumption of usual activities after gynecologic surgery helps integrate women back into their normal life. Available data do not support many of the recommendations previously provided. Restrictions on lifting and climbing stairs should be reconsidered. Guidance on driving should focus on the concern about driving while using narcotic medications rather than concern about opening the wound. Much more study is needed to better define all the above issues.

Dr. Parker’s Comments: As the authors state in the introduction to the article, “recommendations for activity after discharge remain based on tradition and anecdote”. To the authors’ credit, they investigated current recommendations and came up with little evidence to support what we usually tell women.

The authors suggest that the new recommendations be fully tested by scientific study, but since this is unlikely to happen soon (or ever), it is best to discuss the new recommendations with your doctor.

Patients are often each others’ best resource for finding and sharing information about recovery after surgery. I encourage you to post comments on this post if you have something helpful to share.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged activity after fibroid surgery, activity after surgery, back to work after surgery, driving after surgery, hysterectomy, instructions after surgery, lifting after surgery, myomectomy, sex after hysterectomy, sex after surgery | Comments (5)

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Hysterectomy, or other options

October 8, 2009 – 7:51 pm

I am 39 and I have a 5 inch fibroid in my uterus plus others and lesions along with multiple cysts on my ovaries. I am considering a partial hysterectomy….keeping my ovaries. Is it necessary or will the fibroid just go away? I do urinate frequently and I am just starting to experience bleeding abnormalities. I do not plan on having children and I have all HPV viruses that cause cancer that I monitor frequently…so I am wondering if this is the right thing to do? I am worried that it will only keep getting bigger and im also worried if I have the surgery I will lose my sexual drive or pleasures. Then the other part of me says I will no longer have to worry about the HPV problems or about the fibroid if I have the surgery done… Please advise.

Thank you, Wendy

Wendy,

Unfortunately, fibroids don’t shrink until menopause, at an average age of 52. So, it sounds like waiting for menopause will take too long. We are not able to predict the growth rate of fibroids, but some do not grow over time while others do grow. If you chose to have a hysterectomy, the procedure will relieve the symptoms of urinary frequency and bleeding related to the fibroid. But, there are other options.

Myomectomy, which could be performed laparoscopically by a skilled laparoscopic surgeon, removes the fibroid and should relieve your symptoms. For more about this see: https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

UAE (embolization ) shrinks the fibroid and is likely to work as well. See this page: https://www.fibroidsecondopinion.com/uterine-artery-embolization/

If you choose not to have a hysterectomy, the HPV virus can be easily monitored with viral tests of the cervix. Often the virus goes away by itself, but if the cervical cells start to become abnormal the cervix can be easily treated in the doctor’s office years before cancer develops.
For more about this see: http://www.gynsecondopinion.com/pap.htm

If you have uterine contractions or pleasurable cervical sensation during intercourse, hysterectomy will eliminate these sensations. Neither myomectomy nor UAE are likely to interfere with your sexuality. However, sometimes just removing the fibroid, either with myomectomy or hysterectomy or shrinking it with UAE makes intercourse more comfortable. More about this can be found here: www.fibroidsecondopinion.com/hysterectomy-for-fibroids/

I hope this is helpful,
Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Comments (4)

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Post-forty = automatic hysterectomy?

October 5, 2009 – 12:40 pm

Hi Dr. Parker,

I am a forty-five year old woman with multiple fibroids, one of which is larger than 8 cm and high up in the uterus (below the belly button). I have only very mild symptoms.

My GP referred me to a gynecologist who, after going quickly through all treatment options, told me that for women over forty she only recommends hysterectomy because they do not need their uterus anymore and in my case since I had not had any children, my vagina would be too tight for a laparoscopic or vaginal hysterectomy. An abdominal hysterectomy would be the only treatment she would recommend.

She gave this recommendation without feeling the fibroid position, without scans and without asking whether I had any symptoms. When I told her that I did not want a hysterectomy, she told me that a large fibroid might block my kidneys.

I thought that the position that women over forty were automatically hysterectomy candidates was no longer accepted. Am I correct in my sense that there is something not quite right going on here? What treatment options are there for a woman of my age? What is the chance that a fibroid this size and in this position could affect my kidneys?

