A Text-book of Diseases of Women

by Charles B. Penrose

The accidents that may happen to the tumor itself, and which imperil the life of the woman, are various and occur frequently. The dangerous forms of degeneration—the edematous, the cystic, the telangiectatic, and the sarcomatous—occur with sufficient frequency always to be dreaded; and, even though these dangers be avoided, the anemia from the continual hemorrhage exposes the woman to fatal results from the diseases and accidents of daily life. The most favorable course that we have a right to expect, in any case of fibroid tumor of the uterus that is not discharged as a uterine polyp, is that it will grow slowly, that it will produce symptoms not unendurable, and that at the menopause it will cease to grow and will atrophy or disappear.

This comparatively favorable course condemns the woman to a life of invalidism, more or less marked, during the years that should be the most useful and active of her existence. The menopause may be delayed for five, ten, or fifteen years, or it may be indefinitely postponed; and even after the menopause has occurred, in a certain number of cases the fibroid, contrary to the usual rule, continues to grow, and may ultimately cause death.

Treatment of Fibroid Tumors of the Uterus.—Operative treatment is usually demanded in the case of fibroid tumors. A few years ago the treatment usually advised was palliative and expectant. The imperfect technique rendered operations for this disease so fatal that it was considered safest for the woman to allow the tumor to pursue its natural course, hoping that, if small and single, it would be discharged as a polyp, or that it would grow slowly and would atrophy at the menopause, the physician meanwhile relieving as much as possible, by palliative treatment, the symptoms that presented before this favorable termination.

Many women, following this advice, have suffered through the years of active life, and have finally found relief and cure when the menopause was reached; others have started upon this dreary course, and have died from some of the accidents incident to these tumors; still others have passed through these years of suffering, and then have found the hoped-for goal vanished, the menopause indefinitely postponed, or the tumor continuing to grow after this period had been reached.

Many of these women are driven to the operating-table to-day, after lives that have been wasted by this expectant plan of treatment.

The great majority of fibroid tumors of the uterus demand immediate operation. The operative technique has been so perfected that the mortality after operation is very small. The danger of operation is much less than the dangers to which the woman is exposed from the various accidents that are liable in this disease.

There are some cases, however, in which immediate operation is not demanded. In a young woman with a fibroid tumor of small size that is not causing serious symptoms operation may be deferred and the case may be watched. This plan is especially desirable if the woman is anxious to have children. She should be told, however, that conception is less likely to occur than in the well woman, that she is liable to abort, and that the tumor will grow more rapidly during her pregnancy. On the other hand, there is the possibility of its disappearance after labor.

If the tumor, even though small, is intra-ligamentous and of pelvic growth, the expectant plan of treatment is not justifiable. Dangerous pressure-symptoms are too imminent, and if pregnancy occurs labor will be obstructed. If the woman has reached the menopause, if menstruation has ceased, and the tumor is causing no serious symptoms from its size and position, the case may be watched with the hope that the disease will shortly become quiescent. Such cases are exceptional. Usually the tumor produces symptoms that render the woman more or less of an invalid, and she should not be condemned to this suffering and to the dangers of waiting. In these cases we must not rely altogether upon the statement of the woman in regard to the suffering caused by the tumor. A woman, dreading operation, will often underrate her suffering, or she will consider as normal the disturbances to which she has, through a long period of years, gradually become accustomed.

No drug has been discovered that has any influence upon the growth of the fibroid tumor.

The most serious symptom, hemorrhage, may be alleviated in a variety of ways. Rest in the recumbent posture, to relieve congestion, is most important. Such rest is especially demanded at the menstrual period. Pressure-symptoms and pain are likewise relieved by rest. Careful attention to the regularity of the bowels is desirable. The administration of saline purgatives to the extent of mild purgation depletes the pelvic circulation, and is especially useful immediately before a menstrual period. Coitus should be avoided immediately before and during the menstrual period.