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UTERINE FIBROIDS

NEW treatments pionered at UMC!!

WHAT IS A FIBROID?

A fibroid is the most common abnormal growth found inside a women's pelvis; in fact, they occur in 20-30% of women over age 30. The fibroid itself is an overgrowth of the smooth muscle tissue which grows in the uterine wall. Fibroids are also known as myomas from myo (muscle) and oma (new growth). A fibroid can be as small as a pea, or grow larger than a grapefruit. Fibroids can occur as one single growth or multiple growths inside the uterus, within the wall, or on its surface.

  • Submucosal Fibroids - Grow from the uterine wall into the uterine cavity sometimes distorting it which can cause pain, abnormal bleeding and infertility.

  • Subserosal Fibroids - Grow from the uterine wall to the outside of the uterus and can push on the bladder, bowel or intestine causing bloating, abdominal pressure, cramping, and pain.

  • Intramural Fibroids - Remain confined within the uterine wall and can cause symptoms similar to those of submucosal and subserosal fibroids.

HOW ARE FIBROIDS DIAGNOSED?

Many fibroids can be felt during a routine pelvic examination, but to exclude other conditions (ovarian tumors, bowel masses or early pregnancy) which can sometimes be mistaken for fibroids, there are several diagnostic tests which may be performed to determine the best treatment options for you.

Ultrasound uses high frequency sound waves to create a picture of the pelvic organs. No anesthesia is necessary for this office procedure. Sometimes the uterus is filled with a water solution, through the cervix, to improve visibility (sonohysterography).

Hysterosalpingography (HSG) is an x-ray of the inside of the uterus in which a special dye is used to outline abnormalities. If there is a fibroid inside the uterus, it can usually be seen during this procedure. HSG is typically performed in the radiology suite with no anesthesia.

Diagnostic hysteroscopy allows the physician to look into the uterine cavity through a telescope-like instrument called a hysteroscope which is inserted into the uterus through the cervix.

Magnetic Resonance Image (MRI) allows the physician to visualize the abdomen and pelvis with high resolution images. Each patient is placed on a table, and a magnet slightly "deflects" water molecules, giving a precise computer-generated signal of the body.

TREATMENT OPTIONS

If your fibroids are small, or you don't feel any symptoms, you may not need treatment. If you develop fibroids when you are close to menopause, your physician may wait to see if the fibroid will shrink as estrogen levels decline.

For fibroids that are large enough to cause bleeding or painful symptoms, several options may be considered. Your physician will evaluate the best course of treatment based on the number of fibroids, their size and location within the uterus.

WHAT ARE MY MEDICAL OPTIONS?

There are no drugs currently available that eliminate fibroids. However, a class of hormones called GnRH agonists may be used to temporarily shrink fibroid size in preparation for surgery, or, to delay surgery in a patient who is close to menopause. Once you stop taking the medication, the fibroid will usually return to its original size. GnRH agonists work by decreasing estrogen levels which will stop your period, and may produce symptoms experienced in menopause such as hot flashes, and vaginal dryness. These symptoms are reversible once you stop taking the drugs.

Hormones are often provided to treat the bleeding associated with uterine fibroids. These hormones (BCP, estrogens, progestins) usually provide little benefit for the bleeding, and are used to show that the bleeding is not occuring secondary to other gynecologic conditions that can be treated medically.

WHAT ARE MY SURGICAL OPTIONS?

Familiar Procedures

Hysterectomy is the surgical removal of the uterus which may be required in cases of very large, rapidly growing or multiple fibroids. A hysterectomy can be performed by making an incision in the abdomen, or by removing the uterus through the vagina. The procedure is most often performed in the hospital with a general anesthesia. Recovery time is typically two to six weeks.

Myomectomy is a surgical procedure which removes only the fibroid, leaving the uterus intact. Traditionally, myomectomy has been performed through an open incision in the abdomen.

Developmental Procedures

Uterine artery embolization. A new procedure that occludes the vessels that provide blood to the uterus. It is performed by a radiologist, and does not require surgery.

Endometrial resection. A new procedure to cut away a fibroid within (submucosal) the uterus. Surgery is performed through the cervix.

Endometrial ablation. A new procedure that destroys the endometrium to stop menstrual flow. Surgery is performed through the cervix.

Cryotherapy. Insertion of a freezing needle into the fibroid to destroy only the fibroid. Traditional surgery is not required. See our developmental work here.

Laser therapy. Insertion of laser fiber into the fibroid to destroy only the fibroid. Traditional surgery is not required.

FREQUENTLY ASKED QUESTIONS

Does a fibroid mean cancer?

In over 99% of cases, fibroid tissue is benign (non-cancerous). In very rare cases (< 1%), a fibroid may become malignant or cancerous.

What causes fibroids?

The exact cause of fibroids is unknown, but there is evidence suggesting that many fibroids require estrogen to grow. Typically, when a woman reaches menopause (average age of 51), estrogen levels decline and existing fibroids will tend to shrink.

Do all fibroids cause symptoms?

Many women have a fibroid and may not even know it. Medical studies have shown that 50% to 80% of fibroids cause no symptoms, and if they don't cause abnormal bleeding or discomfort there may be no reason to treat them.

What are the symptoms of fibroids?

Some fibroids, due to size, number, and location may cause symptoms such as:

  • changes in your period (heavy bleeding, longer periods or more frequent periods)
  • pain or pressure in your abdomen or lower back
  • pain during sex
  • difficulty urinating, frequent urination or constipation
  • miscarriages or inability to conceive
  • anemia due to chronic excessive bleeding

Can fibroids cause infertility?

The medical literature reports that between 2-10% of fertility problems can be caused by fibroids which can block the fallopian tubes or prevent implantation.