Uterine Fibroids

On an annual basis, thousands of women are treated for uterine fibroids. It is estimated that up to 30% of women in the 35- to 50-year-old age group develop these growths. Prior to the year 2000, hysterectomy was a primary treatment for this condition. Today, we have much more conservative measures that may be taken to improve a woman’s health and well-being.

What Are Uterine Fibroids?

Uterine fibroids are benign growths that may also be referred to as myomas or leiomyomas. They may develop in various numbers, sizes, shapes, and locations of the muscular uterine tissue, including on the outside of this structure. Fibroids are attached to the uterus by a “stem.” The growth of a fibroid may stagnate while it is still small, or it may progress into a large growth.

Uterine Fibroids Symptoms

There are several symptoms that may develop for women who have uterine fibroids. Menstrual changes such as longer duration or heavier flow is just one of several indicators of abnormal tissue growth. Additional symptoms of uterine fibroids include:

• Bleeding in between periods
• Anemia due to heavy menstrual bleeding
• Painful intercourse
• Chronic abdominal or low back pain
• Abdominal cramping
• Rectal pain and/or constipation
• Frequent urination or difficulty urinating
• Enlarged abdomen
• Miscarriage or infertility

It is also possible to have no symptoms.

Are Fibroids Serious?

Fibroids do not indicate uterine cancer, nor do they increase the risk of that disease. The primary complication of uterine fibroids is physical discomfort. If a fibroid stem twists, a woman may experience pain, as well as fever or nausea. Large fibroids can present an obstacle to the routine pelvic exam. Although fibroids can be cited in some cases of infertility, this is rare.

Diagnosing Uterine Fibroids

Your healthcare provider may perform diagnostic testing to accurately diagnose fibroids. There are several tests that we may recommend depending on appropriateness for your circumstances.

• Ultrasound helps us observe the pelvic organs, including the uterus.
• Sonohysterography involves the insertion of fluid into the uterus (via the cervix pathway) prior to ultrasound examination. The presence of fluid increases visual clarity.
• Hysterosalpingography is x-ray imaging that observes the uterus as well as the fallopian tubes.
• We may perform a hysteroscopy to observe the inside of the uterus. We insert this small scope into the vagina, through the cervix, and into the uterus.
• Laparoscopy is a minor surgical procedure in which there is a small abdominal incision. This diagnostic procedure enables your physician to observe fibroids that have formed along the outside wall of the uterus.

In addition to initial diagnosis, we may perform these imaging tests periodically to monitor the condition or growth of fibroids.

Do Fibroids Need to Be Treated?

If no symptoms result from the presence of uterine fibroids, the recommendation for treatment may only be monitoring. Symptoms that may warrant treatment include:

• Persistent pelvic pain
• Rapid fibroid growth
• Bleeding in between periods
• Menstrual flow is disruptive to a woman’s lifestyle or well-being (anemia)

Your doctor may recommend removal as well, if diagnostic tests cannot confirm that the growth is a fibroid rather than a tumor.

Fibroid Treatment

There are several approaches to fibroid treatment. Medications that may treat fibroids include:

• Oral contraceptives, which can control menstrual flow and pain.
• Gonadotropin-releasing hormone agonists. This type of medication is generally for use before fibroid surgery as a way to reduce bleeding risk. These drugs are not for long-term use.
• We may use an Intrauterine device (IUD) that releases progestin in cases where there is no uterine distortion. This method does not treat the fibroids themselves; rather, it controls menstrual symptoms.

Therapeutic Treatments For Fibroids

• MRI-guided ultrasound surgery breaks up fibroids with ultrasound waves, guided by magnetic resonance imaging.
• Hysteroscopy destroys fibroids with laser energy or electricity via a small instrument called a hysteroscope.
• Endometrial ablation removes the lining of the uterus where fibroids attach. There are several ablation techniques.
• Uterine artery embolization cuts off the blood supply to uterine fibroids by introducing tiny particulates into the vessels the feed them.

Surgical Treatment for Fibroids

• Myomectomy, or the direct removal of fibroids, leaving the uterus intact. This procedure enables a woman to maintain her reproductive possibilities, but it does not prevent the future growth of new fibroids.
• Hysterectomy is the removal of the uterus and the fibroids, in some cases, will also remove the ovaries. A definitive treatment for many of the symptoms associated with having fibroids, especially abnormal periods. Your provider and you will discuss your options as your needs arise.