Thank you very much for an enormously helpful website.

T.P.

You are absolutely right and you should get a second opinion from someone who takes care of women with fibroids on a regular basis and is skilled at other options. While blockage of the ureters has been reported rarely in the medical literature, I have never seen this happen in 31 years of practice. Also, a kidney ultrasound can detect this before it becomes worrisome.

Your treatment options should include: no treatment unless your symptoms become bothersome; myomectomy, either laparoscopic or abdominal depending on the sizes and positions of the other fibroids; embolization; or focused ultrasound (results do not appear to be as good). If you wished to have a hysterectomy, laparoscopic hysterectomy can often be performed by someone skilled in this procedure.

I hope this is helpful,

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Comments (4)

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Uterine artery embolization for fibroids is associated with an increased risk of miscarriage.

October 5, 2009 – 9:15 am

Authors: Homer H, Saridogan E.
Journal: Fertil Steril. 2009 Apr 8. [Epub ahead of print]
Study performed at: Department of Obstetrics & Gynaecology, Institute for Women’s Health, University College London Hospitals, London, United Kingdom.

Problem: There are a number of small studies that show either a small risk or no risk for pregnancies conceived after UAE. Small studies are hard to interpret because the statisticians cannot make sense out of small numbers of women. Also, no study has ever compared the results to women with similar fibroids who had not been treated.

Study: These authors combined the results of many already-published studies and analyzed the information as if it was one, larger study (called a meta-analysis). They compared the results of 227 women who got pregnant after UAE with 4,454 women who were the same ages and who had similar fibroids, but who had not been treated before they got pregnant.

Results: Miscarriage rates were higher in UAE pregnancies (35.2%) compared with women who had fibroids but no treatment fibroid (16.5%). The women who had UAE before their pregnancies were also more likely to experience excessive bleeding after delivery (13.9% after UAE vs. 2.5% in women with fibroids but no treatment). There were no differences in the rates of early delivery, underweight babies, or breech babies.

Conclusions: For women who get pregnant after UAE, the risk of miscarriage and the risk of excessive bleeding after delivery seem to be greater.

Dr. Parker’s Comments: While studies with just a few women are hard to interpret, a study such as this (meta-analysis) isn’t perfect either. Since the authors never see ANY of the women in the outside studies, it is possible that differences in the separate groups of women were present, but not reported in the original articles. Nevertheless, since it is unlikely that any interventional radiologist will have 227 women in their practice who will get pregnant after UAE, this kind of study may be the best information we can get.
Most interventional radiologists in the US advise women not to get pregnant after UAE. This advice is given not because they know that UAE causes harm during pregnancy, but mostly because there is not enough experience with UAE and pregnancy to tell women everything should be OK. For now, that advice is likely to stay the same as before.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroids, pregnancy, UAE, uterine artery embolization | Comments (1)

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Can “watchful waiting” be used when a patient is anemic?

September 28, 2009 – 4:06 pm

Is it possible to build up hemoglobin enough to be able to just wait and watch fibroids. My hemoglobin was 6.6 and is now 7.5 from taking iron supplements. My uterus is 6 times normal size with one fibroid the size of a softball, and numerous others. My doctor is strongly recommending a laparoscopic hysterectomy. I just found your website today, and it is the most helpful and informative site I’ve found. Thank you for your help.

-Cynthia

You did not say, but I assume the anemia is from heavy menstrual bleeding due to the fibroids. If so, it is unlikely that you will be able to correct the anemia because you will be losing blood every month. However, there are many other ways to help you other than hysterectomy. Depending on the size, number and positions of the fibroids, hysteroscopic myomectomy, laparoscopic/robotic myomectomy, endometrial ablation, abdominal myomectomy, or uterine artery embolization are alternatives. Myomectomy is always possible and should work just fine. You should discuss these options with your doctor, or consider getting a second opinion. Also, take a look at these web pages regarding alternatives;
https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/
https://www.fibroidsecondopinion.com/abdominal-myomectomy/
https://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged anemia, fibroids, hemoglobin, large fibroid, myomectomy, watchful waiting | Comments (0)

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Will There Be Scar Tissue After a Second Abdominal Myomectomy?

