It is indeed an honor to be asked to submit a blog for The Fibroid Foundation website.  I certainly have no experience with blogs but have committed my professional career to caring for women suffering from fibroids.  It is a privilege to be able to counsel and manage patients with this condition.  I have seen women with symptomatic fibroids ranging the extremes of the reproductive lifespan: a premenstrual 12-year old girl through an 85-year-old great-grandmother. While most women present with symptoms of pain, bulk symptoms, bleeding or infertility, one patient came directly to labor and delivery, convinced that she was pregnant after experiencing 9 months of an expanding abdomen coupled with other gestational symptoms.

Women often journey with their fibroids.  Initially their symptoms are bothersome but do not interfere with daily life.    With each menstrual cycle, symptoms incrementally worsen but women accommodate.  They purchase a second box of superpads, miss an additional day at work or start taking an extra iron capsule. It takes a sentinel event to finally seek a physician such as a horror movie type menstrual bleed at the grocery store.  When they finally seek out their primary obstetrician – gynecologist, only a small number of possible options are discussed.  It is incumbent on the patient to seek out other consultants and understand the full range of therapeutic modalities.  Most women with larger fibroids aren’t offered minimally invasive approaches and settle for the traditional open surgery with its inherent post-operative pain and healing.  Uterine artery embolization has been around for 16 years, but is still considered ‘experimental’ by physicians that are unfamiliar with it.

You are the consumer, and just as you research the computer you purchase, car you drive and vacation you take, you need to ask your doctor the hard questions:

1.     If you can’t do this, can you recommend someone that can?

2.     How many of these procedures have you done?

3.     How often have you seen a complication from this procedure?

4.     How often have you had to do a hysterectomy, when the plan was simply a myomectomy?

5.     How often do you have to transfuse blood for this procedure?

When patients are fully informed of the full range of options, risks and benefits, they are empowered to make the best decision for themselves.  Only you know what symptoms you live with and what other responsibilities you juggle.

Dr. Magdy Milad is Professor of Obstetrics and Gynecology and Residency Program Director at the Northwestern University Feinberg School of Medicine.

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