Uterine Fibroids
Symptoms Are Not Always Present
Uterine fibroids are benign growths (noncancerous tumors) that form in the uterus, or womb. They are made of muscle and connective tissue, and their cause is unknown. These growths can be small, or grow to the size of a grapefruit, filling the entire uterus and weighing several pounds. Often, when uterine fibroids are present they do not cause symptoms. When they do cause symptoms, common complaints are a fullness or pressure in the abdomen, cramping, heavy menstrual bleeding, anemia, painful intercourse, or the frequent urge to urinate. Treatment depends on the size of the fibroids, the symptoms they are causing, and the patient’s age, general health, and desire to have children in the future. Hormonal treatments have been used to shrink the fibroids, but they have unwanted side effects and the fibroids enlarge again when the treatment is discontinued. Surgery to remove the fibroids or the entire uterus is often recommended. A new procedure called uterine fibroid embolization is now being used in many women; it does not involve general anesthesia and is associated with a short recovery period. With this procedure, the doctor injects tiny particles into the arteries leading to the fibroids, cutting off their blood supply and causing them to shrink and die.
Hysterectomy, which remains the second most frequently performed surgery in the U.S., will eliminate the problem of fibroids. But a new and simple surgical procedure called uterine fibroid embolization shrinks the fibroids by stopping their blood supply and leaves the uterus intact.
Fibroids Aren’t a Cancer Risk
Uterine fibroids are commonly diagnosed in women during their childbearing years. Rarely are they seen prior to the beginning of menstruation. They usually stop growing or actually shrink after menopause, probably because estrogen hormones stimulate their growth. They are more often seen in black women, and the actual incidence rate is unknown, since in many cases they do not cause symptoms and are too small to be noticed during a routine pelvic exam. A diagnosis of uterine fibroids often causes great concern, but these tumors almost never develop into cancer and do not increase the risk of developing cancer of the uterus. Uterine fibroids usually do not interfere with becoming pregnant, but can cause both premature labor and premature contractions.
Diagnosis: Uterine fibroids are typically diagnosed during a routine gynecologic exam when they are large enough to be noticed or cause symptoms. Heavy or painful bleeding, bleeding between periods, fullness or pressure in the lower abdomen, painful intercourse, frequent urination from a fibroid pressing on the bladder, or lower back pain may all be symptoms. In most cases, the diagnosis is made by a pelvic exam and confirmed using ultrasonography, computerized tomography (CT), or magnetic resonance imaging (MRI).
Treatment Options: In patients without symptoms, no treatment is required, except for annual follow-up examinations. Treatment in patients with symptoms depends on the size of the fibroids and the seriousness of the symptoms, as well as the patient’s age, health, and desire for future pregnancies. Mild symptoms of cramping and pain may be controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. If anemia has developed due to heavy menstrual bleeding, iron therapy is needed. Hormonal treatment with gonadotropin-releasing hormone (GnRH) agonist drugs, progestins, or danazol can help shrink uterine fibroids, but they are only used for short times since they cause hot flashes, vaginal dryness, weight gain, and loss of bone mass. The fibroids enlarge again after hormonal treatment is stopped.
Surgery: Surgical treatments include myomectomy, in which the fibroids are removed, or hysterectomy, which involves the removal of the entire uterus. Both are major surgeries, requiring general anesthesia, an extended hospital stay, and a 6-8 week recovery time. A myomectomy is often chosen by younger women who may wish to become pregnant; it often relieves the symptoms, but very small fibroids may remain and grow larger in the future, causing symptoms to return. A hysterectomy is a cure for fibroids, since it involves the removal of the entire uterus. Typically, this procedure is chosen by older women who do not wish to have children in the future. A new treatment, uterine fibroid embolization, shrinks fibroids by stopping their blood supply though a simple, painless procedure. It does not require general anesthesia and recovery time is typically one week. A small incision is made in the groin area in order to pass a tube through an artery to the uterus. Tiny particles are injected through the tube into the arteries that supply the fibroid with blood. With the blood supply cut off in this manner, the fibroid will shrink and die. This procedure is an exciting advance for women who suffer from the symptoms produced by uterine fibroids.