August 10, 2009 – 3:04 pm

Hi Dr. Parker,

Thank you so much for your website. It is quite informative. I have 3 very large fibroids on the left side of my uterus. One in particular is causing a great deal of pain. My Dr. said it was dying so it has to be removed. I had a myomectomy about 11 years ago, so this will be my second. I still do not have children and would like to at some point. Is it safe to perform another myomectomy? Will this leave my uterus with too many scars?

Have you performed more than one myomectomy on the same patient? If so, were they successful in becoming pregnant and carrying a baby? Any information about a 2nd myomectomy would be greatly appreciated.

Thank you. W

In the hands of a skilled surgeon, a second myomectomy is likely to be successful. Yes, I have had to do this and yes, it was fine. With good surgical technique, the scars on the uterus heal very well and should withstand the stretching that occurs with pregnancy. If the incisions in the uterus go all the way into the uterine cavity, we often recommend that you have a Cesarean section so the scars do not have to withstand the forces of labor.

Also, I use an adhesion barrier called Seprafilm to help prevent scar tissue around the outside of uterus, tubes and ovaries, so you might ask your gynecologist about this.

Bill Parker, MD

For more about abdominal myomectomy see:https://www.fibroidsecondopinion.com/abdominal-myomectomy/

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged abdominal myomectomy, adhesion barriers, adhesions after fibroid surgery, fibroid surgery, scar tissue after myomectomy, Seprafilm | Comments (0)

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Is Watchful Waiting A Good Option for Fibroids at Age 50?

August 10, 2009 – 2:42 pm

Dear Dr Parker

I found your site while researching the possible treatment for my fibroids. Thank you for creating such an informative resource.

I am 50 this year and have had fibroids for some time which recently began to grow. This week I had a uterine ultrasound and my doctor has told me I have about “a pound and a half” of fibroids in my uterus. I’m afraid I don’t have specifics as he called me last night to just go through the test results. He seems keen on surgery (hysterectomy) and I am not keen on that for the following reasons:

I have only recently started having minor discomfort in association with the fibroids, some heaviness and some changes in the need to urinate but nothing drastic. My periods have become lighter recently with far less pain than in the past when the fibroids were probably smaller.

What would be an alternate choice of action to surgery at this point? My doctor says they fibroids don’t seem to be interfering with urine flow but I would be happy to have my kidneys checked out to make sure all is well there. I am worried that some doctors are just too prepared to perform major surgery when this may resolve itself after menopause. Of course, if things get worse then I would reconsider the surgery option.Any advice? Thanks so much again for offering your views on this issue to women who are looking for a balanced view.

T.S.

Hi T.S.,

It is very, very rare for fibroids to block the flow of urine from the kidneys to the bladder and the fibroids would have to huge to do this. I cannot give medical advice over the internet, but since you are close to menopause you should ask your doctor about watchful waiting. Myomectomy, removal of just the fibroids is always an option if the symptoms increase. If the doctor persists with talk of a hysterectomy, then get a second opinion. Thanks for the kind words about the website.

Bill Parker, MD

For more information about fibroids and surgery, please see:

https://www.fibroidsecondopinion.com/surgery-for-fibroids/

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged fibroids and kidney damage, myomectomy, no hysterectomy, watchful waiting | Comments (1)

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Laparoscopic Myomectomy, Robotic Myomectomy or Abdominal Myomectomy – Which Doctor Should I Choose?

August 10, 2009 – 2:13 pm

Hello Dr. Parker,

I was doing some research online and came across your website and looking at Laparoscopic and Robotic Myomectomy. But I have few questions for you, hope you would be able to answer it for me.

I am 27 years old and found out about the Fibroid when I just turned 26. The nurse, doctors, radiologist, everyone were surprised that for a young person like me has Fibroids. And I do not have a family history of Fibroids either. Since, then I have been doing Ultrasound and regular checkup every 6 month with my doctor. I have 2 big fibroids, one on the top of the Uterus and another behind or on the wall of the Uterus. Since I am so young, there are so many complications, I have to think before choosing the Option.

