Dr. Parker's Fibroids Blog

Endometriosis – do I need a hysterectomy, do I need my ovaries out?

May 30, 2011 – 7:35 pm

Hi Dr. Parker,

My ob/gyn strongly suggested that I start thinking about having a hysterectomy as well as having my ovaries removed.

My background is:

49 years old, No children

Uterine Ablation in 2005

Diagnosed with Endometriosis 2006 by laparoscopy -Stage III with two or three endometriomas on one ovary.

Family history – mother diagnosed with breast cancer. 1st case – 59 years old – lobular carcinoma. 2nd case – 72 years old – ductal carcinoma. Both times the breast was removed.

My Mom tested negative for the BRCA gene.

My endo does not cause regular pain – only when I have my period or am ovulating. Due to the ablation and my age, I am not even sure how often it has been happening, maybe once or twice a month for a couple of days.

My Dr. is concerned about my risk of ovarian cancer. I have been researching this subject and am more confused than ever. It seems like rearranging deck chairs on the Titanic. I can remove the risk of ovarian cancer and cut my risk of breast cancer in half. But, the estrogen add back brings my breast cancer risk up but not as much if I stay on it for a short duration at a low dose. But, then I run the risk of stroke, bone loss, etc.

Of course, I also have a greater risk of having clear cell carcinoma which would be difficult to detect until it is advanced.

I feel that there is no real solution. I’m just trading one problem for another. I read your article on ovaryresearch.com but I don’t know how to interpret the data as it applies to someone like me.

Any insight would be appreciated.

Thank you,

L

You are right to be a bit confused by all this. First, your mother’s history of non-BRCA breast cancer would NOT increase your risk of clear cell carcinoma of the ovary related to endometriosis – these are unrelated conditions. While endometriosis of the ovary may increase the risk of ovarian cancer, the risk goes from about 1% in the general population to 2% for women who have had endometriosis; or, you have a 98% chance of not getting ovarian cancer .

If you were to choose to have a hysterectomy with removal of your ovaries, you would only need to take estrogen (again, if you choose to take anything). In the Women’s Health Initiative study, there was no increased risk of breast cancer for women who took estrogen only (risk was slightly increased only for women on both estrogen and progestin). In our analysis of the Nurses’ Health Study data, women who took estrogen after removal of their ovaries appeared to have much less risk of developing cardiovascular disease than women who had their ovaries out but did not take estrogen (during 24 years of follow-up).

So, both risks seem to be very, very low.

I hope this is of some help,

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged benefits of having ovaries, endometriosis, hysterectomy, oophorectomy, ovarian cancer, ovaries removed | Comments (0)

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Fibroids, bulk symptoms and anemia

May 30, 2011 – 6:33 pm

Hello, Dr. Parker.

I am on Carla Dionne’s list, which I joined 11 years ago when I was first diagnosed with uterine fibroids at age 36. At that time, the ultrasound showed 3 fibroids. I have lived with them for all this time because my symptoms, although at times severe, were manageable.

Now, my fibroids have grown (apparently into one 8 X 8 X cm fibroid), the bulk symptoms are bothering me, I have anemia (successfully treated with prescription iron), and my bleeding is getting worse and more unpredictable.

I know it’s time for me to have this fibroid removed. However, I am very frustrated with the practice that came highly recommended to me. I had one meeting with a doctor there, but do not wish to go back to him, and I find that the other two surgeons each do separate procedures. I like that you routinely do several different treatments and may come to see you in California even if it means traveling. You are a fibroid specialist and not so much a gynecologist who happens to sometimes deal with fibroids.

My questions to you:

1. Would you think that the radiologist’s report, which states, “dominant upper uterine body fibroid,” means that it’s within the uterine cavity and therefore possibly treatable via hysteroscopy? He does not use the words “submucosal,” “subserosal, “intramural,” etc., just “upper uterine body.”

