Ask Dr. Hilda

Question: I am 46 years old. I had an IUD put in 3 years ago. At the time of my check-up (to make sure it was in place) the string was missing. I was sent for an ultrasound and the IUD was in place. I was told at that time that I had fibroids and that I should also not do anything about the missing string until it was time for the IUD to be removed. Since the IUD I have had longer and heavier bleeding. For the past 3 months I have been getting a menstural cycle every 2-2 1/2 weeks. I thought it was the fibroids, but my doctor thought it was the IUD. He suggested I have it removed to see if my cycle went back to normal. I had another ultrasound. No IUD was detected. Now he feels that the problem is definitely the fibroids. He suggests either a hysterectomy or myomectomy. He thinks the hysterectomy best because of the bleeding, my age and the fact that no more children will be born to me. I don't have anemia. My questions are; 1. Can I do nothing and just wait for menopause? 2. What do you think about a more non-evasive option? UAE?

Answer: Since your fibroids were only diagnosed when you had a sonogram to check for the IUD, they are probably not very big. And the bleeding seems to have started after you received the IUD. Though your bleeding is heavier than before, you are still not anemic. Putting that all together, I doubt that you need to have surgery at this time. I suggest that you have an endometrial biopsy to make sure that you do not have cancer or pre-cancer of the endometrium. If your biopsy is normal, you can either try a hormonal treatment like birth control pills, or you can try a non-surgical treatment like uterine artery embolization (UAE). Fibroids do decrease in size after menopause. And since the average age of menopause is 50, you are probably in the perimenopausal phase already. Surgery has the potential for serious complications. For that reason, I think that surgery should be the option of last resort. Make sure you get more than one opinion. --Dr. Hilda

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