Last week, my doctor told me, both fibroid have grown to the size of not quite as Soft ball but larger than BaseBall. And recommended I have the Laporoscopy Myomectomy done, as soon as I can. Since, the bigger, it gets, harder and complicate for surgery. This week, I went for second opinion and the doctor recommended/told me da Vinci myomectomy. I read a lot about it online too. But I am really confused now and scared too because I have never had any surgery before. Both has its advantage and disadvantages, I was wondering if you have suggestion for me. I called my regular doctor and told about da Vinci Myomectomy, she told me I am not the candidate for that since my fibroids are big. I have the surgery date scheduled in few weeks, I am getting more and more scared and worried, as to what I should do. What would be the good decision for me, since I plan on getting pregnant in the next few years when I am married?

I appreciate your time and opinion. Hope to get a reply from you.
Thanks,
A.

Is the first doctor recommending a laparoscopic myomectomy (telescope through the navel) or an abdominal myomectomy (bikini incision)? Laparoscopic myomectomy and robotic myomectomy are very similar and both have a faster recovery than abdominal myomectomy. It sounds like your doctor does not perform either laparoscopic or robotic myomectomy and is nervous about the size of the fibroids. The important thing with either of these procedures is to find a gynecologist who has a lot of experience and skill doing the procedure.

Bill Parker, MD

Thank you for the reply. My regular doctor does the laparoscopic myomectomy. Because my fibroids are big, she can’t do the laparoscopic myomectomy. She said she has done many myomectomies, however I should ask more questions.

The procedure she will be performing on me is “myomectomy per Laparotomy” which is the abdominal myomectomy. I think I am going to do more research. And also waiting to find out, how often my doctor performs this procedures and complication, successes etc. I think she already has given answers to a part of these questions.

Thanks, A.

You should also ask the other doctor how many da Vinci (robotic) myomectomies they have done, how many for women with fibroids the size of yours, how many have gotten pregnant, how many complications they have had. This is a relatively new procedure and some doctors are just learning. You do not want them practicing on you!

Bill Parker, MD

For more information about laparoscopic and robotic myomectomy please see:

https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged abdominal myomectomy, experienced myomectomy surgeon, fibroid surgery, laparoscopic myomectomy, robotic myomectomy | Comments (1)

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Outcomes after Uterine artery Embolization for Pedunculated Subserosal Leiomyomas

July 30, 2009 – 7:07 pm

Journal: Journal of Vascular and Interventional Radiology. 2008;19:657-661.
Authors: Margau R, Simons M, Rajan D, Hayeems E, Sniderman K, Tan K, Beecroft R, Kachura J.
Study from: Department of Medical Imaging, New York Hospital and Mount Sinai Hospital, New York
Problem: In the early days of uterine artery embolization there were two published instances where pedunculated fibroids (on a stalk) detached from the uterus and caused inflammation in the abdomen which required surgery to remove the fibroid. However, we did not know whether this was a frequent or rare problem.

Study: Among 240 women who had UAE, 16 women had fibroids on a stalk on the outside of the uterus. The average size of the fibroid was about 7 cm (3 inches) in diameter. The average width of the stalk was 2.7 cm (1 inch) and 6 fibroids had a stalk less than 2 cm in width.

Results: None of the 16 women had a pedunculated fibroid detach as a result of UAE. The average reduction in size of the fibroid was 39%, the same results that have been published for other types of fibroids.

Dr. Parker’s Comments: These results are very encouraging and will allow more women to have UAE. The only problem with the study is that it is possible, in fact likely, that some women with large fibroids on long or thin stalks were not recommended for UAE in the first place. So, the recommendation for UAE will depend on the interpretation of the MRI by the interventional radiologist. More about UAE can be found here: https://www.fibroidsecondopinion.com/uterine-artery-embolization/

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroid treatment, pedunculated fibroids, UAE uterine artery embolization, UFE | Comments (0)

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.