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Have low blood count. Scan showed fibroid in uterus. Should I go for medicine or uterus removal?

Mar 2016
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Practicing since : 2011
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Hello, Am currently in the hospital due to low blood count from heavy menstrual cycle. Hemoglobin count was 5, but is now at ~9 thanks to bld transfusions. Turns out there is a large fibroid (6cm x 4cm) in my uterus. Doctor is saying I should remove my entire uterus. I am 38 and never married, and still dream of having my own children. Is it not possible to just remove the fibroid rather than the entire uterus?...or is the fibroid too large hence posing a big risk? Re my health background, I've NEVER had any health problems whatsoever (food poisoning was the biggest drama in my life), so this is quite a shock. By the way, there is no blood in my stool, urine, etc. In addition, my stomach is very bloated - Doctor thinks this is fluid in the pelvic due to inflammation.
Much appreciate your responses! Must make decision soon.
Posted Thu, 14 Feb 2013 in Women's Health
Answered by Dr. S Patra 2 hours later

Thanks for posting your query. I have gone through your history in detail.

I am trying to give answer your query with explanation.

The size of uterine fibroid is acceptable for myomectomy (removal of fibroid only) in both type of surgical method -Laparoscopy (keyhole) & Laparotomy (Open). As still now you desire for child, myomectomy is the option of choice to preserve reproductive function.

But you have low hemoglobin (anemia), so certain risk is there whether size of fibroid is slightly larger than usual (in your case). You should know some important facts prior to myomectomy like:

1) It is more risky operation when size of fibroid is large enough (your 6 x 4 cm).
2) Risk of recurrence & persistence of fibroid is about 30-50%.
3) Risk of heavy bleeding is about 1-5%.
4) Pregnancy rate following myomectomy is about 40-60%.
5) Risk of relaparotomy is more than 25%.

In addition, some pre-requisites are there prior to consideration of myomectomy in such cases like:

1) Husband semen analysis for checking fertility status.
2) Hysteroscopy or HSG (Hysterosalpingography) to exclude submucous fibroid or polyp or tubal block.
3) Diagnostic Dilation & Curettage (D & C) to exclude endometrial polyp or carcinoma (in rare case).

If above three considerations are within normal parameter, then you have the option to give a trial for myomectomy with certain risks & complication as above said and also if your treating doctor permits.

If you not desire for child, then being large fibroid, total hysterectomy (removal of entire uterus) is the ideal & safe procedure of choice in consideration with present hemoglobin status. That is also your doctor's choice.

Hope I have answered your query. If you have any further questions I will be happy to help.

Wish your good health in future.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Have low blood count. Scan showed fibroid in uterus. Should I go for medicine or uterus removal? 28 hours later
Thank you so much for your advice! Much appreciated. After another consultation with my doctor, she has suggested putting me on Lupron to reduce the size of the fibroid before undergoing surgery to remove it completely. In conjunction, she has suggested I begin to take birth control pills to eliminate the heavy bleeding during my mentrual cycles. What are your thoughts on this?
Additionally, I my pelvic/abdomen area is swollen. My doctor says there was a cyst on one of my ovaries that burst, and its fluid has filled the area, hence causing the swelling. The strange thing is, she said that there is no need to do anything about it, because my body will just absorb the fluid, which will eventually reduce the swollenness and go back to "normal." Is this a correct assessment? She says there is no blood in the fluid. By the way, I don't really feel any pain in my abdomen area. It's just a bit of discomfort bc it's swollen.
Thanks in advance for your expertise!! Very much appreciate it:)
Answered by Dr. S Patra 1 hour later

Thanks for follow up query. I am giving answer according to your query.

1) Lupron depot is advisable in case of shrinking of large fibroid or in the treatment of endometriosis. It is recommended for 2-3 months depending on doses. If fibroid size becomes small than earlier, then it is easier to perform myomectomy operation.

Also, progesterone pill is very much helpful in combination with above to control heavy bleeding. In that sense, your doctor is right.

2) As your ovarian cyst is burst with fluid only and no blood, then there is no risk of infection/ XXXXXXX hemorrhage. Body can easily absorb that fluid without any harmful effect. It will be gradually normal over time span.

Before proceeding any type of operation, fertility check up of your husband is must as still now you desire for child. In your case, tubal block and ovulation problem are also to be ruled out.

If you do not have any clarifications, you can close the discussion and rate the answer.

Take care of yourself and consult with your gynecologist.

Dr Soumen
Above answer was peer-reviewed by
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