2. Do you think hysteroscopy is a “simple” procedure, which is what this practice is telling me?

3. What do you think of single-port laproscopic myo? Doesn’t the fibroid have to be low in the uterus in order to allow room for all the tools inserted through the belly button?

Obviously you can’t diagnose by email. I recognize I am asking for some big guesswork and won’t hold you to anything. I just happen to think that, after all this time suffering with it, this fibroid can actually be removed very easily.

Thank you in advance for your replies and for all the good work you do.

T

1. Would you think that the radiologist’s report, which states, “dominant upper uterine body fibroid,” means that it’s within the uterine cavity and therefore possibly treatable via hysteroscopy? He does not use the words “submucosal,” “subserosal, “intramural,” etc., just “upper uterine body.”

Since the radiologist does not describe the type of fibroid, there is no way to tell from the report which type it is. The radiologist may be able to go back and get this information from the films, and you might ask them to do this. A better way to tell is with either a sonohysterogram (using fluid placed into the uterine cavity) or better yet is an MRI.

2. Do you think hysteroscopy is a “simple” procedure, which is what this practice is telling me?

I think it is highly unlikely that an 8 cm fibroid can be removed hysteroscopically. Perhaps they are planning to just look in the uterine cavity to see if it is possible.

3. What do you think of single-port laproscopic myo? Doesn’t the fibroid have to be low in the uterus in order to allow room for all the tools inserted through the belly button?

I have not adopted single-port myomectomy because I do not think the instruments are developed yet to the point where good suturing can be done. There should be plenty of room to remove an 8 cm fibroid laparoscopically with standard instruments.

Obviously you can’t diagnose by email. I recognize I am asking for some big guesswork and won’t hold you to anything. I just happen to think that, after all this time suffering with it, this fibroid can actually be removed very easily.

From what you describe, I would think a laparoscopic myomectomy should be straight-forward to perform in experienced hands.

Thank you in advance for your replies and for all the good work you do.

Thank you for saying this.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged experienced fibroid surgeon, fibroid specialist, fibroid treatment options, fibroids anemia, fibroids bulk symptoms, single-port laparoscopy | Comments (0)

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Dr. Parker performs live telesurgery for AAGL

April 16, 2011 – 1:57 pm

William H. Parker Laparoscopic Myomectomy Telesurgery

Dear William,

On Thursday, April 7, 2011, the AAGL will be streaming a live laparoscopic myomectomy on our web site at AAGL.org. This event is being offered in conjunction with the Turkish Society of Gynecological Endoscopy, who is hosting the Vth AAGL International Congress on Minimally Invasive Gynecology in Istanbul, Turkey this week.

The telesurgery will feature a laparoscopic myomectomy by Dr. William Parker from St. John’s Medical Center, Santa Monica, CA. You can view the surgery live by navigating to AAGL.org and clicking on the WATCH LIVE NOW link on right-hand side of the web site.

The times for the event are as follows:

Event Time:
Istanbul 6:00pm – 7:00pm
New York 11:00am – 12 noon
Los Angeles 8:00am – 9:00am

We look forward to having you join us for this exciting event on Thursday!

Sincerely,
Linda Michels,
Executive DIrector – AAGL

About Dr. William Parker

Clinical Professor, UCLA School of Medicine

Dr. William H. Parker is board-certified by the American Board of Obstetrics and Gynecologists and is an elected Fellow of the American College of Obstetricians and Gynecologists. He has a successful private practice and a very impressive academic medical career. Dr. Parker is a Clinical Professor at the UCLA School of Medicine and is in private practice in Santa Monica, California.

Dr. Parker is chair, Department of Obstetrics and Gynecology, Saint John’s Hospital and Health Center and the former Chair of the Department of Obstetrics and Gynecology at Santa Monica-UCLA Medical Center. Dr. Parker was President of the AAGL in 2000, an international association of over 5,000 gynecologists from 76 countries, after serving on its Board of Trustees for many years.

About this Event

This live telesurgey event is being produced through a partnership among the AAGL, the TSGE, and St. John’s Medical Center of Santa Monica, CA. Click on the links below to learn more about these organizations:

AAGL – Advancing Minimally Invasive Gynecology Worldwide
AAGL.org

TSGE – Turkish Society of Gynecological Endoscopy
TSGE2011.org

St. John’s Medical Center
Santa Monica, CA
StJohns.org

Responses to this Event

“Everyone thought you had a very hard case that you made look easy.”
Charles Miller, MD
Telesurgery Moderator, 5th AAGL International Congress on Minimally Invasive Gynecology in Istanbul, Turkey

“Thank you very much for doing the live surgery transmission today. It was a hard case and you pointed out multiple educational points that the conference attendees appreciated very much.”
Ceana Nezhat, MD
Program Chair, 5th AAGL International Congress on Minimally Invasive Gynecology in Istanbul, Turkey

“I felt that the event was a complete success and well received by the audience in Turkey as well as the online viewing audience.”
Craig Cocca
SurgeryU.com and AAGL.org

Responses to this Event

By Bill Parker, MD | Posted in Announcements | Comments (0)

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My doctor said there is a chance it is cancer because of rapid growth

April 4, 2011 – 9:32 pm

Hi Dr. Parker,

First of all, I want to tell you how informative your website is. I am 35 my dr found a fibroid in May 2010 and it was 8cmx8cm at that time. Another ultrasound was done in Sept 2010 and the size didn’t change. 3 weeks ago, I started having leg pain and severe lower back pain so another ultrasound was done. The size has grew to 8.9cm x 9.9 cm. My dr said there is a chance it is cancer because of rapid growth. Is my case considered rapid growth? Thanks for your time.

Ultrasound is not very accurate to measure the size of fibroids. The difference in the measurement is 1.9 cm, or 2/3 of an inch, not very much. The risk of you having cancer is extremely, extremely low. I wrote an article about this more than 10 years ago and we found that only one of the 371 women with rapid growth had cancer. You might consider getting a serum LDH, total and iso-enzymes and a dynamic MRI with gadolinium dye as precisely described on this webpage:

https://www.fibroidsecondopinion.com/fibroids-and-cancer/

I hope this is helpful,

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged fibroid cancer, rapid growth, sarcoma, ultrasound for fibroids | Comments (0)

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Myomectomy and Fertility

March 26, 2011 – 1:45 pm

Dear Dr Parker,

I was first diagnosed with fibroids back in 1998 at the age of 28 after a routine ultrasound scan. The fibroid then measured 3cm and the DR also noticed other very tiny ones and advised that i should start having children soon or i might find it difficult to conceive. Subsequently i have been going to my local hospital and they have been monitoring its growth. In 2004 it was revealed that the fibroids were about three but the DR said that since they are not growing where the baby is supposed to grow that he is not worried.

In 2007/2008 i went to the hospital and had another ultrasound scan that reveal more fibroids and the fibroids measured about a 20 week size uterus. The risks of surgery were pointed out to me and this scarred my off. My periods have also become very heavy over the last three years and since last year i started noticing blood clots during my periods. My periods last 5 days and by the 6th day its over, i do not bleed in between my periods. My abdomen appears big.

In October 2010 my haemoglobin dropped to 7.5 and i was anaemic and put on Iron supplements, i had an MRI scan that revealed mutiple fibroids – intramural, submucosal and subserosal the biggest measuring 6.2.

The first gynaecologist i saw recommended UAE since i was scarred of surgery, but i later discovered that this may not be advisable for women still desiring children. So my GP referred me to another gynaecologist for a 2nd opinion and i was told that even having a myomectomy now would not be beneficial due to the number of fibroid, that my uterous has been distorted by the multiple fibroids so it will be difficult for me to conceive but i insisted that maybe it will be okay to remove the large troublesome ones and was then told that i had to lose a lot of weight, i currently weigh 92kg but had to drop to 80kg before i could undergo the surgery. I am now open to having a myomectomy but what would you suggest. I would ideally like to have a baby in the next year or so.

