I'm 41 years old and have found out that I have a 10-12-week size myomatous uterus. My gynecologist advised me to have a hysterectomy. I feel I'm not a candidate since I get my periods on time, my only heavy bleeding is during my first day, I don't feel any pain and I don't urinate frequently. Most of all I feel I am too young to have this procedure. Do you have any suggestions that might help me?

C.D.

Myoma, also known as fibroids, are extremely common, benign (noncancerous) growths of the uterine wall. When cut in half, fibroids look a lot like the inside of a golf ball. Because they increase the size of the uterus, fibroids may lead to heavier bleeding during periods and more cramping. Often, though, a woman with fibroids has absolutely no symptoms at all, and they are only noted on a routine pelvic exam.

Just because you have fibroids does not mean you have to do anything about them. Left untreated, the fibroids you have may grow, and new fibroids may develop. In the future, you may develop bleeding and cramping. But this is not a given. Many a woman has pretty large fibroids and nary a symptom, and manages to get through life without a hysterectomy.

If you do develop symptoms, there are several options for dealing with fibroids. One is to use medication to shrink them. GnRH-agonists (such as Lupron or Synarel) trick the body into thinking it is in menopause; the resulting lower hormone levels cause the fibroids to shrink. Surgery can be done to remove the fibroids, either through an open incision, through a laparoscope (a miniaturized surgical tool that requires only small incisions in the abdomen) or through a hysteroscope (a tool passed through the vagina into the uterus), depending on the size and location of the fibroids. This can be effective, but as long as the uterus remains in place, more fibroids may develop. Hysterectomy, or the removal of the entire uterus (but not necessarily the ovaries) is the most definitive approach.

If you are having no symptoms, you can elect to just watch and see what happens. Once you reach menopause (probably not for another 10 years, though), your fibroids will no longer grow and may even shrink. If you develop symptoms at any point, you can revisit the idea of having a hysterectomy.