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Fibroids


 

Fibroids - Just the Facts

Uterine fibroids are also called uterine leiomyomas or myomas.

What they are:

  • Benign overgrowths of smooth muscle tissue in the uterus.
  • The most common pelvic “tumor” (benign) in women, appearing with age but declining after menopause. 

Generally, in the USA, more prevalent in black women than white: 59% black; 43% white, but into their 40s, these rise to 80% and 70%, respectively.

What they do:

  • Often, nothing at all.

They’re benign, so if symptoms are absent or don’t warrant intervention, they can be simply “waited out,” as they get smaller after menopause.

  • Cause heavy/prolonged menstrual bleeding.

This is the most common cause for needing them removed (myomectomy) or hysterectomy, especially if anemia develops.

  • Cause symptoms due to their sheer bulk—heaviness:
  • Pain and pelvic pressure.

Their extra weight on the uterus can pull on and stretch the suspensory ligaments, causing pain and pressure.

  • Bladder issues.

They can put pressure on the bladder wall, causing urgency to urinate.

  • Bowel issues.

They can put pressure on the rectum, causing an urgency to have a bowel movement, straining, and constipation.

  • Compression of pelvic veins.

They can press on pelvic veins, obstructing their flow, leading to engorgement and the pain it causes.

  • Painful intercourse.

The weight and displacement of the uterus, as well as the pressure against the ligaments, bladder, rectum, and/or vaginal wall, can cause mechanical jostling of these tissues, making sex very painful.

  • Fibroid degeneration.

They can outgrow their blood supply, leading to their tissue death within, which causes pain and fever.

They can loosen at their base and extrude down and out of the cervix/vagina as a mass that can bleed, degenerate (die), get infected, and cause pain. 

They can:

  • physically interfere with egg/sperm transport by blocking the entrance/exit to the tubes;
  • they can interfere with implantation of a fertilized egg or
  • make for a poor site for implantation, increasing the risk of miscarriage;
  • they can increase the risk of pre-term labor, due to the extra size of the pregnant uterus they create with growth, even to the point of reaching term size as early as the 2nd

The different types of fibroids are:

  • Subserosal: lie on the outside of the uterus.
  • Intramural: lie within the uterine wall.
  • Submucosal: from the internal lining of the uterine wall.
  • Cervical: in the cervix of the uterus, not the main body.

Fibroids are diagnosed via: 

  • History and physical: history of symptoms and feeling an larger-than-normal uterus on exam.
  • Ultrasound: usually confirmatory only.
  • CT: usually confirmatory only.

Confirmation is very important to rule out other causes of a mass associated with the uterus, such as malignancy, which has an entirely different approach for treatment.

How fibroids are treated:

  • Doing nothing. If there are no signs or symptoms warranting intervention.
  • Hormonal suppression: birth control pills, hormonal IUD, medications used in endometriosis to suppress the cycle.
  • NSAIDs (ibuprofen, etc.), for the pain only.
  • Uterine artery occlusion to block the fibroid’s blood supply.
  • Uterine artery embolization—occluding the uterine artery with foreign bodies or substances.
  • MRI-focused ultrasound for thermal destruction of fibroids.

Many of the above methods, while sparing the uterus (preventing hysterectomy), have imitations as to the size of the fibroids that can be successfully treated.

  • Surgery
  • Laparoscopic destruction with heat, “cryo” (freezing), or radiofrequency.
  • Myomectomy in women who desire their fertility or who feel that their uterus remaining is the ideal solution for personal reasons.
  • Hysteroscopic myomectomy of submucous fibroids.
  • Hysterectomy in postmenopausal women or in those finished childbearing. 

A note from Dr. Bozdogan about Treating Fibroids

Dr. Bozdogan: 

Certainly, conservative approaches make sense, especially in those who need to maintain their reproductive potential. However, in these younger women—and especially in those whose childbearing is considered “complete”—I have found the more conservative measures are neither completely harmless nor overwhelmingly successful. In spite of that, here at Advanced Endometriosis Center I support the conservative approach, but I also will give my patients a realistic and personalized assessment of their condition and which approach would make the most sense. I will also explain the advantages of robotic myomectomy–that is, why robotic surgery is superior to minimize scarring and pain and shorten your recovery compared to other surgical approaches and why it is more definitive compared to even what are considered the “conservative” approaches.”

Summary: 

Uterine fibroids are benign overgrowths of the uterus which can be completely without symptoms or have minimal symptoms that are bearable; although when they become unbearable, fibroids can be completely removed with or without hysterectomy, depending on one’s fertility wishes. Today, at Advanced Endometriosis Center, Dr. Bozdogan can begin your evaluation for an informed decision by your simply making an appointment.

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