Do you need surgery for your fibroids?
Fibroids are non-cancerous growths that develop from the muscle of the uterus. They’re incredibly common. In fact, by age 50, most women will have at least one fibroid.
The important thing to understand is that having a fibroid and having symptoms from a fibroid are not the same thing. So here are the top three questions I need to answer before I help a patient make a decision about their fibroids.
Question #1: Is the fibroid actually bothering you? Common symptoms include: heavy bleeding, bleeding between periods, pelvic pressure, frequent urination, constipation, pain and in some cases infertility or recurrent miscarriage. Still, if you’re not having symptoms, surgery may not be necessary. I've had many patients whose fibroid is an incidental finding, like it was found on a CT scan when something else was being evaluated. If you never knew about it because of no symptoms, surgery may not be necessary. One of the hardest things for patients to hear is that we may simply watch a fibroid. But medicine isn’t about treating the CT scan images. It’s about treating people.
Question #2 Where is the fibroid located? This is something patients often don’t realize.Location is often more important than size. Remember fibroids are like real estate, location is usually the most important factor. Keep in mind that there are different locations fibroids can be within the uterus, pedunculated meaning with a stalk on the surface, subzero, which is just right under the surface intramural which is in the muscle layer and submucosal, which I hate the most is within the cavity and it can definitely cause more symptoms. To review the location of fibroids in detail check out my Fibroids 101 video below. The takeaway point is, you can have a relatively small fibroid inside the uterine cavity causing severe bleeding and fertility problems, while a much larger fibroid on the outside of the uterus causes almost no symptoms.
Question #3 What are your goals? This question changes everything. Do you want future pregnancies? Are you done having children? Do you want to avoid surgery? Do you want the most definitive treatment possible? I remember seeing one patient who had more than 10 fibroids removed a few years before I met her and she had a long recovery, was hoping for relief which she got for a while but unfortunately 10 new ones grew back in a relatively short time and she was right back where she started. She didn't want to necessarily have anymore children, but was only offered a myomectomy and didn't know the risk of new ones returning. I am sure some of you listening went through the same thing. This is why knowing your goals and having your surgery understand them is important because The best treatment for one woman may be the wrong treatment for another. While the exact root cause of fibroids is unknown, we do know risk factors and ways to potentially reduce the risk. Check out my How to reduce your risk of fibroids video below!
So once these questions are answered there ends up being 4 categories that you can fall into and my Fibroid Treatment Scorecard can help you figure out where you land. The categories are Team Watch and Wait, Team Medical Management, Team Minimally Invasive Procedures, and Team Surgical Consultation. Take the quiz today to see where you land!!
This scorecard is for educational purposes only and is not intended to diagnose, treat, or replace medical advice. Fibroid treatment decisions should be individualized and made in partnership with your gynecologist and you can move from one category to the other over time.
