NetWellness receives many questions about uterine fibroids. Uterine Fibroids are benign (non threatening) tissue growths found in the uterus. Many women (as many as 50%) have uterine fibroids. Each woman’s case is different and some women may require treatment for their fibroids while others may not. Fibroids vary in size, number, and location and can cause severe symptoms, moderate symptoms, or no symptoms at all. Only about 30% of women with fibroids require any treatment at all.
Here are some common symptoms of Uterine Fibroids:
- Heavy, prolonged menstrual sometimes with clots. This can lead to anemia
- Pelvic pain during menses
- Pelvic pressure heaviness or pain caused by the bulk or weight of the fibroids pressing on nearby structures
- Pain in the back or legs as the fibroids press on nerves that supply the pelvis and legs
- Pain during sexual intercourse
- Bladder pressure leading to a constant urge to urinate
- Pressure on the bowel, leading to constipation and bloating
- Abnormally enlarged abdomen
Though many women with uterine fibroids experience some or all of the symptoms, many other women experience none at all. For this reason it is important to keep up to date with annual women’s health exams. Part of the standard pelvic exam is designed to search for uterine fibroids.
A main concern for women with uterine fibroids is that they will inhibit fertility or make pregnancy impossible. Though uterine fibroids can make it difficult to become or maintain a pregnancy, the majority of women never have any problems. However, extra measures may need to be taken in order to help a woman with uterine fibroids conceive. If you have been diagnosed with uterine fibroids and are concerned about your future fertility consult your healthcare provider.
There are many treatments available for uterine fibroids. They range from more invasive procedures like surgery to less invasive procedures like hormone therapy. Here is a list of current treatments available:
If you have fibroids and have mild symptoms, your doctor might only suggest pain medication. Over-the-counter anti-inflammatory drugs, such as ibuprofen, or other analgesics can be used for mild pain. If pain becomes worse, your doctor can prescribe a stronger painkiller.
Other drugs used to treat fibroids are called gonadotropin releasing hormone agonists (GnRHa). They work by stopping the production of estrogen by the ovaries similar to menopause. These drugs can decrease the size of the fibroids since estrogen is needed to stimulate the fibroids to grow. Sometimes they are used before surgery, to shrink the fibroids, making them easier to remove. Side effects are a result of the loss of estrogen and can include hot flushes, vaginal dryness, depression, not being able to sleep, and decreased sex drive. Anti-hormonal agents, such as a drug called mifepristone, also can stop or slow the growth of fibroids. These drugs only offer temporary relief from the symptoms of fibroids; once you stop the therapy, the fibroids often grow back. Also, for a woman taking GnRHa, the loss of estrogen can have long lasting effects such as osteoporosis. For this reason, it is only used for a short time such as six months.
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
- Myomectomy – a surgery to remove fibroids without taking out the healthy tissue of the uterus. There are many ways a surgeon can perform this procedure. It can be major surgery (with an abdominal incision) or minor surgery (by using instruments placed into the abdomen through small incisions or through the vagina). The type, size, and location of the fibroids will determine what type of procedure will be done. Talk with your doctor about the different types of this surgery. There is the possibility that fibroids too small to be removed can grow and cause problems later. New fibroids can also develop. As opposed to a hysterectomy, women who have a myomectomy can still become pregnant. Depending on the type of myomectomy, a weak area may have been created in the uterine wall that is at risk of rupture during pregnancy. A scheduled cesarean delivery may be recommended after a myomectomy.
- Hysterectomy – a surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids because there is no area for one to regrow. This surgery is used when a woman is having severe symptoms, has failed medical management (or isn’t a candidate for medical management) and has no desire for future childbearing. Since this is a very invasive surgery, you should feel comfortable that all conservative options have been considered.
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization (UFE) is a treatment where particles are released into the small blood vessels that supply the fibroids therefore blocking the blood supply to the fibroids so they shrink. UFE is proving to be an alternative to hysterectomy and myomectomy. The recovery time is also shorter, and there is a much lower risk of needing a blood transfusion than for these surgeries. Many women can have UFE and go home the same day. There is a small risk of infection in the treated fibroid, but these are usually managed with antibiotics. Recent studies also suggest that most fibroid tumors are not likely to re-grow after UFE, although more long-term data is needed.
Not all fibroids can be treated with UFE. All patients must first be evaluated with ultrasound or MRI to make sure the fibroids will respond well to this treatment. Doctors called interventional radiologists perform UFE. The best candidates for UFE are women who:
- have fibroid tumors that are causing heavy bleeding
- have fibroid tumors that are causing pain or pressing on the bladder or rectum
- don’t want to have a hysterectomy
- don’t want to have more children
Sometimes after UFE, the particles that are put into the fibroids to cut off their blood supply have traveled to the ovaries decreasing their blood supply. In a few women, the ovaries then stop working for a short time or permanently. Although researchers know that UFE may affect how ovaries function, they are unsure of how exactly UFE affects fertility. Too few women have gotten pregnant after UFE for researchers to know if there is an increased risk of pregnancy complications. UFE is not considered an option for women who wish to retain the ability to bear children.
ExAblate® 2000 System
ExAblate® 2000 is a medical device that uses magnetic resonance image guided focused ultrasound to target and destroy uterine fibroids. The device is intended to treat women who have completed child bearing or do not intend to become pregnant. ExAblate® 2000 is non-invasive surgery.
ExAblate combines two systems – a magnetic resonance imaging (MRI) machine to visualize patient anatomy, map the volume of fibroid tissue to be treated, and monitor the temperature of the uterine tissue after heating, and a focused ultrasound beam that heats and destroys the fibroid tissue using high frequency, high-energy sound waves.
The treatment requires repeated targeting and heating of fibroid tissue while the patient lies inside the MRI machine. The procedure can last as long as three hours. The new device can be used to treat some – but not all – fibroids. Fibroids close to sensitive organs such as the bowel or bladder and those outside the image area cannot be treated.
This is still a fairly new procedure that needs more long-term data before being considered the standard of care.
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