Dear Doctor,

I’m writing this letter to let you know that I’ve decided to leave your practice and seek a new gynecologist. I’ve been a patient of yours for 8 years now and have found you to be a knowledgeable, ethical and dedicated doctor. So this decision to leave your practice was not one I made lightly and I need to let you know why I’ve come to this decision.

Over the years, we’ve discussed my uterine fibroids and you’ve followed them with ultrasound examinations to see whether they have changed noticeably. For most of the last 8 years, they haven’t. We’ve discussed what to do should they become troublesome. Your only recommendation for treating them, should they become a problem, has been that I should have a hysterectomy.

The last 2 ultrasounds I have had have shown that the fibroids have begun growing rapidly, and at the same time I’ve been having increasingly troublesome symptoms of bleeding and pressure. At my last visit with you, you again recommended hysterectomy. When I asked about myomectomy, you told me that doctors "across the board" agreed that hysterectomy is an appropriate way to treat a symptomatic fibroid uterus for a woman of my age (at the time, 47). I was quite firm about my intention to retain my uterus if at all possible and told you I did not see the point of amputating a bodily organ to treat what is, after all, a benign condition.

The following week you called me to suggest a new procedure called uterine balloon ablation, which you explained would stop the heavy bleeding I’ve been experiencing. I agreed to this procedure, but before I got to the scheduled treatment date, I learned 2 things about ablation that altered my decision. That first was that, while ablation would almost certainly stop the bleeding problem -- in fact, I would probably never have another period again – it would make later detection of uterine cancer more problematic. The second was that ablation would do nothing to stop the fibroids from continuing to grow. To me, this seemed like an extreme treatment that would only solve one-half of my fibroid problem. So I ruled out ablation.

While doing my research on ablation, I came across info on another procedure called uterine artery embolization. I learned that UAE would not just stop the fibroids from growing, but would actually cause them to shrink and die. This was the result I was looking for.

However when I spoke to you about UAE, you were very discouraging. Among other things, you said the procedure was not appropriate for my condition. However, you did say that you wanted to speak to the interventional radiologists who were doing this procedure and I agreed. Much to your credit, you called me back in a couple of days to say that after speaking to the interventional radiologists, all your questions had been answered and you now felt it was an appropriate treatment for my fibroids.

So why do I want to find another gynecologist? Because I expect certain things from my gynecologist which you apparently don’t consider important.

• I expect my gynecologist to make me aware of ALL my options for treatment. I realize that you may not be in favor of some options and I would expect you to let me know your opinion of these procedures, but I have a right to know what’s available and to make my own decisions.
• I expect that you’ll give me complete information about any treatment you recommend. I had to find out on my own that the balloon ablation you recommended would not stop my fibroids from growing, and would also make it more difficult in my later life to detect uterine cancer should it occur.
• I expect my gynecologist to keep up to date on new treatments. It was obvious from your first comments to me that you were aware of uterine artery embolization, but apparently you either had never learned about it in detail or had maintained your initial opinion on it without following its later development and research.
• And most importantly, I expect my gynecologist to see a value in keeping me an intact woman regardless of my age and decisions about future childbearing unless my life is threatened, such as by cancer. In the case of treating my fibroids, you recommended the most invasive and destructive treatment as my only option when other womb-sparing procedures were available.

It’s for these reasons, Doctor, that I’ve reluctantly decided to seek out a new gynecologist, one who shares my belief that a woman’s uterus is necessary for reasons other than childbearing.

Yours truly,

LJF