To someone who is wondering whether or not to have a myo

Lots of women get pg with fibroids in place, it is an elective procedure however so in part you get to decide when it is right for you. Some considerations I've noted about when it is a good time to have fibroid surgery:

• you feel like you have exhausted all other possible treatment options
  
• you are feeling pain and discomfort, even some of the time. This can include back pain, pelvic pain, leg pain, etc.
  
• you are having bleeding problems (really heavy periods, or periods that don't seem to stop -- this can lead to problems with anemia which can impair fertility and put you at risk for other health problems such as clotting)
  
• you have had trouble conceiving or have had miscarriage/s
  
• you are wanting to try hormonal fertility treatments and your fibroids are already a good size
  
• you are having difficulty urinating or are having to pee all the time or you are developing urinary tract infections
  
• you can't stand the thought of having fibroids inside of you and want to get rid of them
  
• you fibroids are compromising the interior space of the uterus
  

Since you are already dealing with TTC with one tube I can see that it doesn't feel like a straight shot decision for you at all. There is a risk of adhesions after any abdominal surgery, but whether or not these will cause problems is another question.

The surgery is a big deal in that it can be quite invasive and most of us haven't had that much physical trauma before. It is also one that you will recover from quickly. An abdominal myo is very similar to a c-section and loads of women have those operations every day.

Have you read What Your Doctor May Not Tell You About Fibroids yet? It is a super book that really helped me to feel empowered about my body and my fibroids. It describes in detail about the various procedure options and includes info about fertility success rates post-op.

Menstrual Irregularities

Here's a page which illustrates/explains different types of menstrual irregularities:

http://www.femalehealthmadesimple.com/FileTwelveFinal.html

"Any woman of childbearing age who has missed more than two consecutive periods -- but was not pregnant -- needs to investigate it and possibly have her period induced. Preventing the development of hyperplasia is the reason."
From: Endometrial Hyperplasia, WebMD

"Excessive estrogen stimulation can lead to significant increases in uterine lining thickness. The tissue becomes hyperplastic or atypically hyperplastic . It may become cancerous."

(and)

"Inadequate ovulation may cause excessive, irregular, or frequent menses recurring less than every 3 weeks. Inadequate ovulation leads to an excess of estrogen, which stimulates growth of the menstrual lining, and a decreased level of progesterone - which normally would be present in levels that would adequately thin the menstrual lining and prevent excess or irregular bleeding."
From: Dr Decker, Heavy Menstrual Cycles Management Options

"We like to see a lining of at least 8mm in thickness when measured by ultrasound at the time of maximal thickness during the cycle (see above ultrasound images of an 11.5 mm lining). There is some ongoing debate as to "how thin is too thin", as well as to "how thick is too thick". In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so could possibly reduce chances for a successful pregnancy."
From: Uterine problems causing infertility or miscarriage

Why we have bleeding problems... Links/References

At the beginning of the year I posted some links about dysfunctional uterine bleeding (DUB) and one list member (on the fibroid group) asked if I would look into why women tend to have flooding first thing in the morning. Most of you probably know this phenomena whether or not you have DUB -- its when you are sound asleep and suddenly awaken because a big gush of blood is coming out all at once and you run to the bathroom if you can though sometimes you wake up too late and the sheets, your underwear and your nightclothes all need washing.

I wish I had a hematologist to confer with but doctors tend to keep to themselves or just don't overlap with my software oriented social network. I've got a few references here some mechanical and some physiological to causes for bleeding. Since excess estrogen/low progesterone is one theory of part of the cause of fibroids it is interesting to see that the same conditions also set the stage for bleeding problems. Also, I couldn't find references to early morning menstrual bleeding but there was a reference to there being early morning changes in the blood which might be related, at least in action.

"Most very heavy menstrual bleeding does not mean that a woman is shedding substantially more endometrium. The endometrial slough is determined by the size of the uterus and the hormonally induced endometrial thickness. The uterus has large blood vessels that come through the myometrium to feed and supply the endometrium. Really heavy bleeding occurs when the uterine muscle cannot do its job of contracting around these vessels. This is important because after the endometrium is passed out, the basilis layer may be very thin, which could expose the raw muscle surface. This means that the large
vessels can pump blood directly into the uterine cavity if the muscle cannot contract well."
http://www.centerforendo.com/news/adenomyosis/adenomyosis.htm

"what frequently happens when excessive amounts of estrogen are secreted. Parts of the endometrium outgrow their blood supply and are discarded but not simultaneously. While the one part recovers another part is discarded and the bleeding continue for prolonged periods. In the illustrations the bleeding might decrease while the one area heals before the the other area starts bleeding."

