Multiple symptoms due to marked uterine enlargement by fibroids

K.C., a 44 year-old woman, called me from upstate New York. Over the past 15 years her uterus has gradually enlarged to the size of a seven month pregnancy due to the presence of multiple fibroids. She also suffered from asthma and her markedly enlarged uterus was contributing to her breathing difficulties. Her periods had become progressively heavier, leading to anemia. K.C. had been offered hysterectomy on multiple occasions but she resisted this suggestion. Her physical condition continued to deteriorate as she searched for a physician who would be willing and able to perform uterine-sparing surgery in her circumstances. I told K.C. that I had successfully treated other women with similar problems, but that, of course, I needed to review her records and examine her before making any decision regarding her care.

The following week I met K.C. and her husband for a complete evaluation. Upon review of her symptoms, K.C. indicated that in addition to feeling weak and short of breath, she suffered from abdominal pain, pelvic pressure, severe constipation and difficulty with urination. Pelvic examination and vaginal ultrasound revealed that she had multiple fibroids. The largest mass was located deep in the pelvis causing distortion of the cervix and other nearby structures. There was evidence of pressure on the bladder and rectum, accounting for her symptoms. Lab tests confirmed that K.C. was indeed very anemic from chronic, heavy blood loss.

K.C. and her husband were relieved to hear my assessment that uterine-sparing was feasible. However, I advised them, that because of the anemia and the size and location of the tumors, it would be best to postpone surgery until after a four-month course of medical therapy. This therapy consisted of a hormone called Lupron which would help shrink the tumors and reduce bleeding during the periods, as well as iron supplements to treat her anemia. We agreed that we would remain in touch with regard to her progress during this course of therapy.

Four months later, her anemia improved, K.C. underwent surgery. A total of 11 fibroid tumors, up to 6 inches in size, were removed through a bikini-type incision in her lower abdomen. The operation proceeded smoothly with only minimal blood loss. K.C. was discharged from the hospital two days later and was able to fly back home with her husband after resting in a hotel for two more days. K.C. reported to me that her life was vastly improved. A check up with her local physician revealed that her uterus was of normal size and she was no longer anemic. In addition, her asthma had become more easy to manage.