Dr. Parker's Fibroids Blog

Hurry – been told I need a total hysterectomy

March 22, 2010 – 8:30 am

I am a 47 year old woman who has never had children. I have recently been told I needed a hysterectomy after being seen by a oncolgist/gyn. I have a 2.5- 3 cm cyst on each ovary- neither are considered simple- one has some solid material and both are septated.

The MD seems to think they are benign. I have had 4 u/s’s since last July and the cysts have remained basically the same. On the last one 1 week ago, it was noted that my uterine lining was also thickened- no fibroids that I know of. I have not had a period since last September and blood work has shown me to be menopausal. I am not taking any hormones, but am taking Remifemin for hot flashes. My Past medical history includes taking infertility drugs (Clomid) X 3 cycles, with no pregnancies. My mother died of breast cancer at age 46- no other relatives with breast or gyn cancers.

If I have the surgery, it will have to be soon due to work issues. Can you please give me any advice as to other options? Thanks so much!

M

Most ovarian cysts are benign and it would be highly unusual for ovarian cancer to remain unchanged on ultrasound over 7 months. Uterine lining thickening is also usually benign and can be easily evaluated in the office with an endometrial biopsy.

I cannot give medical advice over the internet, but I think you should consider getting a second opinion from someone knowledgeable about ovarian cysts.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged ovarian cancer, ovarian cyst, ovarian cyst hysterectomy | Comments (0)

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Doctor Recommends Hysterectomy Without an Examination

March 18, 2010 – 2:36 pm

Good afternoon.

I just went to a new gynecologist for fibroids that I have and he immediately said when do you want to have a hysterectomy? I told him, “I was not ready for that and he immediately said “well then we will start you on Lupron.” At this point I am so confused, still in pain and he has all these suggestions but he did not even do an exam on me. He continued to tell me that my last gynecologist was wrong to remove the fibroids!

Bottom line is I want out of pain and to make sure this is not a more serious problem. Oh, he did say make an appointment in a month and he will do a biopsy of the uterus and check to see how things are going.

I am an RN and for once I am lost! I need a recommendation on what to do. Is there anything you would recommend for treatment? Would you do an exam on a patient before talking about any kind of treatment?

M

Yes, run from this doctor and get another opinion. It is unreasonable to make a recommendation without an exam, and there are certainly other options other than hysterectomy for women with fibroids. Find a gynecologist who takes care of women with fibroids on a regular basis.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged confused about fibroids, fibroids hysterectomy, lupron, no pelvic examination | Comments (0)

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Fibroids Effects on Pregnancy

February 7, 2010 – 9:49 pm

These are the conclusions of a lecture I gave at the 2009 Annual Meeting of the American Society of Reproductive Medicine in Atlanta, GA

1) About 18% of African-American women and 8% of white women have fibroids during pregnancy.

2) Only 30% of women have fibroids grow during pregnancy and most of the growth is within first three months.

3) The risk of fibroid degeneration that leads to pain and early contractions is very small (5%).

4) There is a small increased risk of early delivery (3 weeks or more) in women with fibroids (19% v 13% of women without fibroids).

5) There is a small increased risk of heavy bleeding after delivery of the baby in women with fibroids (8% v 3% of women without fibroids).

6) There is an increased risk of breech (13% v 8% of women without fibroids).

7) There is a greater risk of having a Cesarean Section (49% v 21% of women without fibroids)

8) There is essentially no risk of fibroids injuring the baby.

Also see this webpage: www.fibroidsecondopinion.com/fibroids-and-pregnancy

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged fibroid degeneration during pregnancy, fibroid growth during pregnancy, fibroids and pregnancy, fibroids injuring baby, risks of fibroids during pregnancy | Comments (0)

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What questions about hysterectomy alternatives should I ask my gynecologist?

January 20, 2010 – 8:29 pm

I will be seeing yet another gynecologist (third opinion) for menorrhagia and severe anemia supposedly due to one large submucosal fibroid. However, my last sonogram showed two smaller growths with one ulcerated and the endometrial biopsy showed polyp tissue so I really don’t know what is going on. All previous doctors have offered me only one option – total hysterectomy with ovary removal. They are not interested in further diagnostics, I guess because of my age. I am 55 and have skipped a number of periods. In the last year however when I do have one it is extremely heavy. I really don’t want a hysterectomy and feel that I always have to fight to even get my thoughts heard by doctors. I need to know what specific questions to ask the new doctor so that I might be offered some other options?

