1. What are Fibroids?

Fibroids are benign growths in the uterus. Depending on their location, symptoms of fibroids may be heavy menstrual bleeding, pain, or pressure on the bladder, bowels or back. Fibroids are the most common benign tumor in humans, affecting 40% of women over 40 years of age. They are the reason for one third of all hysterectomies [removal of the uterus] performed each year in the United States. Slightly larger numbers of African American women are affected with fibroids, but they cause suffering for women of all ages and ethnic groups.

2. How are they treated?

Depending on the symptoms which fibroids are causing, different medical therapies are available. Hormonal suppression may decrease the amount of blood loss caused by fibroids, at least temporarily. If the fibroids are causing pain and pressure, medicine is available which will shrink the uterus, again, lasting only short term. Surgery for fibroids is either removal of the uterus and fibroids together; this is called a hysterectomy. If fertility is desired, a myomectomy, or removal of the fibroids will preserve the chance of child bearing. Myomectomy carries with it the additional high risk of recurrence. Both of these surgeries are usually done through a large incision in the abdominal wall. Typical hospital stays are four days, and recovery takes about 6 weeks.

A new therapy, uterine artery embolization [UAE] offers women an outpatient treatment for fibroids. Instead of general anesthesia as needed for major surgery, a light sedation is all that’s required for this brief, one time treatment for fibroids. We hope you will find answers to your fibroid questions here in our web site.

4. Can Fibroids Turn Into Cancer?

Almost never. A cancer called sarcoma in the uterus may resemble fibroids. This is rare, affecting only a few women. Whether sarcomas are fibroids which are not treated, or a new disease is not known. Even though fibroids are not cancer, the symptoms they may cause are anything but benign. Pain and heavy bleeding may be a disabling side effect of fibroids. Women should seek their health providers advise as soon as they experience a change in normal bleeding pattern, or pelvic pressure.

4. Symptoms of fibroids

Uterine fibroids cause different symptoms depending on the fibroid’s size and position within the uterus. Fibroids may be within the wall, where they are called intramural fibroids. They can be outside the uterus, where they are termed subserosal fibroids. If the fibroids are within the cavity of the uterus they are referred to as submucous fibroids.

Submucous fibroids often cause heavy bleeding. Such fibroids need not be large to cause life threatening bleeding. Menstrual bleeding may be very heavy, or a patient may have bleeding outside of the regular cycle of period bleeding. Such fibroids may also cause a woman who is pregnant to miscarry.

Subserous and intramural fibroids often cause pain and pressure in the pelvic area. Patients complain that their fibroids cause them to urinate often, and not completely empty their bladder. Similarly, fibroids in this position may cause pressure on the rectum leading to constipation. When the fibroids grow large enough, they can press on the ureters leading from the kidneys. This can lead to kidney problems. Back pain has also been noted with fibroids outside the uterus.

If the fibroids are on a stalk, a pedunculated fibroid, they may also twist on themselves and become necrotic. Inside the endometrial cavity, a pedunculated fibroid may pass through the cervix.

Many fibroid symptoms may mimic other diseases in the uterus. Fibroids are very seldom cancerous. However the symptoms of fibroids may also be the symptoms of a malignancy. For example, a woman with heavy menstrual bleeding in her 40s may be at equal risk of having endometrial cancer. Even if a woman has a history of fibroids, she should not assume that the vaginal bleeding is coming from the fibroids.

Also, pressure in the pelvic cavity, may be a symptom of ovarian cancer, as well as fibroids. If you have symptoms which are not normal for you, contact your health care giver as soon as possible.

5. How does uterine artery embolization work?

Uterine artery embolization [UAE], is an endovascular procedure. That is to say, the procedure is done through the arterial system. Under x ray guidance, a surgeon will identify the uterine artery on both sides of the uterus. These arteries supply the blood source for the fibroids in the vast majority of patients suffering from fibroids. When the doctor has identified the uterine arteries, he or she will inject tiny particles into the fibroids, about the size of a grain of sand. When enough of the particles are injected, the flow of blood will slow to the fibroid, causing it to stop bleeding, and shrink it’s size.

Bleeding will stop immediately in almost every patient suffering from fibroids. The shrinkage of the fibroids is more gradual. Most fibroids shrink 50 per cent within six months. Some patients have continued shrinkage after that six month period.

Because this is a non invasive procedure, it can be performed under sedation. Unlike general anesthesia, you will not have a tube down your throat during the procedure. You will breathe on your own. The surgeon will numb the skin usually on the right groin area, and insert a small needle, the size used to draw blood for testing. The whole procedure will be performed through that small incision.

Patients typically experience pain after a fibroid embolization. This is easily controlled with medicine. Some patients undergo fibroid embolization as an out patient procedure. Others will remain in the health care facility overnight for pain control. After fibroid embolization patients are usually off work for 5 days.

6. Why are hysterectomies performed?

Fibroids are the most common cause for hysterectomy, they are associated with as many as 40% of hysterectomies performed in the US. depending on their location, fibroids can cause either heavy bleeding, pelvic and back pain, or pressure on bowel and bladder. Most hysterectomies performed for fibroids [the medical term is myoma] are performed by the abdominal route since the fibroids may grow to be quite large. Fibroids are almost never cancerous.

Cancer may involve the uterus. Although not as common as fibroids, cancer may affect either the lining of the uterine cavity [endometrial cancer] or cancer of the cervix. Both of these cancers are treated with hysterectomy. Often the ovaries will be removed at the same surgery to prevent spread. Hysterectomy may also be necessary for more rare malignant growths within the walls of the uterus call sarcoma. Sarcoma may look like fibroids on imaging, and it is important that your doctor has evaluated you for this rare malignancy.

Endometriosis is another common cause for hysterectomy. In this disease, the lining of the uterus [the endometrium] spreads to other parts of the pelvic cavity such as the ovaries. It is stimulated each month as if it were inside the uterus. Women often complain of intense crampy pain with exercise, intercourse or menstruation when they suffer from endometriosis. Medical therapy may slow the spread of this disease. Laparoscopy may allow a physician to remove some of the disease. In spite of the best efforts, many women require hysterectomy to cure their chronic pain.

Other conditions which may require a hysterectomy include drop of the bladder and rectum after childbearing.

Do You Really Need a Hysterectomy?

If you've been diagnosed with fibroids and your doctor has recommended a hysterectomy without discussing less invasive therapies, you owe yourself a second opinion. A hysterectomy (the surgical removal of the uterus) is a major operation. In addition to a lengthy hospital stay and recovery period at home, there's a 30% complication rate and obvious issues regarding a woman's sexuality, fertility and quality of life once the uterus is removed.

40% of All Hysterectomies Are Due to Fibroids.

Most are unnecessary. While a hysterectomy will certainly cure a fibroid problem, many women don't want to lose their uterus. Remember, fibroids are usually not cancerous. You don't have to rush into anything. Research your options.

Types of Hysterectomy.

Removal of the entire uterus is a total hysterectomy. Leaving the cervix but removing the rest of the uterus, is called a sub-total hysterectomy. Removing ovaries ( bilateral salpingo-oopherectomy), is a separate decision which a patient and her doctor make before surgery. Hysterectomies are performed in one of two ways; either through an incision in the stomach (Abdominal Hysterectomy) or through the vagina (Vaginal Hysterectomy.) Abdominal hysterectomies are the most common form and typically require the longest recovery time.