Why do drs say my naturally degenerating fibroids are bad when a UAE would make fibroids degenerate?

I am 49 years old and perimenopausal (my periods have become more frequent, although I have missed two periods in the last 12 months.) I have had fibroids at least since my early 20s. (I'm originally from the US, where women have regular gynaecological health checks.A the time, gyn found a pea-sized fibroid he at first thought was a poo. ) After an ultrasound several years ago, I was told I had the uterus the size of about a 16 or 17 week pregnancy. Until very recently, I have had no symptoms other than a big belly.

 In the past year or so, I have noticed that I have brief, intermittent pain occasionally. It feels like the nerve pain you get if you hurt yourself on your coccyx, except from the inside.  I have pedunculated fibroids, so they move, and I can make the pain go away by changing position. I also occasionally have pain when defecating, although I am not constipated. (I can usually clear that up with exercise or a nice long walk.)

I decided to see my GP just in case, as I hadn’t had my fibroids looked at in a few years.   A blood test revealed that my CA 125 was high, so I was referred to a gynaecologist. 

However, when I saw the gyn, I learned that while my CA 125 was above reference range, it was nowhere near the level seen in people with cancer. (I have no family history of cancer,  by the way.) 

 After being given another ultrasound, I was advised that I might be a candidate for UAE. This surprised me, as I had never been given this option before and thought my fibroids were too big for it. It seemed like a good idea, so I was scheduled for a pelvic MRI to determine whether the UAE was a possibility.

The MRI showed that I was not a candidate, because I had two or three (sorry, I don’t remember) pedunculated fibroids, each around 5 cm diameter, of which I believe at leaslt two were degenerating. I thought that this was fantastic, as the fibroids were dying on their own, and I didn’t have to do anything. (The MRI also showed numerous smaller fibroids.)

I was scheduled to have a second MRI three months later, to see if the fibroids were growing.  Several weeks after this second MRI, I received a letter from the gyn, which said that my fibroids were indeed growing and that I had some fluid in my pelvis which had increased over the three months. She had “taken the liberty” of scheduling me for a CT scan of my chest, abdomen and pelvis. I had the CT scan last week, and today I just received a call saying that a gyn wanted to see me tomorrow. (I had to postpone till next week.)

By the way, I got my period the day after my second MRI, and was on my period during the CT scan.

Also, I have asthma and have trouble breathing when I am lying flat on my back, so I had difficult doing the breathing for the MRI and CT scan. (I normally sleep with lots of pillows.) Plus, at the second MRI, I had a cold and I had an allergic reaction to the Buscopan, which may have hindered my breathing even more. so I wonder if that might have caused unnecessary concern. (I was given a chest x-ray after the 1st mri but never heard anything back. I assume it was normal.)

I have been offered a hysterectomy, which I don’t want unless it is absolutely necessary.  My understanding is that it is normal for fibroids to grow during perimenopause and for degenerating fibroids to swell, and that pelvic fluid is normal, (I don’t know by how much the fluid has increased) so I don’t understand what the problem is.  If I’d had a UAE, I would be intentionally causing my fibroids to degenerate; I don’t understand what the difference is.  I have no  fever or other symptoms that would indicate infection or sepsis . (As I said, I am pretty sure that the intermittent fibroid pain that isdue to pressure on a nerve - I can relieve it just by moving it.)

I have researched and discovered that the risk of a rapidly growing fibroid becoming cancerous is less than 1%. However, the risk of complications from hysterectomy is greater. (I have never been pregnant except for an unintended pregnancy that ended in early  miscarriage when I was 42. I know that increases my cancer risk somewhat.)

Is there any reason why I should be concerned and consider a hysterectomy, considering that most of the time I am symptom-free and the symptoms I do have don’t affect my life? I am in good physical condition and very active. Why am I being told that my degenating fibroids are bad when I was previously offered a UAE which would intentionally cause fibroid degeneration? Do many women who have UAEs end up having hysterectomies after, anyway? My plan was to just wait until menopause and let the fibroids die slow, natural deaths.

 Also, my understanding is that a CT scan provides a less accurate picture than an MRI, so I don’t undersand why I was given one after the MRI. When I called the gyn's office to ask what the gyn saw in my second MRI to make me need a CT scan (I was concerned about unnecessary exposure to radiation), I was only able to speak to the gyn's secretary, who told me that the dr wanted to see more of me than my pelvis, and that I "needed a CT scan.")

 My periods have gotten less regular and for the most part, more frequent, but that is normal for a woman my age.  Based on my family history, it should be at least another five years or so before I reach menopause. (I became pregnant, unintentionally,when I was 42, but miscarried.)My concern is that the doctors are treating me as though I am post-menopausal, where bleeding and growing fibroids would be a real worry.

Another issue is that while I don’t have a family  history of cancer, I do  have a family history of heart disease and osteoporosis, and I understand that even a partial hysterectomy (because it decreases blood flow to the ovaries) could increase my risk of both. . Any advice on what to say to the doctor at my next appointment? If there is a risk of cancer, I would like to ask for a biospy first, but I don't know if that is possible.

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