I have researched extensively on the internet and seen that women whose cases are worse than mine have succesfully undergone myomectomies even removing as much as over 30 fibroids and still had successful pregnancise

Please what would you advise or is it too late.

Thanks

N

You can certainly have a myomectomy and, with an experienced surgeon, pregnancy should be feasible after 3 months. However, the main issue for you will be that natural fertility declines with age. If you are willing to undergo IVF or even use donor eggs then myomectomy may be worth the time, expense and recovery. You should consider seeing a fertility doctor before surgery so that you have a plan right after surgery if you want to get pregnant. The longer you wait the more difficult getting pregnant will be.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged age fertility, fibroids fertility, myomectomy fertility | Comments (1)

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Hysterectomy for Fibroids with Minimal Symptoms

February 27, 2011 – 2:03 pm

Dear Dr.Parker:

I have just turned forty and I have recently had a pelvic ultrasound , which revealed four uterine fibroids, the largest being 8.6 cm in diameter (my uterus measuring 16 x 14 x 8cm).

I have never had children and have chosen not to in the future, my gynecologist suggested a hysterectomy based on that fact. I am really scared about this, as I was only in the hospital the first time ever in my life in 2009 to have my gall bladder removed. I have a conctraceptive implant Implanon, heavy bleeding only two days a month, but this has improved while taking iron tablets and vit B12 injections as perscribed for anaemia.

After reading your informative website, should I seek a second opinion? As I am not keen on the idea of making such a rash decision, I wish to make the right one.

I thank you for your kind attention.

There should be many options available to you , as outlined on my website, including the option of no treatment since the fibroids do not sound like they are bothering you. Hysterectomy should not be necessary and you should seek a second opinion from a gynecologist who can offer you the other options in order to see what is right for you.

See these webpages: https://www.fibroidsecondopinion.com/treatment-for-fibroids/

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

https://www.fibroidsecondopinion.com/uterine-artery-embolization/

I hope you find this information helpful,

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged fibroids, hysterectomy, laparoscopic myomectomy, minimal fibroid symptoms, myomectomy, second opinion for fibroids, watchful waiting | Comments (1)

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Irregular Bleeding and Fibroids

January 31, 2011 – 7:52 pm

Hello Dr. Parker,

I have been reading your website for the past few hours. I am very grateful to have learned so much about my condition.

I am a 42 year old female living in NYC who was diagnosed with 2 fibroids about 6 cm each. One of them is close to the uterine cavity. Right before I was diagnosed I noticed that my period was coming closer, every 23-24 days and it was lasting up to 7 days instead of the usual 4-5 days. In addition, I started to get cramps, which I never had before and this was when I went to my GYN who said I had fibroids. He suggested surgery but I was reticent. I started seeing a homeopathic doctor that put me on MYrrh tablets, Omega 3 pills, and Estro-factors and told me to cut out all meat, dairy, soy which I’ve been doing for the past 5 months. My period became lighter and lasted for a shorter time and the cramping decreased. I did another sonogram and was told that the Fibroids are stable, down by about .4 of a cm. However, in the last 2 months I have been bleeding (not heavy) on and off, all the time. I took something called STem The Flow for about 10 days and my period stopped. Then I started exercising and it came back again. Sometimes I drink tea or soup and that starts me back bleeding again. I have no pain but the bleeding will not go away. It is totally ruining my sex life, as I cannot have intercourse or exercise because of the intermittent bleeding. What can I do? Please help.

It is important that you tell your doctor about the irregular bleeding. Fibroids usually cause heavy bleeding. Irregular bleeding is usually from hormonal swings, but the lining cells of the uterus should be checked to make sure no polyps or overgrown lining cells (it is extremely rare for this to be precancer or cancer) are causing this problem.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged fibroids and heavy bleeding, fibroids and irregular bleeding | Comments (1)

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My Doctor Says My Growing Fibroid Could Be Cancer

January 31, 2011 – 7:20 pm

Dear Dr. Parker,

Thank you very much for your website. I have benefited from it.

