Late in September I went in for my ultrasound on a Friday and had an appointment with the OB/GYN Surgeon that the Nurse Practitioner recommended the following Friday. It was in that meeting with the Surgeon that I got the results of the ultrasound and found out what my options were.
The ultrasound showed I had a very large fibroid inside my uterus. Though they couldn't say with 100% accuracy from the ultrasound, it appeared that the fibroid was pedunculated, which means it is actually on the inside of the uterine wall/lining and not necessarily embedded in the uterine wall/lining or on the outside of the uterus.
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The fibroid was 9cm (4 inches) the size of a large grapefruit and the uterus was about 15cm - the size of an approximately 4 month pregnancy. That's the end of the first trimester, the beginning of the second! No wonder all my clothes were so tight and I had a massive tummy pooch that I couldn't ever seem to get rid of no matter how much I worked out, watched my food, or did crunches/pilates! Everything was starting to make sense.Just knowing what the problem was helped make it easier to manage, however It was still hard on the ego. I'd seen people eyeing my growing belly, thinking that I was probably pregnant. I know those looks. My husband and I have been married just the "right" amount of time to start having kids, so I'm sure people wondered. Thankfully, no one ever asked me. They did ask my husband though, which I just recently found out. He didn't tell me because he knew what a delicate state of mind I was in at the moment.
I found out from the doctor that the fibroid just two years ago was the size of the kiwi (5cm), half the size of what it became. It doubled in size in just two years! Probably no thanks to the continuous BCP and the lack of attention from my regular Dr. Oh, how I wish she'd followed up on me or explained that the fibroid could grow. I had no idea it could grow. I was clueless. She was the Dr and I trusted her.
So, I sat down with the Dr my NP recommended and she looked me in the eye and said "You're going to need surgery. It's too large to get any other way." The cut-off for a laparoscopic surgery or vaginal removal is a for a fibroid 5cm or smaller, and mine was almost double that size. I was going to need a Uterine Myomectomy. This was the only option if I wanted to preserve my fertility.
At age 27, though I didn't know for sure I wanted to have children, I also wasn't for sure I didn't want to have them. I was far too young to make a decision. For women who know they don't want kids or who are older, the hysterectomy is the best option. There are also other options such as Uterine Fibroid Embolization, but the chances of getting pregnant after a Uterine Embolization is highly rare and not recommended. I guess if I knew I wanted kids, I'd probably go for the hysterectomy.
I asked a zillion questions, hoping there was another option than a myomectomy. But there wasn't. The fibroid was just growing far too quickly and there was a itty bitty chance that the fibroid could possibly NOT be a fibroid and be a cancerous tumor. This is not likely, but better safe than sorry. So my Surgeon recommended getting it out and sending it to the lab to be 100% sure.
The other downfall to having a myomectomy is that if I do become pregnant eventually, the baby will have to be taken via planned C-section 4 weeks early. They do not want me to go into contractions or labor whatsoever. The incision on the uterus can actually burst and put the life of the baby and me into jeopardy. At 4 weeks, they do an amniocentesis to check the baby's lung development to see if they're ready for the real world. If not, they'll push it out one week and take the baby 3 weeks early. It would be considered a high-risk pregnancy. Having the uterus burst during pregnancy is one of my biggest fears. I cannot even imagine what that pain would feel like, much less the fear.
I know many people these days have vaginal births after having a C-section, so I wondered why that wouldn't be an option for me. I asked my doctor about this and she explained that with a full term baby, the uterus muscle is so stretched out and 'thin' at that point, the incision is much smaller. Doing a surgery on a smaller uterus, the muscle is still very thick and therefore, the incision is much larger, with much more weakness. What about if I become pregnant with twins? I don't know. I guess I'll cross that bridge when I get there. That's on my list of things to ask my Dr next time we talk.
Of course, with any full surgery, there a risks. There are risks of hemorrhaging, requiring a blood transfusion. A chance that the uterus was so badly destroyed or bleeding that a hysterectomy was required. But the rewards were deemed greater than the risks, so we went on the books for surgery. She originally said it would be Jan or Feb of 2009 before the surgery would take place.
It makes me angry that my original Dr never did any follow up or explanation. Had she did, I wouldn't be facing the surgery that I am now. A smaller sized fibroid has less-invasive options for removal, but because of (what I consider) her lack of dedication, I have to have the full thing.
In the meantime, she put me on a 3 month shot of Lupron Depot. Lupron is basically an estrogen blocker that can help reduce the size of the fibroid by up to 20% (ish). Unfortunately, that wouldn't be enough for a less invasive surgery for me, but it would help her get it out once she was in there. And, also, it would mean that I would stop bleeding, which was enough for me. As an estrogen blocker, that means I would be thrown into a temporary menopause of sorts for those three months. Including mood swings, hot flashes, etc. Heh. This should be interesting.
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