"Fibroids usually cause excessive cyclic bleeding. The amount of blood loss is increased and /or the duration of the bleeding is increased. The mechanism is probably due to enlargement of the womb, thus increasing the surface area of the endometrium."
http://www.femalehealthmadesimple.com/FileTwelveFinal.html

"The plasminogen (fibrinolytic) system (Figure 1 ) comprises an inactive proenzyme, plasminogen, that can be converted to the active enzyme, plasmin, that degrades fibrin and that activates matrix metalloproteinases (MMPs), which in turn degrade extracellular matrix(ECM)"
"There is a clear correlation between the circadian variation in the time of onset of myocardial infarction, with the highest incidence at about 8 a.m., and the circadian rhythm of plasma PAI-1 activity, which is also highest early in the morning."
http://www.asheducationbook.org/cgi/content/full/2001/1/1

"PGE2 --> vasodilation; PGF2a --> vasoconstriction; progesterone is necessary to increase ararchidonic acid, the precursor to PGF2a. With decreased progesterone there is a decreased PGF2a/PGE2 ratio. Since vasoconstriction is promoted by PGF2a, which is less abundant due to the decrease in progesterone, vasodilation results thereby promoting AUB [Abnormal Uterine Bleeding]"
http://www.unmc.edu/Olson/PowerPoint/36 (no longer available)

ouch! Agonizing and debilitating cramps

So Wednesday night I lost half of my pg belly -- that was pretty dramatic. I can't believe how fast my body was reorganizing itself.

Today, Friday I missed work again since I still had a killer headache and some cramping. This progressed to major agonizing cramping around 4pm that had me moaning and writhing in pain. I ate chocolate -- helps keep anandamine, a pain and tranquilizing substance the body produces (similar to THC in marajuana) around in the body longer. I drank 2 glasses of red wine, took an anti-cramping drug I got in France a couple years ago when I had salmonella and then drank 1/3 cup of passion flower tea. I then tried breathing exercises and sat in the summer heat on my front porch with a hot water bottle for 2 hours and finally my cramps started to subside.

I was then able to go out for dinnner with friends, drank more red wine, and the cramping was pretty quiet for a couple hours. Then I went to a friend's house and she's an herbalist and made me lemonbalm tea which, like passion flower, is supposed to be a nerve tonic. Drinking that and holding the hot mug to my belly both helped some as the cramps were coming back.

I wasn't having any major bleeding until about an hour ago, still light by the menses benchmark but red and not dark like before. I feel like someone has stabbed me with a sword a couple times in the abdomen and I'm dying to be honest. I'm now having another glass of red wine and going to go to bed with the hot water bottle clutched to my abdomen in spite of the heat wave we are having here in Seattle. Whatever it takes.

OUCH!

I hope this subsides by morning.

Two years ago when we were starting to TTC I was having some odd spotting around ovulation or so. It wasn't normal for me and yet it kind of fit the description of ovulatory spotting from TCOYF. A couple months later I was having pelvic pain and my doctor found a fibroid. I then switched to a naturopathic doctor for treatment and the spotting stopped. She had the full basic hormone work done, but not the CD 21 progesterone test. I had to change my diet, my stress level, my lifestyle to help my body to be healthy. I was on herbal supplements for several months as well and on iron to help combat anemia that was hanging around for years.

At the beginning of this year I started seeing an acupuncturist and he helped balance my hormones further. It was a little ouchy at times but amazing. I think he helped even my cycles more than anyone I have cycles that are so regular.

I also saw 3 REs and had more hormonals tests, an HSG, and several u/s (for my fibroid). I have to say that the combination of alternative therapies combined with traditional western medicine helped me to feel like I had all bases covered. I talked to a lot of docs because they wanted me to have surgery and I didn't want it (for the fibroid). Talking to lots of different practitioners was really valuable, though time-consuming. My insurance covered all but the co-pay but that fibroid was helpful in validating the consultations.

Doctors gave us miniscule odd of conceiving on our own but we did it. I think acupuncture had a lot to do with it.

Here is a link to a page that references many studies about acupuncture for use in fertility issues:
http://www.easternharmonyclinic.com/medart/medart.html