Uterine Fibroids Blog — An Expert Speaks Out

When I first saw Dr. Indman in October 2009, I was seeking a second opinion. The gynecologist I had been seeing for about 10 years, and who had originally diagnosed my fibroid, told me that in her opinion I should have my uterus removed. She had been monitoring my fibroid by doing ultrasound exams every six months for about six years. The ultrasound images showed the fibroid had been growing slowing during that period.

So she was alarmed when she compared the ultrasound she did in March 2009 to the one she did in September 2009; she saw that my fibroid had been growing quickly during that six months. At her direction, I had an MRI. When she received the results of the MRI, she felt she couldn’t “rule out cancer.” That’s when she called me to recommend a hysterectomy.  I immediately phoned my husband. I was still in shock, and my husband asked if I wanted to get a second opinion. Indeed I did!

The idea of having my uterus surgically removed did not sit well with me for many reasons. Although having children was no longer an issue, I recoiled at the idea of having surgery that might not be necessary. From what I knew of fibroids, I didn’t think it was very likely that this was cancer. I felt extremely healthy and had no pain or other symptoms. I also wanted to prevent the trauma to my body and to my sense of self that I knew would come with a hysterectomy. And lastly, I am self employed, so if I don’t work I don’t make money. The recovery time would have been a period of zero income for me.

The day I was told I needed a hysterectomy, I hopped on the Internet and learned as much as I could about fibroids, treatment, the aftermath of a hysterectomy and the possibility that what I had could be cancer. I learned a great deal from one site, www.myomectomy.net. What I read there educated me and also validated some of the things I was already thinking.

That web site provided information about Dr. Indman, and I was surprised and happy to find out that his office is only a half-hour drive from my house. I called his office the next morning and made an appointment to see him that same week. I was told to bring the recent MRI results, radiologist’s report, and ultrasound results with me. At that first appointment, Dr. Indman talked to me; conducted a thorough physical examination, including an ultrasound; and studied the MRI results, radiologist’s report, and previous ultrasound results. He explained that based on statistics, the chance of my fibroid being cancerous was quite slim. We agreed that I would come back for another ultrasound a month later. The results of that exam  showed no growth of the fibroid.

In a follow-up ultrasound with Dr. Indman six months later, he found that the fibroid was actually a little smaller than it had been. I was delighted when he finished the exam and said, cheerfully, “Another hysterectomy bites the dust!”

One last thing about Dr. Indman. In addition to his professional abilities and his many years of experience, he has a very pleasant manner with patients. I greatly appreciate the respect with which he treats me. He wants me to be involved in my own care, and he listens—really listens—to what I have to say. And he answers my questions thoroughly. I’m very glad I went to him for my second opinion.

— Kate

A  47 year old woman with “rapidly growing uterine fibroid”. P.D.M.  contacted us because she was told she had a rapidly growing fibroid.  She wanted to avoid a hysterectomy, but in her home state of Wyoming was only offered hysterectomy with removal of both ovaries because of the possibility of cancer.  Several years ago she was noted to have a small myoma on ultrasound, but it appears to have grown rapidly in the last year.  She noticed some pelvic pressure but no abnormal bleeding.

When she contacted my office we suggested that she get an MRI, which showed a 10 cm. (4 inch) mass in the uterus will cystic (fluid filled) areas (which are white), suggesting a degenerating fibroid.  (This is a fibroid that has outgrown it’s blood supply.)  Her MRI is shown to the left.

We discussed options, and the very low risk that this could be cancer.   With that knowledge, she chose to come for a myomectomy.

P.D.M.’s myomectomy is shown in the photographs.  An incision was made that was smaller than the fibroid, but it was possible to remove the fibroid through this incision.

Once the fibroid was partially removed it was possible to lift the uterus through the incision to aid in removing the fibroid entirely.

Here is the removed fibroid, which has been cut open to show the fluid filled areas.

The pathology report showed a benign degenerating uterine fibroid.

She left the hospital on the second day after surgery, and was able to return to Wyoming the following week.

Dr. Indman’s Comment:  P.D.M. was advised to have a hysterectomy because of concern that she may have had Leiomyosarcoma, or malignant fibroid.   A sarcoma is serious, but fortunately they are uncommon.  There is no evidence that benign fibroids can become malignant.   One large study has shown the risk of cancer in rapidly growing fibroids to be 0.26%, or about 1 in 400.   As 70-80% of women have fibroids (although many are too small to notice), and malignant fibroids are rare, it is hard to justify removing most fibroids or doing a hysterectomy because of the possibility of cancer.    In my patient’s situation the fibroid was growing rapidly and causing symptoms, so she chose to have it removed.

The decision to remove the fibroid or do a hysterectomy in a 47 year old woman who is not planning to have children is personal, and there are advantages and disadvantages to each approach.  In the very unlikely chance that a malignancy is found, a hysterectomy would of course be necessary.  On the other hand, we would be doing hundreds of hysterectomies for benign fibroids to find one that had cancer.  In addition,  I would strongly recommend against taking out her ovaries, as the increased risk of heart disease, osteoporosis, and other problems outweigh the risk of later developing ovarian cancer.

I feel that my role is to explain all of the reasonable options available to women, and help them make the best decision for their own lifestyle.  As P.D.M.  felt emotionally that she wanted to keep her uterus, and there was no medical need for a hysterectomy.    The fibroid was easily removed while leaving her uterus.

Read what P.D.M. writes about her experience!