Uterine Fibroids Blog — An Expert Speaks Out

Michelle with her sons

I first saw Michelle when she was 35 in 2005.  She had her first myomectomy at the age of 26 and her second at the age of 33.  She was sent to me by her Ob-Gyn after an ER visit for severe bleeding.

I did an ultrasound on the first visit, and there was fluid in the uterus which outlined a large submucous fibroid. The bulk of the fibroid was in the wall rather than inside the cavity of the uterus.  Because of the location I felt hysteroscopic treatment was inadviseable.  Although we were concerned because she already had two abdominal myomectomies (elsewhere), I did her third myomectomy.

I did an ultrasound in September, 2006 showing a healthy 10 week prgnancy.  Michelle delivered her first son by cesarean in 2007. Her OB noticed some scar tissue inside her uterus at the time.  I later did an office hysteroscopy to clear this and a small amount of retained placental tissue and treat the scar tissue.  In October, 2010, she returned with another healthy early pregnancy.

Comment:  Michelle came in today with her 4 year old son, her 4 month old baby, and a picture of them taken when he was just born.  Even if you have had prior surgery don’t give up hope without seeing an expert in the treatment of fibroids.

Aisha was 38 when I saw her in 2007 with a long history of infertility and fibroids making her look 5 months pregnant.  She underwent a myomectomy in which 31 fibroids were removed.  She had a normal pregnancy and delivered a healthy boy by cesarean.   She recently came in with her 16-month old son.

When I originally saw her her uterus was the size of a 20 week pregnancy. An MRI showed multiple fibroids.  She underwent a myomectomy to remove the fibroids. 

Her uterus, before the removal of fibroids, and the fibroids that were removed are shown below.

Now, four years after her myomectomy and successful pregnancy her uterus is normal size.

Comment:  Some of my most satisfying moments as a gynecologist are seeing women who thought there was no hope for having children come in with their babies.  — Paul Indman, M.D.

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 »

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 »

Deborah, a 54 year old woman from the Midwest, called stating that her uterus had multiple fibroids which have grown over the last two years, and she wanted to avoid a hysterectomy for personal reasons. She was having regular menstrual periods and lab work (FSH) showed that she was not yet menopausal, and was quite uncomfortable from the pressure of her huge uterus and heavy menstrual bleeding.  An MRI was ordered, in which over 30 fibroids were identified.    (Sticky post) Read the rest of this entry »

Read about and see photos of Jan’s abdominal myomectomy

March 09, 2010 was the first time I met Dr. Paul Indman for a second opinion on fibroid treatment. I’d been searching for the specialist in this field in Bay Area since September 2009, when I was told by my general OB/GN doctor my fibroid was so big (11cm by ultrasound and my tummy as big as 16~18 weeks pregnant ) that I need to consider surgery. She talked about the rapid growth of my fibroid (in January 2009 it was 8cm) that would possibly be sarcoma (cancerous) that I would need to remove the whole uterus. I was not comfortable by this conversation and just replied that I need to find a second opinion before I make a decision (I don’t blame my general OB/GN doctor in any means, in fact she’s helped me all the time for woman issue and helped me on my childbirth with a C-section in 2006). Luckily in the beginning of this year, I found Dr. Indman’s website and read all the articles there and found they all make sense. So I made a phone call to his office for the appointment.

I was already very anemic at the time Dr. Indman first saw me. My hemoglobin was only 5 (normally 12 ~16). And he diagnosed me with ultrasound and confirmed the big fibroid. So he treated me in two steps: first, heal my anemia first by controlling my blood loss during menstrual period and second, do the surgery to remove the fibroid. When the second time I saw Dr. Indman in about a month, my hemoglobin has increased to 11.3. The first step treatment seems very encouraging so we scheduled the surgery.  May 10, 2010, I had my abdominal myomectomy surgery by Dr. Indman and I stayed in hospital for two days.  Now I’m home and it’s the fifth day after my surgery.

When I’m looking back what has happened in the last two months, my heart is filled with gratitude to Dr Indman and his staff team. I’m very satisfied to the outcome of the treatment and convinced with his expertise and skills, his truly caring to patients. I know surgery is not an easy decision to everyone. From my experience, my piece of advice would be to find the doctor that you think you’re really comfortable to work with.

Sincerely,

Jan F.

At the time I was starting this blog two patients with similar fibroids came to see me. Both were severely anemic, and one was hemorrhaging and in shock.
Before any procedure was done I received both patients’ permission to share their stories.  At the time of the initial writing one had treatment 6 weeks ago and one 3 weeks ago.  Neither of their experiences to date are necessarily typical, but I am following through on my commitment to share their stories.

Comment:   (Updated 6-17-2010)

Yesterday was a difficult day. We did surgery on my first patient (who had the embolization) and found a high-grade sarcoma (cancer) which had spread throughout the abdomen. I talked to her about deleting her story, but she was comfortable with leaving it in.  Uterine sarcoma is very uncommon, being seen in fewer than 1 in 500 rapidly growing fibroids. The risk of cancer is much lower for fibroids that are not rapidly growing. Benign fibroids have never been shown to undergo malignant change.

Could this have been diagnosed earlier, and if so would it have made a difference? Probably not.  There is a single study in which a blood test coupled with a special MRI done with IV contrast rapidly infused differentiated between sarcoma and fibroids.  To my knowledge this has not been confirmed by other studies, and by the time the tumor can be diagnosed there is a high probability that it would have already spread.

It is easy to overreact and be overly aggressive in removing fibroids because of the fear of cancer, which is in fact rare. We would be doing hundreds of unnecessary surgeries to find a single sarcoma.  Yes, had she chosen myomectomy or hysterectomy, we would have diagnosed her sarcoma two months earlier, but it is unlikely that the outcome would be different.  I was tempted to remove this story for fear that it would frighten women into surgery that is not needed.  But I promised to tell the story as it is.  Please understand that this is very unusual, and most women do well when embolization is done in appropriate situations.  — Paul Indman, M.D