a long answer to your question

[Guest guest]

****I wonder if Dr. only reserves doing hysterectomies for those who

have cancer. And whether he mostly does myos because he believes they are

the best option or because it is what his patients come to him for.***

The posts about the issues of medical options and patient choice have been

interesting and I think are important, so I will add my opinion to everyone

else's. I see my role as a physician as an educator and advisor as well as

one who is able to provide treatment. When I see a woman in consultation for

fibroids (or any gynecologic problem, for that matter) I think it is

important for me to outline all the available options, even the ones that

make less medical sense for that patient or even options that she clearly

would not want. I do indicate which of these options I think might have

more risk or be less effective medically in her particular situation. I

have spent most of my medical career acquiring the skill and experience to

feel comfortable with all the surgical options, so that I can offer them all

and be knowledgeable about risks and benefits of each one. I also am happy

to refer women for embolization when they wish that option. I do think

doctors often bring their own biases to these discussions and may only offer

treatments with which they feel comfortable, rather than others that might

be better for the patient.

In 25 years of practice I have seen women make extremely different decisions

based on similar clinical symptoms and similar options for therapy. There

are so many personal issues, as well as medical ones, that rightly get

factored into these decisions. For instance, in the past year I performed a

laparoscopic myomectomy for a woman who had a small (5 cm) fibroid pressing

on her bladder that required her to urinate a few extra times a day. I think

many women would have opted to live with this and avoid surgery. However,

this woman was very bothered by the problem and really wanted to take care

of it. On the other hand, I have many women in my practice who have large

fibroids and who wish to avoid treatment altogether. Other women in this

position might choose surgery or embolization or enroll in clinical trials

of focused ultrasound or Mefipristone. Some women come into the office with

an idea of what they want and leave with two or three other options they had

not been given before.

Many women who wish surgery choose myomectomy because they wish to preserve

their uterus, and I am very comfortable with this decision. Other women may

choose laparoscopic supracervical hysterectomy (leaving the cervix and

ovaries) because it allows them to return to work, activity and family

sooner than after abdominal myomectomy. For women with bleeding, endometrial

ablation or hysteroscopic myomectomy, both outpatient procedures, may be all

that is necessary.

Having all the information allows each woman to make the decision right for

her - which is why I think this group does such a great job advising women

of their choices and supporting each other through these tough decisions.

On this message board I so often see encouragement to " educate yourself " ,

and I could not agree more. Each woman will know her symptoms and how they

affect her, but the more you know about your options, the more questions you

ask your doctor, the greater the likelihood that you will make a good

decision.

Bill , MD