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Have an enlarged uterus and fibroids. Is surgery the only treatment available?

DOCTOR OF THE MONTH - Mar 2013
Mar 2013
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Practicing since : 1998
Answered : 4356 Questions
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I'm a healthy 58 year old woman, 5'6"; 160 lbs

Cholesterol 201
Triglycerids 104
HDL 64
LDL 117
VLDL 21
HDL Risk Factor 3.2
TSH is 3.18

FSH 13.8 (not menopausal - what does mid cycle peak mean?)
LH 19.5 (Postmenopausal ?)
CA125 30 (should be <21)
OVA1 5.1 (low premenopasal ?)

I have an enlarged uterus and 2 fibroids -- is surgery (remoe uterus & ovaris) the only answer?
If I am not in menopause yet, won't that put me "into" menopause?
Can't it just happen naturally?



What does this mean and what can I do to get my cholesterol levels to the best or ultimum
Posted Tue, 5 Mar 2013 in Vaginal and Uterus Health
 
 
Answered by Dr. Aarti Abraham 51 minutes later
Hello
Thanks for writing to us.
May I ask request a few more details from you, before assisting you further ?
One - could you attach your latest ultrasound reports, elaborating status of your uterus and ovaries ?
Two - any reason why the CA 135 and OVA 1 levels were done , as they are done for evaluating ovarian cysts / tumours , and you have not mentioned any.
Third - you mentioned you are not menopausal, so how are your current periods, and on what day of period were the blood tests done.

These questions are relevant to your queries and would help me in assisting you further.

Looking forward to hearing from you.
Above answer was peer-reviewed by
 
Follow-up: Have an enlarged uterus and fibroids. Is surgery the only treatment available? 1 hour later
I am not sure how to attach the report. I have it saved on my computer but there is no option to attach it. So, I am offering some details that I hope will help.

I went to the OB GYN to only establish with a new dr in my new town, I had no problems or symptoms of anything. Upon pelvic eval, she thought my uterus is enlarged, thus ordered complete abdomen, pelvis and tansvaginal ultrasound. I provided her with the past 3 years of my period 2010 (56 yrs) I had a period 7 months out of 12. In 2011 (57 yrs) I had a period 5 months out of 12. In 2012 (58 yrs) I had 3 periods out of 12, including December 2012. Then again in January 2013. These periods are associated with breast tenderness and cramps, normal 4-5 day flow. The dr can NOT believe that I am still having my period. She also can not believe that I am 58 and asked me repeatedly if I was lying about my age and said she would belive that I am 48 and if so, my lab tests and ultrasound would be normal. I showed her my drivers license. She asked if I was adopted...no I am not. I am 58 years old and still have my period as above. I have had NO children and I do not smoke or drink. I took birth control pills from age 18 to 42 (24 yrs)

Ultra sound results:
Normal size of uterus: 8.0 x 6.0 x 4.0 cm
Mine on 1/30/13: 10.2 x 8.1 x 9.5 cm
Right ovary: 2.7x2.6x2.2
Left ovary: 1.7x2.3x1.9
Distal fibroid left fundus: 2.2 cm
Prixmal posterior fibroid left: 2.5 cm
Cysts on both right (1.8 cm) and left (1.4 cm)
Endometrial stripe is 6 cm (normal is 8-13 cm)

The reason for the CA125 and OVA1 with FSH and & LH were to evaluate those levels due to the fibroids that are present.

Doctor wants to do hysterectomy w/ovary removal which will push me into menopause, potential hot flashes and perhaps needing HRT in the future.

Are there other tests that should be given consideration prior to surgery?
Is there alternative things to do? Diet? Accupuncture?
Cancer does not run in any of my family history (not that I can't get it)

Currently I had a period in December and January and I am now feeling breast tenderness/fullness and some lower calf leg cramps occassional and moderate, but these were all normal signs n the past that I would be getting my period soon. My last period started 1/2/13. So, it's been 42 days which is longer than normal. Normal was about every 28-30 days. But, I know that perhaps I won't get it this month (Feb) and maybe not next month. I know that I am moving in the direction of menopause, obviously.

Is it impossible for all of this to just be "natural" for my body?
Online woman bloggers say many have periods at age 60 and 61.
I'm not so quick to jump into surgery and more inclined to have more knowledge before going through that to "determine" that it is not cancer and that what is going on with my body is normal for MY body.

Thank you.
 
 
Answered by Dr. Aarti Abraham 2 hours later
Hi again,
Its a pleasure interacting with somebody so involved and knowledgeable as you are.
Firstly, CA - 125 and OVA -1 values are just borderline and there are no tumours in the ovary to speak of.
Also, I have gone through your ultrasound reports, and the fibroids are small, and you are not symptomatic ( symptoms would be heavy and prolonged menstrual bleeding with clots and cramps and pain during periods which are severe ).
Also, fibroids are estrogen dependent tumours, which shrink to a great extent after menopause, once hormonal influence is diminished.
Your lipid profile is also normal, Cholesterol is borderline high, which can be controlled by a diet with restricted saturated fat intake.
Moderate exercise and regular fitness regimen will definitely help.
Use oils , sugars, fats and processed foods in moderation and increase greatly your intake of fresh fruits, fibres, whole grain cereals, fresh XXXXXXX leafy vegetables and fluids. These would ease your peri menopausal transitional symptoms also.
At present, frankly speaking, I can see no indication for hysterectomy, as you are totally asymptomatic and the ultrasound findings were coincidental ones.
The hormone levels show that the FSH and LH are nearing the menopausal range ( midcycle peak means hormone levels equal to those found at the mid menstrual phase, when they are pretty high ).
Given your sparse periods of late, I am sure you are moving into menopause pretty soon.
Five out of 100 women have periods until they are 60 - having them at 58 is a rarity, but in absence of other ominous signs, a natural variation.
You are definitely not having " cancer " as you can obviously gather.
I would recommend a wait and watch policy in the form of routine gynecological check ups and follow up ultrasounds regularly, and management accordingly.
If the fibroids persist even after menopause, but you are asymptomatic, there is STILL no indication for surgery.
However, enlarged ovaries and endometrial thickness > 4 mm once you attain proper menopause warrant vigilance and treatment.
However, menopause is defined as a year of no periods, so you definitely can tide over a year or more.

Hope I have been of help
Feel free to ask for further clarifications.
Above answer was peer-reviewed by
 
Follow-up: Have an enlarged uterus and fibroids. Is surgery the only treatment available? 10 hours later
Hello Doctor,
I am a believer that I know my own body better than anyone and I feel great! I have no symptoms and no complaints. I am relieved after receiving your input. You have validated what I have researched on line AND what my intuition is tellling me. Western doctors are eager to do surgery when insurance is available and/or write Rx. I believe in a more natural way to live my life and care for my body and well being.

I will watch my diet more closely and I have done more research on what to eat and how to lower my cholesterol -- my Mother has high cholesterol and this is a red flag for me to watch!

Thank you very much. I will continue to monitor and get regular check ups and ultra sound, etc etc. I will also continue to keep my records of my menstrual cycle...and I believe it is beginning to taper off....but naturally.

I wish you all good things and thank you for your help!
XXXXXXX
 
 
Answered by Dr. Aarti Abraham 4 hours later
Hi XXXXXXX
Thanks for your input and appreciation.
Take care and wish you a long, healthy life.
Above answer was peer-reviewed by
 
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