G.

I agree that hysterectomy should be a last resort. First, you need to know exactly where the fibroid is. An MRI or saline-infusion sonogram is much better than regular ultrasound at this diagnosis. If the fibroid is mostly in the cavity and less than 5 cm, it can probably be removed by hysteroscopic myomectomy: see https://www.fibroidsecondopinion.com/hysteroscopic-myomectomy/

If this is not possible, then a myomectomy, either laparoscopic or abdominal, should then be possible. See: https://www.fibroidsecondopinion.com/abdominal-myomectomy/

Unless you have a family or personal history of ovarian or breast cancer, the current thinking is that the ovaries may provide long-term health benefits.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged endometrial polyps, hysterectomy with ovary removal, menorrhagia, severe anemia, submucosal fibroid | Comments (0)

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Question on “mini” laparoscopic surgery

January 20, 2010 – 8:24 pm

Hello!

I have a fibroid that is uncomfortable due to bulk and extends length of menstruation (7-9 days at least). I recently saw a fertility specialist who did an exam and recommended a “mini” laparoscopy to remove the fibroid. The doctor said the “mini-lap” would involve a three inch (approx) incision at the bikini line.

Can you explain the difference between the mini-lap and regular laparoscopy? Including the typical size of a bikini line incision (if one is involved)?

Thank you in advance.

G.

A mini-lap is the term used for mini-laparotomy. As you describe, a mini-laparotomy involves a 2-3 inch incision above the pubic bone and uses standard surgical instruments and technique. Laparoscopy uses 3 or 4 much smaller incisions (1/2 inch each) and uses long instruments passed through these incisions to perform the surgery, which is viewed on a large video monitor. See the illustrations here: https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/ compared to here: https://www.fibroidsecondopinion.com/abdominal-myomectomy/

I hope this is helpful,
Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged bikini incision, laparoscopy, mini-lap, mini-laparotomy | Comments (0)

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Large Fibroids Can Be Removed by Myomectomy

January 20, 2010 – 8:21 pm

Dear Dr Parker,

I am a forty year old female living in Australia and recently tests have shown that I have a very large fibroid growing on the Uterus Muscle. The fibroid is 17.5cm X 16.3cm X 6.8cm. I am worried that so far most have the notion that I would require a full hysterectomy in order to remove the mass. About four years ago I had GBS and now suffer from chronic fatigue and I am scared about having a hysterectomy. Have you removed fibroids this large from woman without the need of a full hysterectomy? I look forward to your reply…

Kind Regards

D.

Yes, a fibroid this size can be removed by abdominal myomectomy with a bikini type incision. I have removed even larger fibroids this way. A hysterectomy is not necessary.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged hysterectomy, large fibroid, myomectomy | Comments (0)

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Should I rush into surgery?

January 20, 2010 – 8:17 pm

I was diagnosed with a 8-cm fibroid only today (13 Jan), after doing an ultrasound, and my gynecologist whom I was seeing for the first time, has scheduled my surgery to be done 13 days later without telling me much about the surgery.

Is this too rushed? Do I need to consult another Doctor before deciding on the surgery? I found out from the staff of the hospital which my gynecologist is working at that she has 8 years of experience and has just been promoted to have her own clinic in the hospital. So, I feel a bit uneasy.

Please kindly advise.

M.

Yes, you need more explanation from the doctor. First of all, the fibroid may not need to be removed at all unless you are having bothersome symptoms. Second, most of the time an 8 cm fibroid can be removed laparoscopically in the hands of an experienced surgeon. See this page: https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/

Laparoscopic myomectomy has the advantage of outpatient surgery and a fast recovery. I always think a second opinion is a good idea if you are recommended to have surgery.

Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged choosing a doctor for surgery, fibroid surgery, fibroid treatments | Comments (0)

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Hysterectomy and Other Treatments for Adenomyosis

January 20, 2010 – 8:11 pm

I was diagnosed with adenomyosis and my Dr. suggested to do a partial hysterctomy.. Is this the right thing to do.. I’m worried of what to feel after, if it will affect my sex life, will it really make a difference and if not what can happen if I don’t get the hysterectomy done?

Thank You,

N.

