Should Perimenopause Put Off Fibroid Surgery Decision?
Dear Dr. Roach: I am 50 years old. In the past three months there have been indicators that I am perimenopausal. I have a very large fibroid. It is described as “six months” in size. I am not a candidate for embolization. I presently have no painful symptoms, and, with iron therapy, I am no longer anemic. Doctors have recommended a hysterectomy. However, I am reluctant, as I am so close to menopause and believe the tumor should shrink. What are the risks of not removing this large fibroid? I am aware this surgery is common; however, I have profound concern about the risk of blood loss. — L.L.
Answer: A fibroid, also called a leiomyoma, is a (usually) benign tumor of the uterus. Fibroids may cause symptoms of bleeding, pain or pressure, or may have no symptoms at all. Gynecologists describe the size of the uterus with its fibroid as the equivalent of a pregnant uterus, so “six months” is a large fibroid indeed. Gynecologists will follow the size of the fibroid by exam or ultrasound in order to show that it is stable. A growing fibroid is suspicious for a sarcoma, a malignant tumor that 1 percent to 2 percent of fibroids transform into.
Because fibroids respond to hormones, they indeed tend to stabilize or shrink at menopause, when female hormone production decreases. If the fibroid is stable in size and isn’t causing symptoms, then there is no need to have surgery; You can see what happens to the fibroid with time.
Dear Dr. Roach: From time to time, I read and hear of great health benefits attributed to eating nuts. I have a very healthy heart, but no one can consider himself beyond the specter of cancer. Also, possibly my neurological or other systems that deteriorate with age could benefit from eating nuts. Unfortunately, eating nuts or peanuts results in constipation that can last for days. Foods with dairy or egg components give me the same problem. Do I do myself a disservice by not eating nuts? Should I consider episodes of constipation worth the benefits? — J.M.
Answer: I have carefully read the new studies on nuts, and they confirm previous studies showing that nut consumption is associated with a lower risk of heart disease and overall death and, as you note, reduced cancer risk as well. However, this doesn’t prove that eating nuts reduces those risks. It is possible that people who eat nuts have other behaviors that are really responsible for their lower risk of disease. However, the authors of the study did as good a job as possible to reduce that possibility.
In your case, I would think of nuts as a medicine. You have to consider the benefits (possibly lower risk of cancer and other diseases) against the side effects (constipation, which can be very unpleasant and reduce quality of life). One estimate is that nut consumption may increase lifespan by as much as a year. You may have less benefit than other people from nut consumption because of your healthy heart. That would make me less likely to recommend nut consumption for you. If your constipation were more than mildly annoying, I probably wouldn’t “prescribe” nuts. Similarly, people with nut allergies, which are increasingly common, cannot enjoy the health benefits of nuts. Only you can determine if the modest improvement in (possible) life expectancy is worth the symptoms.
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