Uterine Fibroids Blog — An Expert Speaks Out

Abby was 37 in 2006, when she came to me with extremely heavy periods.

She felt heavy pressure from her growing uterus, and she was so anemic that she almost needed a blood transfusion. I ordered an MRI, which show too many small fibroids to count. The largest fibroid was only 3.5cm (about 1 1/2 inches) and the uterus was like a big bag of small marbles.  I did office hysteroscopy to look directly inside the uterus, and this confirmed that there were numerous submucous myomas on the inside of the uterus as well as in the walls.

Photo shows “too numerous to count” small fibroids.  Read on to learn about Abby’s decision making process. Read the rest of this entry »

Shortly after posting Michelle’s story (below) and family picture she sent me the following note. I thought it best to share it directly.  — Paul Indman, M.D.

One correction that Dr. Indman may/not choose to make to the story (I think it’s important) is that I was not originally referred to him by my OB after a trip to the ER. My OB did not help me at all after that trip to the ER, so  Derek [Michelle’s husband] found Dr. Indman on-line (we wanted a second opinion from someone who was an expert on fibroids). I think it’s important because the doctor I was using at the time basically sent me on my way with bleeding so severe I couldn’t even stand up without losing large amounts of blood.  Dr. Indman not only immediately correctly diagnosed the problem, he helped me solve it while preserving my fertility options.

Thanks.

Michelle

Medical Journal Article

Tranexamic Acid Treatment for Heavy  Menstrual Bleeding

Andrea Lukes et al.: Obstet Gynecol. 2010 Oct;116(4):865-75.

Tranexamic acid has been used around the world for over 20 years to treat heavy menstrual bleeding. It was recently approved by the FDA in the U.S., and is sold under the trade name LYSTEDA™. In this study 196 women were randomized to receive either LYSTEDA™ or a placebo (sugar pill).  36% of women in each group had fibroids. Menstrual blood loss was measured before any medication and after taking either LYSTEDA™ or the placebo.   Read the rest of this entry »

A 43 year old woman came to me with irregular bleeding despite being on birth control pills.  She had a Mirena® IUD inserted previously, which failed to stop her irregular bleeding. We did an office hysteroscopy, and saw the IUD resting on the fibroid.

Mirena IUD next submucous fibroid

The IUD was removed.   Since she was not planning any more children, we removed the fibroid by hysteroscopic myomectomy, and did an endometrial ablation at the same time as an outpatient procedure.

Comment:   The Mirena®  IUD (LNG-IUS) is often effective in treating heavy periods, but a fibroid inside the cavity can interfere. I always recommend doing a simple ultrasound exam in women with abnormal bleeding before deciding on a treatment.  Other studies such as diagnostic hysteroscopy may also be done, as only with proper diagnosis can appropriate treatment be planned. In her situation a simple outpatient procedure was able to solve her bleeding problem.

Dr. Indman performed two procedures for me at the same time – a hysteroscopic myomectomy and an endometrial ablation. From the pre-op to post surgery, I did not experience any pain or a single cramp. I was back to work the next day and back on my regular workout schedule within two weeks. After three weeks, I went on a cycling vacation and rode 350+ miles over hilly terrain. I felt great! Without the surgery, there was no possible way I could have done this. For the first time in 1 1/2 years, I am not experiencing heavy bleeding and checking where the nearest bathrooms are.

My experience with Dr. Indman and his staff have been nothing short of fantastic. Dr. Indman is a warm, caring, highly skilled surgeon – with a fun sense of humor to boot! He is one of those rare gems in the medical profession today – someone who truly puts patients first. I found Dr. Indman while researching my symptoms on the Internet. The wealth of helpful information on his website gave me a lot of confidence even before I met him. His deep expertise and decades of experience are evident from his thorough examinations and explanations.  — S.K.

Comment:  S.K. had a submucous fibroid, which was treated by hysteroscopic myomectomy and endometrial ablation as an outpatient.  Here are actual pictures from her surgery.  The first shows the fibroid on the right side of the uterus, with the loop that will be used to remove it.  The second shows the fibroid having been removed, and the third is after endometrial ablation.  I do the endometrial ablation under direct vision to be sure that no areas are missed.

It is not unusual for women to resume most normal activities within a day or two.  Careful patient selection and utmost skill are required for a safe and successful procedure. — Paul Indman, M.D.

Update:  12/14/2010: S.K. came in for a 4 month check after her procedure, having recently run a marathon.   She said that she kept thinking that without the surgery running a marathon would have been impossible.

I suffered for many years with uterine fibroids and experienced very heavy bleeding during periods. I was very fearful about having the surgery, and was very concerned I may lose my uterus. I met Dr. Indman through a referral, and was very impressed with his professionalism, compassion, experience and successful track record with this type of surgery. I felt like he really cared about me as a person and cared about my concerns. Read the rest of this entry »

I recently saw J.L. with severe anemia. Her uterus was the size of a 16 week pregnancy.  She was having regular but heavy periods.  An MRI showed an 11 cm. (cantaloupe size) fibroid. Read on to learn how she may be able to avoid surgery. Read the rest of this entry »

March 9, 2010 a 46 year old woman came to me having been told that she needs a hysterectomy because of heavy bleeding from her fibroid. She wanted to know her options.  Ultrasound showed a tennis ball size fibroid that was 2/3 in the uterine wall and 1/3 in the cavity of the uterus. We confirmed the ultrasound by doing an office hysteroscopy, where we could see the fibroid protruding into the cavity. Read on to learn about her options and see photographs of her treatment. Read the rest of this entry »

Today I saw Jan, who had her abdominal myomectomy four months ago.  (See Jan’s story and photos of her surgery). Today her hemoglobin (blood count) is 13.3, which is normal and up from 5 when she first came in.  She returned to work in two weeks and felt fully recovered in four weeks.  Her periods are now normal and light.  Her only regret is that she waited so long to have her surgery!

Comment: Many women suffer needlessly because of their fear of surgery. Most women find that the fear of surgery is far worse than the actual procedure.  Many women tell me that their periods (when they had the fibroids) were far more disabling than the surgery to correct the problem. This is not to say that surgery is always easy… just that the solution may not be as difficult as the problem you are living with.  — Paul Indman, M.D.

A 37 year old woman came to me in July, 2009 with a prolapsing 8 cm. fibroid. She had been seen by her HMO doctors multiple times for heavy bleeding, had 15 ultrasounds, but nothing was done.  An MRI showed an 8 cm. (grapefruit size) fibroid low in the uterus which appeared to be prolapsing (coming out of) through the cervix.  Since she wanted another child, she did not want to have a hysterectomy, which was the only option she was given.

On exam, I could feel the fibroid coming through the cervix and filling the vagina.  Most of the time prolapsing fibroids can be removed vaginally.  Continue to see photos of her surgery.  Read the rest of this entry »