recommend a good GYN in Bangkok for menopause/fibroids

[rgrdns]

Hi Sheryl,

 

My Thai spouse (age 52) had since last year November more blood loss than usual (besides period cyclus) we visit 2 gynecologists (Nov. and Dec.) both checked with ultrasound and found 2 fibroids size 4.5 and 5.5 cm both doctors said to remove the womb (general practice?), I asked for another option and both said this is the best...we disagree, there are more options. Meanwhile the first doctor gave an DMPA injection (only one) and the 2nd doctor precepted contraceptive pils, it all went more and less back to normal for 2 months until March when the everyday extra bleeding started more or less depending on the period cyclus.

Sheryl can you recommend a good gynecologist in Bangkok...we have private insurance.

 

Regards

[Sheryl]

Of course I can recommend various doctors but I do not think it will  achieve your desired aim of avoiding surgery. 

 

With fibroids, no treatment is needed if the symptoms are tolerable. That is, obviously, a subjective assessment.  I do find though that Thai women tend to be unduly worried by menstrual irregularities and also to fear (incorrectly) that fibroids may turn cancerous.  If her problem is more this (fear/worry) than that the symptoms are physically  intolerable, simple reassurance may suffice,. 

 

If the symptoms are not  tolerable, then first line of treatment is hormone therapy. The hormones least likely to cause significant side effects (e.g. birth control medications) have already been tried in your case. Next approach would be either surgery or classes of drugs known as Gonadotropin-releasing hormone (GnRH) agonists and Gonadotropin-releasing hormone (GnRH) antagonists. These drugs have significant side effects including loss of bone mass which is especially undesirable in women nearing menopause age, and hot flashes. Unless there is a desire to have children, most doctors at this point would advise a simple hysterectomy instead for a woman her age. 

 

There is a drug called Ulipristal which some places here are using, but it has been linked to serious liver damage in some women and is thus not approved for use in Europe except in women with a medical contraindication to surgery and intolerable symptoms from fibroids. 

 

I am not clear what you mean by "everyday extra bleeding started more or less depending on the period cyclus". If you mean she is now having spotting (light bleeding) on most days, or between periods, this could also just be because she is nearing menopause, irregular periods are normal during that time.  Even iuf she were to revert back to DMPA injections, might still have soem menstrual irregularity for this reason .

 

In short, continuing to try non-surgical treatments at this point -- given that the safest/simplest ones have already been tried and failed -- may cause more (and more serious) problems than just having the hysterectomy, assuming she cannot simply tolerate the symptoms. The latter would be best if possible, as at age 52 the fibroids are likely to shrink  on their own soon as she enters menopause (though if she then needs to use HRT, that can sometimes cause the fibroids to not shrink or shrink more slowly). 

 

I don't think any Gyn is likrly to give different advice than this given her age and experience with hormone therapy to date.

 

May I ask why the determination to avoid hysterectomy? For fibroids it would be removal of only the uterus,  a very simple procedure which can often be done laparoscopically or even sometimes vaginally with minimal or no abdominal incision. 

 

 

 

 

 

 

[Sheryl]

P.S. while your post talks only sbout fibroids, title mentions also menopause.. please clarify.

 

If she also needs treatment for  menopausal symptoms (e.g. hot flashes, mood swings) then

 

(1) all the more reason to have hysteretomy if  fibroid related symotoms are intolerable,  as medical management of fibroids will often worsen menopausal symptoms. 

 

(2) unlike fibroids, which any GYN can handle, there is much more limited range of  doctors skilled in HRT so please specify.

 

 

[rgrdns]

Hi Sheryl,

 

That's my observation too (my spouse is worrywart/sensitive person who also has a very stressful job also taking pils for anxiety attacks).

A) "With fibroids, no treatment is needed if the symptoms are tolerable. That is, obviously, a subjective assessment.  I do find though that Thai women tend to be unduly worried by menstrual irregularities and also to fear (incorrectly) that fibroids may turn cancerous.  If her problem is more this (fear/worry) than that the symptoms are physically  intolerable, simple reassurance may suffice,"

 

Yes, from what she tells me with periods light bleeding and around her period heavier bleeding.

B) I am not clear what you mean by "everyday extra bleeding started more or less depending on the period cyclus". If you mean she is now having spotting (light bleeding) on most days, or between periods, this could also just be because she is nearing menopause, irregular periods are normal during that time. 

 

Actually, not really but we wanted to try first other options which both doctors didn't mention until I spoke about e.g. laparoscopy etc....and actually both doctors didn't give us a safe good feeling in this even 10 min visit. 

C) May I ask why the determination to avoid hysterectomy? For fibroids it would be removal of only the uterus, a very simple procedure which can often be done laparoscopically or even sometimes vaginally with minimal or no abdominal incision. 

 

Might this information help you further?

 

 

 

[Sheryl]

2 hours ago, rgrdns said:

we wanted to try first other options which both doctors didn't mention until I spoke about e.g. laparoscopy etc....and actually both doctors didn't give us a safe good feeling in this even 10 min visit. 

C) May I ask why the determination to avoid hysterectomy? For fibroids it would be removal of only the uterus, a very simple procedure which can often be done laparoscopically or even sometimes vaginally with minimal or no abdominal incision. 

 

 Laparoscopy is still a hysterectomy, just a less invasive (but more costly/technically difficult) approach. While fibroids make it a bit harder, a skillful surgeon would usually be able to do laparoscopic hysterectomy with 2 medium sized fibroids in the uterus.  I say "usually" as they don't know until they try and it can sometimes happen that they have tyo switch to open approach after first trying laparoscopically.  Doctors  would not usually mention laparoscopy as an option separate from hysterectomy, since it is a hysterectomy. The issue of laparoscopic vs open approach comes into play only if the patient has decided on hysterectomy.

 

Re GYNs, depends on what you most want. I find this doctor at St Louis to be a very good communicator, unpretentious, frank  and  personable:

 

https://saintlouis.or.th/doctor/dr.petcharat--pitahongnun/8ec97b6a-7666-4fa5-8561-fbbaac15ba7b

 

However, as of last time I saw her (admittedly some years ago), she herself did not do laparoscopic surgery though has no issue referring to someone who does.

So if what you mainly want right now is explanation and discussion of options she would be a good first choice. At St Louis it is first come, first serve so I'd suggest a Wednesday or Thursday as apt to be less crowded which means more time possible with the doctor.