Endometrial biopsies are a fairly common minor procedure performed in many gyn offices when patients are experiencing heavy painful periods. The technique involves sticking a needle into the uterine lining to obtain a small tissue sample; it can be very painful and often produces inconclusive information. Blind biopsies, via either needle or currette, can very easily completely miss the area in question, rendering an inaccurate outcome. When dealing with fibroids and adenomyosis, biopsies of the lining do not render any information as to the make up of the tumors. The biopsy is strictly giving information about the uterine lining. The procedure is rather like sticking an needle in an orange to try to locate a seed…..probably not successful. If you have fibroids, or adenomyosis, taking a blind biopsy of endometrial tissue does not render a conclusive diagnosis about your disease….
This is a sad but very honest posting. We recently had a prospective patient that decided not come for our surgery because we would not guarantee fertility after fibroid tumor surgery. No surgeon can give that guarantee. We told her our philosophy was to remove her tumors without leaving any intentionally, offer a video viewing of her surgery to ensure we did everything possible, with no blood transfusions and no hysterectomy….she elected to go to a local gyn who promised all the same things AND fertility. Sadly, we heard the day after surgery that the bleeding was to intense they had to stop the surgery and left several large tumors….although transfusion was suggested and warranted, the gyn elected not to. The patient had to stay three extra days due to dangerously low blood pressures and dizziness…had multiple fainting spells once discharged home and was unable to have visitors for 2 weeks due to weakness. They have recommended IVF treatments to attempt fertility in a few months. This is just bad medicine….this patient was promised something that could not be delivered…and suffered in the process. Fertility is once again in question and she will no doubt require more fibroid tumor surgery. Make sure you know what your surgeon is capable of..the procedure you are having and the potential complications.
Many women are trying to avoid traditional drug therapy when treating menopausal symptoms like hot flashes, depression, sleeplessness, and dry vagina. Hormone replacement therapy with either synthetic or bio-identical hormones can significantly reduce these symptoms however are not without side effects. IF you have female diseases that are reliant upon estrogen like Fibroid tumors, Endometriosis and Adenomyosis these replacement therapies can and will fuel your disease process. There are a few herbs on the market that can be effective at mitigating the above symptoms…..pine bark (pycnogenol), black cohosh, and St. Johns wart have shown some effectiveness. Herbs are not without side effects so check with your doctor prior to taking them…..but they may be an effective alternative to traditional hormone treatments.
We recently had a patient in the office who was diagnosed and treated 10 years ago for fibroid tumors and endometriosis. She had experienced early menopausal symptoms of hot flashes and mood swings. At that time her naturopath recommended a bio-identical estrogen supplement. She was told that hormone therapy would NOT have an effect on any possible remaining fibroids. Sadly, this is not true. She now has a 7cm fibroid producing serious low back pain. IF you have any female disorder that requires estrogen to proliferate: fibroids, endometriosis, or adenomyosis, you run the risk of recurrent disease once you begin hormone supplementation.
MRgFUS is a relatively new technique in treating fibroid tumors. The MRI technology is used to locate the tumor and ultrasound beams are passed through the skin to ablate or destroy the fibroid. This is a minimally invasive procedure, however long term effectiveness is still being determined. The concern is whether the entire tumor can be destroyed and then what becomes of the decaying and necrotic tissue? Medical studies have shown fibroid tumors can turn malignant when they decay and begin to die. I still believe removing the tumors surgically (female alternative surgery) is the best treatment for positive long term outcomes. Do your research before consenting to any surgery.