I am 50 and still having regular periods. I have had a pelvic and pap every year since I was 16. I had one in June 2009, and then the next one in October 2010 with a new gynecologist who identified a uterine fibroid, which an ultrasound confirmed to be the size of a grapefruit. I am to have another ultrasound in 3 months. My gynecologist is concerned this it could be cancerous, basing this on the fact that a fibroid was never detected in previous exams. She mentioned a hysterectomy.

In reading your articles, it seems plausible that a fibroid could grow to the size of a grapefruit within 16 months and not be cancerous. Actually, studies seem to indicate that less than 1% of uterine fibroids are cancerous.

I am not bleeding heavily. I do have what feels like a bit of a “stitch” in my side which I presume to be this fibroid, but I have no pain worthy of requiring surgery.

I know this is not much information for you to base an opinion on, but I would like to hear your thoughts on this matter. I don’t want surgery, and I can live with a fibroid as long as I am not jeopardizing a possible cancerous tumor. It’s the “cancer” word that scares me. Otherwise, I would think nothing of having a fibroid.

Thank you again for providing this website.

In a study we published, the risk of sarcoma (cancer of the uterine muscle) was 2/1000. It is much more likely that this is a growing fibroid. There is a protocol that has helped me rule out sarcoma – it is described on this page: https://www.fibroidsecondopinion.com/fibroids-and-cancer/

I hope this is helpful,

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged doctor recommends hysterectomy, fibroids and cancer, growing fibroid | Comments (2)

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New Abdominal Myomectomy Video

January 27, 2011 – 8:32 pm

I am posting an edited video of an abdominal myomectomy. The uterus was 20 weeks size and contained 18 fibroids. The video has been edited to 5 minutes and shows two fibroids being removed, suture closure of the uterine muscle and the use of Seprafilm adhesion barrier. The video appears as part of the section titled: “Are Some Fibroids Too Big for an Abdominal Myomectomy?”

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

Readers are welcome to post comments or questions on this blog entry about the procedure.

(NOTE: Video shows very graphic footage of an actual surgery)

By Bill Parker, MD | Posted in Announcements | Comments (2)

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The effect of myomectomy on health-related quality of life of women with fibroids

January 3, 2011 – 6:15 pm

Authors: Dilek S, Ertunc D, Tok E, Cimen R, Doruk A.

Journal: Journal of Obstetrics and Gynaecology Research 2010; 36:364–369.

Study From: Mersin University School of Medicine, Turkey

Problem: There are very few studies that report on the improvement in quality-of-life following fibroid treatments, and virtually none following myomectomy.

Study: A standardized health-related quality-of-life questionnaire was filled out before, and 6 months after, myomectomy in 72 women with fibroids. These results were compared with the questionnaires from 75 women without fibroids.

Results: At the beginning of the study, women with larger fibroids had worse quality-of-life than women with small fibroids or women with no fibroids. Following myomectomy, significant improvement in physical role (physical interference with work and daily activities), bodily pain, general health, vitality (energy), social function (interference with social activities) and emotional role (emotional interference with work and daily activities) were noted. Physical functioning (dressing, bathing) and mental health (depression) were similar before and after surgery.

Author’s Conclusions: The findings from this study suggest that myomectomy improves health related quality-of-life.

Dr. Parker’s Comments: Despite 50 years of myomectomy surgery, this is the first study to carefully evaluate whether women actually feel better as a result of having a myomectomy. So, now we have studies of women following treatment with UAE, myomectomy and hysterectomy that show improvement in quality-of-life. As I said on an earlier post, this leaves the decision about which treatment to have up to each woman, since these three treatments all help. And, since I perform mostly myomectomy surgery, this study validates what my patients have been telling me for years – they feel great after myomectomy.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged feeling better after myomectomy, improvement in health following myomectomy, improvement in pain following myomectomy, mental health after myomectomy, quality-of-life following fibroid treatments, quality-of-life following myomectomy | 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.