Uterine Fibroids

What are uterine fibroids?

Uterine fibroids are tumors made of abnormal muscle cells that grow slowly within the wall of the uterus or attach to the inside or outside of the uterine wall. They are very common and almost always are benign (not cancerous). Cancerous fibroids are extremely rare, less than 0.5%, and are usually detected by very rapid growth. A uterine fibroid can range in size from a small pea to the size of a grapefruit or larger. Other terms used for a uterine fibroid are leiomyoma or myoma of the uterus.

The different types of fibroids are:

• Subserous — grow on the outside of the uterus
• Intramural — grow within the muscle lining of the uterus.
• Submucous — grow on the inside of the uterus.
• Pedunculated — grow on the uterus by forming stalks to attach.

How do they occur?

The cause of uterine fibroids is not known. Estrogen is required for their stimulation and growth. They are more prevalent in women who are between puberty and menopause. It also appears that women may inherit the tendency to develop fibroids.

What are the symptoms?

Often there are no symptoms and typically found on a pelvic exam. When there are symptoms they may be:

• painful menstrual periods
• heavy menstrual bleeding
• more frequent or uncomfortable urination
• painful intercourse
• backache
• constipation
• pelvic pain or pressure
• infertility
• miscarriage.

How are they diagnosed?

Uterine fibroids are usually found during routine pelvic exams. An ultrasound scan can be used to help show the area, measure the size, and follow the growth of fibroids. Other ways in which fibroids can be detected are through:

• Laparoscopy (outpatient surgery using a thin metal rod with a camera attached to the end to view the outside of the uterus through an incision in the umbilicus)
• Hysteroscopy (outpatient surgery using a thin metal rod with a camera attached to the end to view the inside of the uterus)
• Hysterosalpingogram (procedure done by injecting dye into the uterus and viewing with x-rays)
• Endometrial Biopsy (in-office procedure that samples the lining of the uterus)

How are they treated?

Most fibroids do not need treatment. However, if you are having symptoms from the fibroids, treatment is based on:

• the amount of blood loss and pain during menstrual periods
• the rate of growth of the fibroid
• the absence or presence of cancer
• your age, physical condition, and desire for more children

For fibroids that require treatment, Dr. Hardy may suggest a myomectomy. A myomectomy is a procedure done to remove the fibroids without removing the uterus. There are several ways a myomectomy may be done.

• Hysteroscopy: Dr. Hardy guides the hysteroscope, which is a thin tube with a tiny camera, through the cervix and into the uterus. He uses a laser or electrocautery to remove fibroids that are inside the uterus.
• Laparoscopy: Dr. Hardy makes a small cut in your abdomen and inserts a scope into it. Another tool used to remove the fibroids is inserted through another cut in your abdomen.
• Abdominal myomectomy: Dr. Hardy makes a larger cut in your abdomen to reach the uterus and remove the fibroids.
• Hysterectomy: Dr. Hardy can either perform this procedure vaginally or abdominally depending on the size of the uterus. This is a procedure that removes your entire uterus.

Before you have a myomectomy or hysterectomy, you might be given a medicine for 2 to 3 months to shrink the fibroid. This will make the operation easier to perform. If you are close to menopause, Dr. Hardy may prescribe this medicine for you to take until you are in menopause, so that you may not need surgery. This is especially important if surgery is particularly risky for you because of one or more medical problems you may have.

An alternative to these procedures is using and Intrauterine Device (IUD) or endometrial ablation that is done in the office. These can be done when the main symptom is heavy vaginal bleeding that may or may not cause increased cramps.

How long will the effects last?

Small fibroids that don't grow usually have no lasting effects. If you have symptoms caused by growing or enlarged fibroids, the symptoms will probably continue until the growths are removed surgically, or until they begin to shrink and disappear after menopause.

How can I take care of myself?

Call the office for an appointment if:

• Pain or heavy bleeding continues to be a problem.
• You notice your symptoms are getting worse.

In addition:

• Take acetaminophen or ibuprofen for cramps and body aches. Do not take aspirin because it may increase the bleeding.
• Rest in bed when symptoms are worst.
• Eat foods high in iron and take iron pills (if it was recommended by Dr. Hardy or the Nurse Practitioner) if you bleed heavily during your periods.
• Put a heating pad at a low setting on your abdomen to help relieve cramps or pain
• Follow the recommendations for treatment with medicine and keep your follow-up visits to see if the fibroid is growing.

What can be done to help prevent uterine fibroids?

No sure way is known to prevent fibroids from developing or recurring.