Mayo Clinic Doctors Claim Hysterectomies Dominate the Treatment for Leiomyomas

All of us have those fun mail days when the post brings our favorite magazines, and when I busted open the January 2011 Obstetrics & Gynecology with that kid with a box glee as I do every month, I found some interesting points about a common cause of heavy menstrual bleeding. It invigorates me, and inspires me to sit and think about my field and the advances , and I mull over ways these articles can help us improve the care of women in my practice. So I was very interested to read the leiomyoma (fibroid) article, by the My Clinic physicians Laughlin and Stewart. Although there are a number of good points, I want to debate that "hysterectomy dominates treatment" for uterine fibroids. I think ignoring fibroids probably dominates treatment, as probably almost 1/2 to 1/3 of all women have fibroids, and most are in fact silent and asymptomatic. But, ok, maybe that's not completely fair, perhaps these gynos are talking about symptomatic fibroids. And it is important to note that in this article they specifically point out the lamentable fact that almost all the literature is just biased opinions not based on well controlled studies! And having just moved to the European classification of fibroids myself in the past year (Class 0,I, II for those in the cavity, 1/5 into the wall and over half into the wall of the uterus) I liked the fact that the authors are trying to get the gynos to move to more precise descriptions of what and where the fibroids are when making recommendations to their patients. The most important points are that there are many scenarios, and many treatments, and treatments should be individually tailored to the patient herself. Most fibroids grow, but some women will even have fibroids that grow in part of the uterus and shrink in other parts. Lots of speculation has been done for years as to why we have a fibroid when a friend may not. The Mayo Clinic physicians explain the current theories of growth which is that genetic abnormalities leading to blood vessel growth factor and muscle precursor cells growth factors are unregulated and produce this abnormal growth. And the article goes on to list many of the treatments we have discussed (see 1/26/11 comment on endometrial ablation discussion) and say that there are a lot of alternatives for women with fibroids. So why they say that with all of this that still greater numbers of women select hysterectomy than any other treatment? Not sure where the data comes from, but it may be time for women to gab about the alternatives!

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