Dr. Parker's Fibroids Blog

Is it a good idea to donate your own blood before having abdominal myomectomy surgery?

July 20, 2009 – 9:28 pm

Dr. Parker’s Comment: I recently attended a lecture by a world expert in blood transfusion medicine and it was eye-opening. It turns out that every day that blood, even your own blood, sits in the blood bank refrigerator, it decreases in quality. Studies show that in an ICU with really ill patients, the ones who were transfused did worse than the patients with similar illnesses and similar levels of anemia who did not get transfused. The reason is that the blood cells become more fragile, then fragment and clog up capillaries, blocking blood flow and oxygen delivery to the tissues. Here is the reference for the abstract: http://jama.ama-assn.org/cgi/content/abstract/288/12/1499

Although serious problems are less of a risk for young, healthy women who are having myomectomies (you are all really young and healthy compared to 80 year-olds in an ICU!), the best strategy is getting your blood counts up before surgery and using a cell-saver during surgery.

For women with very low hemoglobin levels (below 9), I usually use Procrit to stimulate red blood cell production for about 3 weeks before surgery. High doses of iron must also be given, so your body has the building blocks to make red blood cells, and vitamin C is also given to help you absorb more iron through the intestines. There is no magic number, but it is nice to have the hemoglobin 10 or higher before surgery, unless heavy menstrual bleeding does not allow us to get the blood counts up even with Procrit and Vitamin C (very rare).

The second strategy is the use of the cell saver, which allows us to replace blood loss, if necessary, immediately during surgery with the patient’s own blood, before it has a chance to deteriorate. Also, there is no risk of HIV, hepatitis or mismatched blood with the cell-saver.

Blood is suctioned from the incision and operative area, stored in the canister, and then filtered and returned to the patient through an IV

And lastly, the current recommendation is to not transfuse blood unless the patient is very dizzy when they stand up or very weak, or until the hemoglobin is below 7 (it used to be below 10). Since the blood doesn’t work very well anyway, it is better and safer to allow the patient to build up her own blood slowly during the recovery period.

There is a push to explain all this new information to doctors because it is different from what we were all taught. So, you will find differences of opinion based on a doctor’s knowledge of this new information.

More about myomectomy surgery can be found at this link: https://www.fibroidsecondopinion.com/abdominal-myomectomy/

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged abdominal myomectomy, blood transfusions, cell-saver, fibroid removal, fibroid surgery, myomectomy | Comments (2)

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Quality of Life after Fibroid Embolization

July 14, 2009 – 11:17 am

Long-term Quality-of-Life Assessment Among Patients Undergoing Uterine Fibroid Embolization.

Authors: Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA.
Journal: American J Roentgenology. 2009;193:267-71.
Study from: Department of Cardiovascular and Interventional Radiology, Medical University of Vienna

Problem: The first use of embolization to treat women with fibroids was performed in France in 1997, so the long-term effectiveness of the procedure is still being investigated. These authors wanted to see how patients they treated over the past 10 years have done with regards to their quality-of-life following UFE.

Study: All 53 women from an earlier publication of UFE were questioned about their quality-of-life and symptoms following the procedure. Thirty-nine women (75%) responded to the questionnaire.

Results: The average time since treatment was 7 years. Reduced bleeding was reported in 90% of the women, reduced pain in 79%, reduced bulk-related symptoms in 90%, reduced fatigue in 77%, reduced limitations of social life in 93%, and reduced depression in 79%. The general quality-of-life for these women improved significantly.

Six women (15.4%) had a hysterectomy at an average of 32 months after UFE. Thirty-two women (82%) were satisfied with UFE, and 30 patients (77%) said they would recommend uterine fibroid embolization to other women. The authors concluded that UFE seems to lead to significant long-term relief of fibroid-associated symptoms.

Dr. Parker’s Comments: Although this is a small number of women, and 14 of the original study patients did not respond to the survey, the long-term results are very reassuring. There was a high satisfaction rate reported by the women over the long follow-up period of 7 years. Only 15% of the women needed to have a hysterectomy after UFE (myomectomy following UFE was apparently not considered). One of the early questions about UFE was whether the results would last over time. I agree with the article that the answer is yes.

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

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What Size and Number of Fibroids Cause Symptoms that Lead to Treatment?

July 5, 2009 – 7:49 pm

The Fibroid Growth Study: Determinants of Therapeutic Intervention.

