QuestionHello Dr. Rappaport,
My name is Alfredia. I am a 40 year old childless black female. My last menses began 10/03/05. I desire to have two children. I understand that I am in my late child bearing years, and may not be able to conceive again. But, I want to try before it becomes impossible due to menopause. About seven years ago I did become pregnant. This was my first and only known pregnancy. I miscarried in the first 1-2 months of pregnancy due to my fibroidal uterus. I have two large fibroids. The biggest one is pendunculate and thin stalked on the top of the uterus measuring 10.6cm X 14.4cm X 14.8cm, and the other is inside the uterus measuring 6.7cm X 7.9cm X 8.7cm. Fortunately, my two large fibroids do not and have never caused my physical pain. My fibroidal symptoms are constant abdominal pressure, frequent urination, and a protruding right abdomen. I have been dealing with this problem for many years; thus, I am very aware of all the medical options available to me to rid myself of the fibroids, such as myomectomy. About six years ago, in an attempt to get pregnant, I went on Lupron for five months. Within the five month Lupron Theraphy, the fibroid in side the uterus totally went away, and the pedunculated one shrunk to about half its previous size. My OBGYN was very pleased at this result. But, unfortunately, my husband was called overseas and this halted the attempt at pregnancy. Within three months, the fibroid in side the uterus had grown back, surpassing its original size. This was no surprise to me due to being informed by my doctor that the Lupron effect is temporary. I know that the fibroid inside the uterus is the one effecting fertility, not the one on the outside. To achieve my goal of getting pregnant, if at all possible, I want to avoid surgery. In order to try and possibly get pregnant, I want to try to again shrink the fibroid in side the uterus. The Lupron had absolutely horrible side effects, including severe night sweats, abrupt mood swings. By far, the worst side effect is that my libido went to zero desire. My libido or my then normal desire level for sex returned about fifteen months later, but never to the same level. This was very difficult on my marrital sex life. Can you please tell me if there is another drug besides Lupron that has the same effect of Lupron on temporarily shrinking fibroids, but not the effect of severely taking away libido?
Thank you,
Alfredia
AnswerAt the present time, Lupron is the only medication that will do what you wish. As you said, the pedunculated fibroid on the outside of your uterus does not pose any problem. The fibroid in your uterus is the problem. We usually give Lupron and follow the fibroid with sonograms until it has gotten very small. Then we suggest that you try to conceive as soon as it has gotten small, because, as you are aware, the fibroid will, indeed, grow back (as long as you are producing estrogen in your body). I would suggest getting a sonogram prior to starting Lupron just to know where you are starting. As you approach 50, fibroids can shrink on their own. Unfortunately, different women react differently to the Lupron and I can't say that you will not have the same symptoms as before. Good Luck. You can also have a myomectomy, become pregnant, and deliver by cesarean section. That would not decrease your libido or give you night sweats or mood swings.
