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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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What us the best course of action very painful fibroid.

Resolved Question:

What us the best course of action for a very painful fibroid. I have already been treated for 3 months with a drug called esmya which stopped the pain but can only be taken for 3 months and the pain has since returned. The fibroid is approx 3pm and on the back wall of the womb. Joanne Clark

Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.
Hi, It's Dr. C. Board certified Ob-gyne. I can help you with this. Because of your age, another option is to speed up progress towards menopause using a medication called Depo-Lupron. Most doctors feel comfortable using it for 6 months at a time, especially if your bones are good. Other treatment options include Uterine Artery Embolization (UAE) and hysterectomy. Did your doctor mention any of those alternatives?
Customer: replied 2 years ago.

Thanks my Doctor has only mentioned hysterectomy...and I understand Lupron is only a temporary solution and the fobroids often return,. Also the fact it carries risks of bone disease as well. Was hoping for a reduction in oestrogen or removal of the fibroid. thanks tho.

Expert:  Dr. C. replied 2 years ago.
Yes Depo-Lupron is a temporary solution but can be useful in women who are already very close to menopause. We can use it for 6 months of temporary menopause with the hopes that a woman in the meantime does go into menopause. The fibroids shrink by about 50% during the treatment time. And if a woman then is menopausal, they won't usually regrow. It's useful if a woman really wants to avoid surgery or is a very high risk candidate for surgery. It does deteriorate the bone. Sometimes to prevent that, we give "add back" which is a very small amount of estrogen or progesterone. This help prevent bone loss and helps with some of the menopausal side effects of being on this medication. Average age of menopause is 51. I wouldn't consider that as an option for a woman who is not already fairly close to that age. Reduction in estrogen can be accomplished with weight loss. Sometimes we can get the estrogen level lowered while on birth control pills because that over-rides the surges in estrogen that many women approaching menopause experience. Myomectomy usually isn't recommended in this situation because the surgery is actually more invasive, more risky and not as good of a guarantee of complete resolution of the issues. Myomectomy is usually reserved for women hoping to preserve fertility. Once in a while we get women who feel strongly about wanting just a myomectomy despite the higher risk and possibility of fibroid recurrence. Any other questions? I hope this more detailed explanation was more helpful.
Customer: replied 2 years ago.

Yes very helpful thank you...I am not sure I want to risk bone deterioratrion either. At present I am not sure if there is a suitable treatment for me but you have been most helpful. We have got the fibroid down from 2.2 inches to 3.2mm so I may continue with alternative therapies and healing. Or tale another 3 month course of esmya, Thank you so much, Joanne Clark

Expert:  Dr. C. replied 2 years ago.
Yes the risk of osteoporosis is very real but for some women it's a good choice. Sometimes I get a bone density scan first to get an idea of how much there is to spare and use that information to weigh out the risks and benefits for the circumstances. Down to 3.2mm from 2.2 inches is really quite a dramatic decrease. I'd say whatever you've done so far is working quite well. Let me know if you need anything else. I'll be on vacation the next week and will have just intermittent internet access so it may take me longer to reply, but I will. Good luck.
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