Uterine fibroids are extremely common benign growths that arise in the muscle wall of the uterus. They can occur in any woman but are more common in certain ethnic groups, and up to 40% of African American women have fibroids. For the majority of women, fibroids are asymptomatic and often go unnoticed. In some patients fibroids can cause heavy bleeding, pain and symptoms of pressure, and as they grow they can even cause a bulge in the abdomen and the appearance of pregnancy. We don’t know why some women have them and some don’t, but there is definitely a genetic factor as they can run in families.
When patients complain of heavy bleeding, pelvic pressure or pelvic pain, we usually will order an ultrasound to check for fibroids as this would be a very common cause. Fibroids have a distinct appearance on ultrasound and we are able to measure them and count them, which helps to plan treatment options. Rarely a fibroid will occur by itself but usually multiple fibroids present together. In other cases a patient may have an enlarges uterus on exam when we do our pelvic exam, and this may be the tipoff that fibroids are present.
In general if a patient is not symptomatic we do not have to treat or remove fibroids. Intervention is warranted if symptoms are significant, and generally involves surgical removal. Fibroids can be removed leaving the uterus intact (this is called a myomectomy) in patients who wish to maintain their fertility. In patients who no longer desire fertility the safest way to remove fibroids is to take the whole uterus out, fibroids and all (this is a hysterectomy). After a myomectomy a significant number of patients have a recurrence of fibroids, and the surgery is also more difficult and has a higher risk of bleeding than a hysterectomy, which is why we do not recommend it for everyone. A myomectomy and a hysterectomy can both be approached in many ways depending on the size and position of the fibroids. Sometimes the surgery can have no abdominal incision (such as with a hysteroscopic myomectomy or a vaginal hysterectomy), may have small laparoscopic incisions, or may require a larger open incision. As with all surgery, our preference is always the least invasive possible.
Fibroids generally do not cause problems with pregnancy, unless they are very large or compromise the uterine cavity. Patients with fibroids do not necessarily need to remove them before attempting pregnancy, but ultrasound can help your doctor to advise the patient about her particular case. In some extreme cases fibroids can increase the risk of preterm labor and miscarriage, but this is not common. Fibroids very rarely affect fertility.
A number of non surgical options can also help with reducing fibroid symptoms. “Lupron” is a drug which lowers estrogen levels, and this causes fibroids to shrink. The down side is that the drug causes menopause symptoms (hot flashes, mood swings etc.) and the effect is also temporary. Uterine Fibroid Embolization (UFE) is another option, in which the major blood vessels to the uterus (the uterine arteries) are blocked through a catheter in the groin, resulting in less blood flow to the uterus and shrinkage of the fibroids. MRI Guided Ultrasound (MRGUS) is a procedure in which targeted ultrasound directs heat into the fibroids which also causes shrinkage. Birth control pills have been shown to have no effect of fibroid growth, but can be used temporarily to slow down bleeding. These are all options that your provide can discuss with you.
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