Women's Health...."Uterine Fibroids", ..What are they? What are the symptoms? What is the risk? What can be done? From Milton M. Hershey Medical Center

Uterine Fibroids

Also known as: Myomas or Leiomyoms

What is it?

Uterine fibroids are tumors made of connective tissue and smooth muscle. They grow slowly within the wall of the uterus or attach to the uterine wall. Most fibroids are noncancerous, but in some rare cases they may become cancerous.


A uterine fibroid may be as small as a pea or as large as a grapefruit. As the fibroid grows, the uterus may become deformed or pushed aside. When the uterus is deformed or blocked by a growth, the resulting pressure may cause symptoms in the bladder or intestine, such as increased urination, constipation or pain.

Who gets it and what are its causes?

Fibroids rarely occur in women younger than 20. They occur most frequently in women in their childbearing years. As a woman approaches menopause, these tumors usually shrink.


The cause of uterine fibroids is not known, but it may be related to changes in estrogen levels. For example, pregnancy, use of birth control pills and estrogen replacement therapy may speed the growth of fibroids.

What are the symptoms?

Often there are no symptoms. When there are symptoms, they may be:

• Painful menstrual periods

• Heavy menstrual bleeding

• More frequent or uncomfortable urination

• Backache

• Constipation

• Pelvic pain or pressure

• Infertility

• Miscarriage

Diagnosis

Fibroids are usually found during routine pelvic exams. If you have severe menstrual symptoms or other pelvic problems, your health care provider may recommend an ultrasound scan or D&C (dilatation and curettage) to determine the cause of the problems.

Treatment

Most fibroids do not need treatment. Your health care provider will evaluate your condition and make a recommendation 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 your desire for more children.


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.

Surgical Treatment

For fibroids that require treatment, your doctor may suggest a myomectomy, hysterectomy or a minimally invasive procedure called uterine fibroid embolization.


A myomectomy is a type of surgery used to remove the fibroids without harming the uterus. This type of surgery is preferred for patients who wish to maintain their childbearing potential or simply wish to retain their uterus. Myomectomy is considered by many to be more conservative treatment than hysterectomy because the uterus is preserved. Sometimes, however, the sheer number of tumors makes preservation a questionable goal. A myomectomy can be technically more difficult than a hysterectomy and can lead to greater blood loss.


In a hysterectomy, the surgeon removes the uterus. This surgery can be performed vaginally, abdominally or assisted by laparoscopy. It is usually simpler and may be less time-consuming than multiple myomectomy and entail fewer complications. Hysterectomy is often the procedure of choice when surgery for uterine fibroids is needed and childbearing years are complete.


Medication may be given two to three months before surgery to shrink the fibroid. This will make the operation easier to perform. Myomectomy and hysterectomy are performed by gynecologists.


In Fibroid Embolization, an interventional radiologist makes a small nick in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray. Then tiny plastic particles the size of grains of sand are injected into the artery that is supplying blood to the fibroid tumor. This cuts off the blood flow and causes the tumor (or tumors) to shrink. The procedure takes approximately one hour and is performed while the patient is conscious but sedated – drowsy and feeling no pain. Studies are have not yet been confirmed about fertility. A recent study shows similar numbers of successful pregnancies comparing myomectomy and fibroid embolization.