In October, 2009 I saw Kate, a 50 year old woman who was told that she needed a hysterectomy. In March 2009 a 3.5 cm (about 1 1/2 inch) uterine fibroid was found by her gynecologist. She was on low dose birth control pills at the time.
On Sept 23, 2009 she was told that the fibroid was 7.2 x 6 cm. She had no symptoms at all. No pain, no pressure, no abnormal bleeding. Her gynecologist told her that the fibroid was growing rapidly, and could be cancer, so she needed an immediate hysterectomy.
I first saw Kate on October 1, 2009. At that time I could feel a small fibroid next to her uterus. I did an ultrasound during which I saw a pedunculated myoma (a fibroid on a stalk) measuring 6.9 x 4.6 cm. Knowing that the risk of cancer is extremely low, we decided to monitor the size of the fibroid closely rather than rushing into surgery.
November 1, 2009. I rechecked the fibroid with ultrasound and it measured 6.5 x 5.1 cm. Essentially the same size.
April 5, 2010: Her fibroid measured 6.3 x 4.7 cm. (a slight decrease in size). As she was 51, we decided to stop the birth control pills and will do lab work (FSH) to determine if she has reached menopause.
Dr. Indman’s Comment: This situation is something I commonly see — a woman has a fibroid detected and told that she needs surgery because it is rapidly growing. In Kate’s situation she had an ultrasound that showed that it really was growing, although frequently these “new” fibroids” have been there for a long time and have just been missed on exams.
The risk of cancer in rapidly growing fibroids is approximately 1 in 400. Understanding that there is a very small risk of cancer, we decided that close monitoring was reasonable. As Kate’s fibroid has actually decreased in size, it is extremely unlikely that she will need surgery.
Economics: Kate would have only had to pay 20% of her insurance company’s “preferred provider’s” contracted rate for the unnecessary hysterectomy. She also would have lost 6 weeks salary off of work, and had an operation that she did not need. The cost of an expert evaluation was far less than 20% of a discounted operation she did not need!