Fibroid Treatment |
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A fibroid is the most common abnormal growth found inside a woman's pelvis; in fact, fibroids occur in 20% to 30% of women over age 30. A fibroid is an overgrowth of the smooth muscle tissue that grows in the uterine wall. Fibroids can occur as one single growth or multiple growths inside the uterus, within the walls, or on its surface.
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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 cause symptoms similar to those of sumacs and subsets fibroids. |
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In over 99% of cases, fibroid tissue is benign (noncancerous). In very rare cases (less than 1%), a fibroid may become malignant, or cancerous.
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 tend to shrink.
Many women have fibroids and don't 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.
Some fibroids, due to size, number, or 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
The medical literature reports that between 2% and 10% of infertility problems are caused by fibroids, which can block the fallopian tubes or prevent implantation.
Many fibroids can be felt during a routine pelvic exam examination. In order to rule out other conditions, such as ovarian tumors, bowel masses, or early pregnancy, which can sometimes be mistaken for fibroids, there are several diagnostic tests that may be performed. These diagnostic tests are not just used to rules out other conditions. They are used to determine the characteristics of fibroids that are present.
Ultrasound uses high frequency sound waves to create a picture of the pelvic organs. No anesthesia is necessary for this procedure. Sometime the uterus is filled with a water solution, through the cervix, to improve visibility.
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. Hysteroscopy can be performed as an office procedure under local anesthesia or in an outpatient surgery center with general anesthesia. Sometimes fibroids can be removed with the hysteroscope (described under surgical options).
With advancing medical technology hysteroscope are becoming smaller and, therefore, less invasive. Using a smaller hysteroscope has benefits for procedures involving fibroid diagnosis or removal.
If your fibroids are small or you don;t experience 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 fibroids will shrink as estrogen levels decline.
For fibroids that are large enough to cause bleeding or painful symptoms, several surgical options may be considered. Your physician will evaluate the best course of treatment based on the number of fibroids, their size, and their location within the uterus.
There are no medications currently available to eliminate fibroids. However, a class of hormones called GnRH agonist may be used to temporarily shrink the fibroid in preparation for surgery or delay surgery in a patient who is close to menopause. Once you stop taking the medication, the fibroid will usually return to pretreatment 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 drug.
Myomectomy: A surgical procedure that removes only the fibroid, leaving the uterus intact. Because a woman keeps her uterus, she may still be able to have children. Myomectomy can be performed through an open incision in the abdomen or through less-invasive techniques.
Laparoscopy: The fibroid id removed using a laparoscope inserted through a small incision in the abdomen; this procedure is used to remove fibroids on the outside of the uterus. more info...
Hysteroscopy: The fibroid is removed using a telescope-like instrument called a hysteroscope, which is inserted through the vagina and cervix into the uterus; no incision is made during this procedure, which removes fibroids on the inside of the uterus. more info...
"Resection" myomectomy: One example of fibroid removal using a hysteroscope. Resection is an electrosurgical procedure that uses electric current instead of a knife (scalpel) to cut away the fibroid tissue. Electric current passes through a wire-loop structure called an electrode, which is built into the hysteroscope. As the electrode shaves the fibroid, small pieces of tissue accumulate in the uterus that the surgeon must remove during the procedure. Resection myomectomy is usually performed using general anesthesia because the cervix must be stretched, or dilated, to accommodate the size of the hysteroscope. The two major advantages to a resection compared with open myomectomy are minimizing blood loss and preventing surgically induced adhesions (scar tissue) that may impair future fertility. In most cases, you can return to normal activity within a few days of the procedure.
Fibroid embolization: A procedure that blocks the blood supply to the fibroids, causing them to shrink. While embolization appears to be effective, the long term results are not known. Until more is known, this procedure is recommended for women who are not planning to have children.
Hysterectomy: The surgical removal of the uterus, which may be required in cases of very large, rapidly growing, or multiple fibroids. The procedure is most often performed in the hospital with general anesthesia. Recovery time is typically two to six weeks depending on how the hysterectomy is performed. There are several techniques doctors use to do hysterectomy, including:
- Standard, or open, hysterectomy is performed through an incision in the abdomen using traditional surgical instruments
- Laparoscopic supracervical hysterectomy is done using a laparoscope a narrow, lighted tube fitted with small surgical instruments and leaves the cervix intact
- Laparoscopically assisted vaginal hysterectomy is performed by making an incision in the vagina.