Prolapsing Grapefruit-size Fibroid - Now Pregnant after Vaginal Myomectomy

A 37 year old woman came to me in July, 2009 with a prolapsing 8 cm. fibroid. She had been seen by her HMO doctors multiple times for heavy bleeding, had 15 ultrasounds, but nothing was done.  An MRI showed an 8 cm. (grapefruit size) fibroid low in the uterus which appeared to be prolapsing (coming out of) through the cervix.  Since she wanted another child, she did not want to have a hysterectomy, which was the only option she was given.

On exam, I could feel the fibroid coming through the cervix and filling the vagina.  Most of the time prolapsing fibroids can be removed vaginally.  Continue to see photos of her surgery. 

The fibroid was so large it filled the entire vagina.  In order to reach the top it was necessary to remove wedges of the fibroid.  (See photo below.)  Each wedge removed allowed a little more room to get to the top of the fibroid.

Eventually it was possible to pull down the fibroid enough to reach the base.

This shows the fibroid after it has been removed.

The edges of the stalk were sutured and she was able to go home later that day.

Comment:  Most prolapsing fibroids can be removed vaginally.

A month after surgery I did a diagnostic hysteroscopy in the office to be sure that no scar tissue was forming.  Her uterus was entirely normal, with no evidence of the fibroid.  Update:  July 13, 2010 I received a call that she is pregnant and expecting her baby in January.  - Paul Indman, MD

Editor's Note:

This post was picked up from 

Uterine Fibroids blog: An Expert Speaks Out

.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.