Authors: Davis BJ, Haneke KE, Miner K, Kowalik A, Barrett JC, Peddada S, Baird DD. J
Journal: Women’s Health (Larchmt). 2009 May;18(5):725-32.
Study performed by: National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA. Barbara.Davis@MPI.com

Problem: A common question in my office is “if these fibroids grow, won’t I just need treatment in the future?” Despite years of studies about fibroids, no one has ever documented if there is a size at which women will always want treatment.
Study: MRIs were done on 116 premenopausal women, ranging in age from 20 to 54 years; 48% were black women, 41% were white women, 10% were women of other racial backgrounds

Conclusions: Neither the number of fibroids a woman had nor the over-all size of her uterus was related to which women chose treatment. The women who asked for treatment had more symptoms, including more bleeding and pain, compared with the women who chose not to have any treatment. The authors suggested that aggressive treatment of pain and bleeding might reduce the need for surgery.

Dr. Parker’s Comment: The size of a woman’s fibroid does not always correspond with the degree of her symptoms. For instance, a small fibroid (even 2-3 cm = 1 inch) inside the uterine cavity can cause severe bleeding and anemia. But, a large fibroid, say 7 cm (3 in), outside the uterine wall will cause no extra bleeding. A 7 cm fibroid sitting directly over the bladder can cause urinary frequency and the need to get up in the middle of the night to urinate, very bothersome symptoms to some women. But, a 7 cm fibroid at the top of the uterus may cause a little bloating, but not enough for the woman to seek treatment. So, sizes, number and position of the fibroids are all important factors in determining which women might have bothersome symptoms.

See: https://www.fibroidsecondopinion.com/fibroid-symptoms/

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroid number, fibroid size, fibroid symptoms, need for fibroid treatment | Comments (30)

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Is my 5 cm fibroid causing my back pain?

June 21, 2009 – 7:55 pm

Dear Dr. Parker,

Thank you for being so available via email. I have never blogged nor responded to this type of med info. I was drawn to your information and presentation of same.

I have a 5cm submucosal fibroid, with no abnormal bleeding. The only symptom I appear to have is severe back ache, and pelvic (hip) pain. I have had an ultra sound, MRI, CT, saline infusion sonogram and an endometrial biopsy. I am 48 and not in menopause. I am healthy and have had two children naturally. Take no other meds.

All the doctors I have seen want to operate. They say the uterine size is an issue. I would like to keep my uterus, cervix, etc intact. Drs. say I am a great candidate for laparoscopic supracervial hysterectomy. Lupron does not interest me. Uterine Artery Embolization does not interest me. Hysteroscopy resection is now less of an option, they say this would have to be done numerous times because of size and Lupron needed.

My question – Would getting off the birth control pill (Ortho Novum 1/35 28 day) be of any benefit? Would this help in reducing the feed of hormones to the fibroid? Along with change in diet, deleting red meat, etc.

Would appreciate any reply or thought on this.

Thank you,

Dr. Parker’s Reply

I doubt that a 5 cm submucosal fibroid would be causing back pain. 5 cm is not big and if it is submucosal it is bulging inward towards the uterine cavity, not outward towards your back. I would recommend you get an opinion from a back specialist before you have a surgery that won’t help you. The MRI should also be able to see if the fibroid is pressing against the spine.

If the fibroid is only 5 cm, then a laparoscopic myomectomy would also be feasible, as would a laparoscopic supracervical hysterectomy. If MRI shows that most of the fibroid is in the uterine cavity, then hysteroscopic myomectomy should be possible if performed by a skilled hysteroscopic surgeon.

Birth control pills neither make the fibroids grow or shrink, so stopping the pill should not make a difference. The studies on diet are hard to do, but one study shows women have fewer (not smaller) fibroids if they never eat red meat.

You might also consider seeing a gynecologist who sees a lot of women with fibroids to make sense out of all of this for you.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged birth control pills, fibroids and back pain | Comments (4)

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A common blood clotting condition that can cause heavy periods and increase your risks of bleeding during surgery.

June 15, 2009 – 9:02 pm

Complications of hysterectomy in women with von Willebrand disease.

Authors: James AH, Myers ER, Cook C, Pietrobon R.

Journal: Haemophilia. 2009 Apr 6 . [Epub ahead of print]

Study performed at: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.

