Menstrual Disorders, Fibroids & Polyps

Doing “Nothing” About Fibroids

Intelligent Observation

There are many instances in which “fibroids” can be observed without intervening. This is especially true when they are producing few, symptoms and the woman is approaching the menopause.

Years ago it was a common teaching that if a fibroid uterus achieved a certain size—about that of a 12 week pregnancy—then it was automatically removed whether it was producing symptoms or not. In hindsight we know that this often led to many unnecessary hysterectomies and that women often do well with simple observation.

Can you give me an example of when it’s okay to simply observe and what you mean by “Intelligent Observation”?

The 47 year old woman who is having few if any issues with a uterus the size of a 3 month pregnancy can be asked to simply have examinations at fixed intervals in order to determine if anything appears to be changing. I often ask these women to return every 6 months for an ultrasound examination at which time the uterus is measured. Oftentimes these fibroids—and the uterus as a whole—begins to shrink as the woman becomes menopausal. After menopause some shrinkage continues to happen though the fibroids never disappear. In this fashion surgery can often be avoided.

Intelligent Observation is a term that is implied to observation by a trained medical professional experienced in the management of fibroids. Unfortunately, many women confuse this with managing their own symptoms. The result—on occasion—is a woman who shows up after many years of self-care with a uterus and fibroids the size of a full term pregnancy. Unfortunately, when a uterus is that large it is often no longer possible to offer her laparoscopic or robotic surgery since there isn’t enough room to place the telescopes and the surgical instruments through minimally invasive ports. Such scenarios often end with surgery requiring much larger incisions that would have been required if the fibroids were observed “intelligently”.

Another example of “intelligent” observation might involve the 33 year old mother of 1 who was found to have a small fibroid as a finding on a routine ultrasound examination. Depending on the size and location of a small fibroid it may be wisest to simply observe it. Oftentimes, small fibroids may not grow over a period of time and it may be unnecessary to intervene by removing them. However, intelligently observing these will determine if, when and how best to intervene.