QuestionI have a follow-up question regarding a portion of your response: "If the fibroid is thought to obstruct the delivery of a baby, when you become pregnant and come to term, then a myomectomy is indicated."
My doctor is recommending C-section following myomectomy. Therefore, the obstruction of delivery does not seem to be an important indicator for myomectomy in my case. In other words, if I elect to forego the myomectomy, I risk needing a C-section due to obstruction and if I elect to have the myomectomy, I will need a C-section anyways.
Consequently, my two follow-up questions are:
1) Are there other reasons why I should consider having a myomectomy instead of trying to get pregnant again first (given that I am asymptomatic and the fact that the fibroid likely did not cause the miscarriage in the first place?)
2) Is there a certain size (of both the uterus and the fibroid) at which point I should consider a myomectomy even if I continue to be asymptomatic?
-------------------------
Followup To
Question -
My OBGYN is recommending myomectomy for a 9.7cm fibroid and I would like a second opinion.
I am 27 yrs old; 0 children; miscarriage at 8 to 10 weeks and related D&C on March 23, 2004; first day of last period was May 13, 2004.
Prior to my recent pregnancy the fibroid was 6.5 cm. In the 8-10 weeks that I was pregnant it grew to 9.7 cm. I had another ultrasound on June 8th to monitor the growth of the fibroid and inform decisions about the necessity of a myomectomy. The fibroid has stayed the same size (9.7cm). My uterus is 19 cm x 7.6 cm x 12.3 cm. My fibroid is currently asymptomatic other than being a possible contributing factor to the miscarriage.
I have surgery scheduled for June 23rd and would like a second opinion. I wish to preserve my fertility.
Thank you.
(Note: my doctor told me that the fibroid is located inside the uterus wall and possibly protruding inwards.)
Answer -
If the fibroid is thought to obstruct the delivery of a baby, when you become pregnant and come to term, then a myomectomy is indicated. However, after a myomectomy, the fibroid usually grows back, so you should plan on becomming pregnant right away and deliver the baby before it grows back. I doubt that the miscarriage was caused by a 9cm fibroid. The baby would not have stopped growing or miscarried by 10 weeks gestation. Miscarriages occur in 15-20% of every pregnancy and are usually caused by problems with the germ cells (sperm and egg) rather than by fibroids in the uterine cavity. HOwever, if your uterus is almost up to your belly button, the myomectomy may help in allowing you to deliver normally, once you conceive.
AnswerI did not mean to imply that you would be able to have a vaginal delivery after a myomectomy. I meant that if the fibroid obstructed the growth of the fetus DURING THE PREGNANCY due to its position in the uterus, a myomectomy is indicated so that there will be enough room for the baby to grow. If the uterine cavity is entered during the surgery for the myomectomy, you definitely would need a cesarean section. If the cavity is not entered, you may not need a cesarean section. It depends on how much damage to the uterus occurs. The only reason for having a myomectomy (along with its post op course of fever) is in order to carry a baby to term. Usually, we perform the myomectomy, allow the patient to become pregnant and deliver the baby, and after the baby is born, suggest hysterectomy for a definitive treatment. Most gynecologists will not suggest myomectomy or hysterectomy for a uterus that is less than 12 weeks size (compared to weeks gestation), unless the patient complains of either urinary symptoms (frequency, obstruction of the bladder), rectal symptoms (constipation, flattened stool), or heavy intractable bleeding. HOwever, if the uterus is large (16-20 weeks size), a hysterectomy is often recommended to avoid pelvic congestion and discomfort. If the fibroid is merely observed and followed with serial sonograms (every year) until you reach menopause (around age 50), it usually disappears on its own. If there are no symptoms, we do not have to do anything. There are other methods of treatment (embolectomy, endometrial ablation, hormonal control). We usually go by the size of the uterus, not of the size of the individual fibroids (which can be multiple). I don't know if my answer helps you, but if you have further questions, please don't hesitate to call back. Good Luck.
