Myomectomy vs Esmya

Due to have a myomectomy on Friday and my surgeon called me in today to mention Esmya. I have been waiting 3 months for the operation and I am now unsure what to do. My fibroid is pendunculated 10x9cm. I have to make a decision by tomorrow morning. I am 32 and have not had children yet.

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I am sorry to learn about your challenge with Fibroid. I can also sense your disappointment with the prospect of perhaps not going to go in for your myomectomy.

I do not think it is a bad thing altogether. Remember though, that you are the boss, and your decision is most important here. Your doctor can only suggest / advice, but you will have to take the final decision.

Your query is: myomectomy vs Esmya: what to go for?

Well. Myomectomy as you know is a major surgery that involves the shelling out of the fibroid from the wall of the womb.

The advantages of myomectomy are that:

• The fibroid is removed and any one in the way of the fallopian tubes that may be causing infertility is taken out of the way almost completely (as much as safely possible)
  
• Fertility is preserved, unlike in hysterectomy
  
• There is no use of hormones here and thus no side effects from hormones
  
• Even though the fibroid could re-occur again, it would take a long time before growing back to a troublesome size again

The Disadvantages of myomectomy include:

• Risk of major surgery, including those of anesthetics
  
• Risk of bleeding heavily during surgery and maybe needing blood transfusion
  
• Very small risk of thing going wrong during myomectomy that the womb has to be removed completely to save life
  
• Risk of recurrence of the fibroid, as it is not a guarantee that it won't grow back

On the other hand, Esmya is a new medication that is increasingly used in the treatment of uterine fibroid. It contains the active ingredient called Ulipristal acetate.

It is used in:

1. Peri-operative treatment of fibroid to shrink it and reduce the extent of surgery
   or
   
2. As an alternative to surgery or postpone surgery.

It is taken as a 5mg pill, once daily for up to 3 months. This can be repeated one more time and most fibroid would shrink up to

The advantage of Esmya over myomectomy is that:

The risk of surgery, anesthesia and bleeding is avoided, at least at the moment

1. No scars and risk of developing post operative adhesion(complications of surgery)
   
2. Less cost implication (overall expense is lesser)

The disadvantages of Esmya are that:

• You will need to remember to take yet another medication on a daily basis
  
• It has side effects like hormone agents, though lesser side effects are reported to occur, compared to those from hormones
  
• Fibroid reduction is not complete (it is reported to be up to 90% though) compared with myomectomy.
  
  
  From the foregoing, you will need to weight your overall health and willingness to take risk and see what is best for you. What do you think?
  
  If I were faced with this decision, and in good health, I probably would opt for myomectomy rather than Esmya, because I do not like taking medications daily and would not want side effects of hormonal agents seen with Esmya like hot flushes, etc, if I can avoid it.
  
  I hope this helps you make up your mind on myomectomy vs Esmya.
  
  The Abdopain Team.