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    Uterine Fibroids

    Uterine fibroids, also known as myomas or leiomyomas, are the most common female reproductive system tumors and account for nearly 60 percent of the hysterectomies performed each year in the United States. Most fibroids are asymptomatic or cause very minor symptoms, however, 1 in 4 women will develop symptoms severe enough to affect their quality of life and require treatment. Fibroids can vary in size from very tiny to larger than a grapefruit. In addition, fibroids, although considered a tumor, are not cancerous, virtually never develop into cancer, and do not increase a woman’s risk for uterine cancer.

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    Types of Uterine Fibroids

    There are four types of uterine fibroids:

    • Subserosal Fibroids, developing under the outside uterine covering

    • Intramural Fibroids, developing within the uterine wall

    • Submucosal Fibroids, developing under the uterus lining

    • Pedunculated Fibroids, developing on a stalk or stem-like structure attached to the inside or outside of the uterus
    Uterine fibroids are made up of muscle and fibrous tissue. What causes fibroids to develop is unknown, however, fibroids have been linked to genetic predisposition and hormone stimulation.
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    Uterine Fibroid Symptoms

    • Excessive, prolonged or painful menstrual periods

    • Bleeding between periods

    • Anemia

    • Increased menstrual cramps

    • Pelvic, lower back and leg pain

    • Lower abdomen pressure and bloating

    • Difficult or frequent urination

    • Constipation

    • Pain during sexual intercourse
    These symptoms may be signs of problems not associated with uterine fibroids. Should you experience any of these symptoms, contact your physician.

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    Uterine Fibroid Treatment Options

    The treatment choices for uterine fibroids depend on many factors including childbearing status, type and size of fibroids, patient's age, and general health. When diagnosed with uterine fibroids, women should work closely with their physician to select the best treatment for them.

    Treatment Choices:

    Watchful Waiting:
    Close observation without treatment may be an appropriate therapeutic option for women who do not have symptoms or problems associated with fibroids. This option is especially important for reproductive age women who have not completed their family. Also, fibroids tend to shrink as women complete menopause, usually between the ages of 50 and 55. Many women can treat occasional pelvic pain or discomfort with over-the-counter pain medication.

    Gonadotropin-releasing Hormone Agonists (GnRH) Medications: When taken, GnRh, a synthetic hormone, stops the natural production of estrogen inducing temporary menopause in women who are still menstruating thus stopping fibroid growth stimulation. GnRh is used temporarily to shrink larger fibroids allowing for less invasive surgery, or a temporary measure when menopause is imminent.

    Myomectomy: The fibroid excision removes fibroids without removing the uterus. Myomectomy can be performed in various ways depending on the fibroids size and location.

    • Laparoscopic Myomectomy removes subserosal fibroids utilizing a laparoscope, a tiny camera connected to a long slender telescope used for viewing inside the abdomen in conjunction to long slender instruments used for performing the operation. Only 4 or 5 small, less than one-half inch, abdominal incisions are required to perform the surgery.

    • Hysteroscopic Myomectomy removes submucosal fibroids via the vaginal canal using a hysteroscope, a thin, telescope-like instrument that is inserted into the uterus through the vagina and cervix.

    • Laparotomy Myomectomy removes numerous or large fibroids. Requiring a larger abdominal incision, laparotomy allows thorough inspection of the uterus to ensure complete uterine fibroid removal.
    Hysteroscopy: Under either a local or general anesthesia, this process can be both a diagnostic tool and an operative procedure. Diagnostic hysteroscopy utilizes a very thin telescope that is inserted through the cervix enabling the physician to view inside the uterus and accurately identify fibroids or other problems that may be causing abnormal bleeding. An operative hysterscopy uses a scope with a channel through which tiny surgical instruments can be passed to remove small fibroids and treat a variety of gynecological conditions.

    Embolization: Uterine fibroid embolization, also known as uterine artery embolization, is a relatively new uterine fibroid treatment approach. Interventional radiologists perform this minimally invasive procedure blocking the fibroid’s blood supply. Through an incision, less than one-quarter of an inch in size, a catheter is placed into the femoral artery; the interventional radiologist guides the catheter into the uterine artery. Tiny plastic or gelatin sponge articles, the size of sand grains, are slowly injected into the uterine artery blocking the blood supply feeding the fibroids. As a result fibroids begin to shrink and die. This procedure is reserved for women who no longer desire childbearing capabilities, as this procedure many times causes early menopause.

    Hysterectomy: 25% – 30% of hysterectomies performed each year in the United States are due to severe bleeding or discomfort and high levels of pain caused by uterine fibroids. Three primary forms of hysterectomy, subtotal and total, involves removal of all or a portion of the female reproductive organs.
    • Subtotal Hysterectomy removes only the upper uterus body leaving the cervix, fallopian tubes and ovaries intact. This procedure is always done through the abdomen.

    • Total Hysterectomy removes the uterus body and the cervix. Total hysterectomy can be performed through the vagina when medically appropriate, however, in the case of large fibroids or when the surgeon deems medical necessity total hysterectomy is performed through the abdomen. Usually the fallopian tubes and ovaries remain intact.

    • Laparoscopically Assisted Vaginal Hysterectomy (LAVH) is a variant of the vaginal hysterectomy. Physicians use a laparoscope to see inside the abdomen and perform some surgical functions, however, the hysterectomy is primarily performed through the vaginal canal.

    • Total Laparoscopic Hysterectomy (TLH) is a hysterectomy performed using a laparoscope. Physicians use a laparoscope to see inside the abdomen and perform all surgical functions. Patients usually go home the same day, however some patients require an overnight hospital stay. Generally patients return to normal activities within a few days.
    Depending on the treatment option, most services are performed on a same day basis. In cases involving fibroid embolization and hysterectomy, patients usually require a few days hospital stay and pain medication. Generally patients are back on their feet within 24-hours controlling pain with over-the-counter pain medication.

    Each treatment option offers comparable results with varying degrees of side effects. Certain patients may not be candidates for one or more of these treatment options. Please review your medical condition with your primary health care provider before making a choice.

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