Brief Answer: DEFINITE TREATMENT IS ABDOMINAL HYSTERECTOMY. Detailed Answer: Hello, Thanks for writing to us on Healthcare Magic. PERMANENT SOLUTION: Best and definite treatment option for multiple fibroid with heavy bleeding is TOTAL ABDOMINAL HYSTERECTOMY with removal of both sided ovaries and fallopian tubes (TAH + BSO). It is the gold standard procedure at this age (40 years) group. TEMPORARY EFFECTIVE TREATMENT: Uterine artery embolization, radio frequency ablation etc are the other options available but they are not permanent solution. PROGESTERONE therapy (no combination) can be tried initially in the form of pill or IUD (like MIRENA) to regress fibroid and control bleeding. She needs periodic follow-up and overall assessment until bleeding is controlled. OTHER MEDICAL THERAPY: 1) GnRH Agonist (like Goserelin) 2) Anti Progesterone (like Mifepristone) 3) Aromatase Inhibitors are very much effective in reducing size of the fibroid along with symptoms. SUGGESTION : Medical treatment can be initialized for controlling bleeding and regressing fibroid size. However, in the failed case, she needs definite treatment as mentioned above. Kindly, consult with your GYNECOLOGIST regarding this for proper management. In the mean time, she would take healthy diet with IRON supplement to combat anemia and maintain genital hygiene properly. Hope, it will be helpful for your information and understanding. Let me know, if you need clarification. Wish her good health and take care yourself. Regards, Dr Soumen For future query, you can directly approach me through WWW.WWWW.WW

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Brief Answer: DETAILS ARE GIVEN BELOW. Detailed Answer: Hello, Thanks for follow up query. 1) Though the problem is inside uterus (multiple fibroid), it is better to remove both side ovary and fallopian tube at this age (40 years) with completed family to AVOID FUTURE RISK OF MALIGNANCY and MICRO-METASTASES. 2) Following removal of both side ovaries, hormonal problem will arise along with surgical MENOPAUSE. However, HORMONE REPLACEMENT THERAPY (HRT) is given for most women after total abdominal hysterectomy to counteract the menopausal symptoms. Low dose conjugated estrogen with other supportive therapy is the preferred hormonal treatment in such case . It can be given for 5 to 10 years with periodic monitoring. Kindly, consult with your GYNECOLOGIST for proper guidance. Hope, I have guided you properly. Kindly, close the discussion if you don't have any other query. Good luck and all the best. Regards, Dr Soumen

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