Problem: Some women having bleeding complications from surgery that can require blood transfusions or, rarely, even cause serious complications or death. An inherited condition, named von Willebrand disease (VWD) after the man who discovered it, can cause both the heavy bleeding that can lead to having a hysterectomy, and cause sometimes dangerous bleeding during surgery.

Study: The authors wanted to estimate how often women with VWD who had a hysterectomy had serious bleeding or other complications. The United States Nationwide Inpatient Sample (NIS) for the years 1988-2004 was examined for all hysterectomies for non-malignant conditions. The differences between women with and without VWD were analyzed.

Results: 545 women with VWD had a hysterectomy. Women with VWD were more likely to experience bleeding during and after surgery (2.75% vs. 0.89%) and require transfusion (7.34% vs. 2.13%) than women without VWD. One woman with VWD died.

Conclusions: Women with VWD did experience significantly more bleeding complications than women without VWD.

Dr. Parker’s Comments: Because I see a lot of women with fibroids, I also see a lot of women with a history of very heavy menstrual periods. Most often, this is due to fibroids (usually the submucous type). Every once in a while, a woman also has a history of heavy menstrual bleeding since adolescence, heavy bleeding during childbirth or during a previous surgery, or she tells me that her mother or sister hemorrhaged after childbirth or surgery. This is the Red Flag that gets me to send them to a hematologist for evaluation for von Willebrand disease (VWD).

As a result, our consultant hematologist, using simply blood tests, has made the diagnosis of VWD many times. This is good news for the patient. First, VWD does not usually cause serious bleeding unless a woman is having surgery or childbirth, so it is not a frightening diagnosis. Second, there is a medication that can be given in the IV just before surgery or childbirth that prevents serious bleeding and, therefore, avoids the complications described in this study. Third, VWD disease makes it less likely that the fibroids are responsible for the heavy periods and often this changes the treatment options.

So, if you have a history of very heavy periods since adolescence, or you have had heavy bleeding during surgery or after childbirth, or you have a family history of heavy bleeding, then you should ask your doctor about being tested for VWD.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroid bleeding, heavy menstrual periods, risks of surgery, von Willebrand disease | Comments (0)

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Which is a better method of finding fibroids: MRI or Ultrasound?

June 8, 2009 – 7:54 am

Magnetic resonance imaging (MRI) and transvaginal ultrasound for determining fibroid burden: implications for research and clinical care.

Authors: Levens ED, Wesley R, Premkumar A, Blocker W, Nieman LK.

Journal: Am J Obstet Gynecol. 2009 May;200(5):537.e1-7. Epub 2009 Mar 9.

Study performed by: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.

Problem: The authors want to determine whether MRI or Ultrasound is better at finding fibroids.

Study: 18 women had both an MRI and an ultrasound before they had a hysterectomy. The uterus was then inspected by the pathologist to determine how many fibroids were present and these results were compared to what the MRI and ultrasounds had predicted.

Results: MRI found 80% of the fibroids, while ultrasound found only 40% of the fibroids.

Conclusions: MRI was superior to ultrasound for fibroid assessment.

Dr. Parker’s Comment: This study confirms what other studies have previously shown – that MRI is the best way to “see” fibroids before choosing a treatment or surgery. I find MRI particularly helpful if a patient wants a laparoscopic or robotic myomectomy. By looking at the MRI images myself, I know exactly where all the fibroids are, and whether they can all be removed during surgery. I have also had a number of women who were discovered to have fibroids inside the uterine cavity that were not seen with ultrasound. These women had all been told they needed an abdominal myomectomy or a hysterectomy, but were able to have a hysteroscopic myomectomy, the least invasive procedure with the fastest recovery.

MRI is not always necessary, though. If many fibroids are found with ultrasound and the uterus is very large, usually abdominal myomectomy is going to be the only successful way to take all the fibroids out. So, MRI will add nothing useful because I will be able to feel all the fibroids during surgery and know where they are. Also, if a woman wants to have a laparoscopic hysterectomy, then it is not necessary to know where the individual fibroids are since they will all be removed with the uterus.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged best imaging, diagnosis, fibroids, MRI, ultrasound | Comments (2)

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Welcome!

June 1, 2009 – 10:39 am

Welcome to my blog for Fibroid Second Opinion. Every Monday, I plan to post my comments about interesting new fibroid research, medical articles about fibroids, topics you ask about in e-mail, or subjects you suggest. I welcome your comments.

Bill Parker, MD

By Bill Parker, MD | Posted in About the Blog | 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.