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Although fibroids — benign tumors that grow in the uterus — can cause pelvic pain, abnormal vaginal bleeding and infertility, women of childbearing age frequently decide against treatment because the available procedure choices don't guarantee continued fertility.

In a study in the December issue of The Female Patient, physicians at Thomas Jefferson University Hospital (Philadelphia) present the case history of a 35-year-old woman whose numerous fibroids formed a large mass in her pelvic area that was comparable to a full-term pregnancy in size.

"Traditionally, treatment for such a large fibroid mass in the uterus has been limited to hysterectomy, because the patient would bleed extensively if an attempt was made to merely remove the fibroids," said Jay Goldberg, MD, lead author and director of the Jefferson Fibroid Center at Thomas Jefferson University. He said that in this case hysterectomy was not an option "because the patient strongly desired future fertility and uterine preservation."

To meet her wishes and remove the fibroids, the physicians performed two procedures a month apart, the first a uterine fibroid embolization (UFE), a minimally invasive radiologic procedure that blocks the arteries that supply blood to the fibroid tumors. This type of procedure reduces blood flow within the patient's uterus and the risk of hemorrhaging at the time of surgery. Then, a month later, the patient underwent an abdominal myomectomy in which fibroids are removed through an abdominal skin incision.

After the UFE, her 38-week sized uterus had decreased to a 34-week size, with decreased blood flow. The myomectomy procedure was successful in removing removed 11 large fibroids with minimal blood loss.

The patient was discharged from the hospital after two days with no complications.

Goldberg, who is also director, Division of General Obstetrics at Thomas Jefferson University, and his colleagues recommend the combination of procedures for women who want to preserve their uterus. They write: "We are noting a trend toward more women requesting uterine-preserving treatment for fibroids — even with massively enlarged uteri, and even when future fertility may not be a consideration.

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