The best way to diagnose adenomyosis is with MRI, so hopefully you have had this done to be sure. Unfortunately, hysterectomy is the only 100% cure for painful periods and irregular bleeding associated with adenomyosis. The progesterone IUD has about a 60% success rate and embolization has about a 50% success rate, so those are also options.

If you do not have a hysterectomy and other treatments fail, then you will continue to have whatever symptoms you have now. You can read more about hysterectomy and sexuality here: https://www.fibroidsecondopinion.com/hysterectomy-for-fibroids/ under the heading “Is There Any Benefit to Leaving the Cervix in Place?”

I hope this is helpful,
Bill Parker, MD

By Bill Parker, MD | Posted in Answers to Patient Questions | Tagged adenomyosis, hysterectomy, sex after hysterectomy | Comments (0)

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Fibroid Research Update from the American Society of Reproductive Medicine Conference

January 11, 2010 – 6:39 pm

I recently gave two lectures (Recent Advances in Fibroid Surgery and Fibroids and Pregnancy Outcomes) at a fibroid postgraduate course given for the ASRM annual meeting in Atlanta.

Dr. Bill Catherino, head of a fibroid research group at the NIH, presented new findings about what causes fibroids to grow and what possible treatments, diets, environmental changes might be used to reduce the health impact of fibroids. The less-than-good-news is that none of the following research was performed in humans, so the results are very preliminary.

Hormonal Influences

Women with fibroids have normal blood levels of estrogen and progesterone. Estrogen dominance does not cause fibroids.

Fibroid cells can make their own estrogen, so the level of estrogen inside fibroids is higher than in blood or other tissues.

Estrogen and progesterone receptors, parts of the fibroid cells that cause them to respond to estrogen and progesterone, are more prevalent in fibroid cells than normal uterine muscle cells.

Fibroids have more collagen than normal uterine muscle cells and more glycosaminoglycans (GAG). GAGs draw water into the cells and make them swell. Lupron causes a decrease in GAGs, which dehydrates the fibroid cells and causes shrinking of the fibroids. When Lupron is stopped, the cells take on water again and swell again.

Dietary Factors

Vitamin D – decreases fibroid cell size and disrupt the formation of fibroid muscle cells.

Resveratrol (found in grapes) – decreases growth and increases death of fibroid cells in a test tube.

Curcumin (spice) – decreases growth and increases death of fibroid cells in a test tube.

Licorice (isoliquiritigenin) – decreases growth and increases death of fibroid cells in a test tube.

Green Tea (epigallocatechin gallate) – decreases growth of fibroid cells in a test tube.

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged curcumin and fibroids, estrogen dominance, estrogen levels and fibroids, fibroid growth, fibroids and diet, green tea and fibroids, licorice and fibroids, vitamin d and fibroids | Comments (1)

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Dr. Parker and Telesurgery

December 10, 2009 – 2:16 pm

On November 19th, gynecologic surgeon William Parker, MD, performed live telesurgery from Saint John’s Health Center for the World Congress of Minimally Invasive Gynecology that was meeting in Orlando, Florida. The broadcast consisted of a laparoscopic myomectomy (remove uterine fibroids using a laparoscope) and was transmitted to an audience of over 1,000 gynecologists from over 60 countries who were attending the conference.

“I am just so pleased with the live telesurgery demonstration,” said the Conference Program Chair C.Y. Liu, MD. “Dr. Parker did such a wonderful job – he mesmerized the entire audience with his fluid and skillful live demonstration of how the laparoscopic myomectomy could be used and should be done. I am thankful for his willingness to share his expert surgical technique with us.”

During the procedure, Dr. Parker explained what he was doing as he operated, and he answered questions from the audience as well as for the doctors watching over the Internet around the world. This surgery was the first time the American Association of Gynecologic Laparoscopists had used the Internet to transmit a live surgery. A short, edited video of the procedure may be viewed at https://www.fibroidsecondopinion.com/laparoscopic-myomectomy/.

httpv://www.youtube.com/watch?v=Fvw3dUesfdI

“Minimally invasive fibroid surgery offers the benefit of outpatient surgery with minimal discomfort and seven to 10 days to full recovery,” Dr. Parker said about the procedure. “Women really benefit from these advantages and they appreciate a quick return to their daily lives.”

By Bill Parker, MD | Posted in Recent Fibroid Research | Tagged American Association of Gynecologic Laparoscopists, laparoscopic myomectomy, telesurgery, World Congress of Minimally Invasive Gynecology | Comments (1)

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