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Gynecology

Fibroids/Enlarged uterus/Anemia

04/14/2008

Question:

I am 53, and off & on during my adult life I have taken iron to battle anemia, to varying degrees. All my life I have had heavy periods. Every doctor in the last 20 years has known I have fibroids and have always had an enlarged uterus, altho maybe not this large: My new doctor in a new city is alarmed that my iron deficiency anemia is presently severe and thinks I should see a GYN to have my large fibroid and 24 week enlarged uterus examined, even though I had a pelvic ultrasound done in 2006, at which time nothing was said about needing to do anything about either of them. My anemia was severe to the same degree in 1998 and after just 2 months of pre-natal vitamins, my HGB was well-improved. So I am presently taking iron again.

Because I am so close to menopause and have lived with the fibroids this long, is there any harm to waiting for them to shrink on their own? Also, should I be alarmed enough at the size of my uterus to see a GYN? I don`t have proof that it`s growing, but it could be. Thank you.

Answer:

Your bleeding and anemia is likely related to your fibroids. Your bleeding, and resulting anemia, can be controlled medically. Iron/ vitamins can help you reverse the anemia, and other hormonal methods can stop the bleeding. You are correct that since you are so close to menopause the bleeding will soon stop. The uterus will shrink, but still remain very large. Pain and pressure would be good reasons to consider surgery. If the fibroids can be shown to be causing problems with compression of other vital organs (the kidneys, bowels, etc) then surgery should also be considered. There is no size criteria for which a hysterectomy needs to be performed. Other invalid reasons for a hysterectomy are, the inability to palpate the ovaries, the risk of it enlarging further, or the surgery would be easier now before it gets larger.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated