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UTERINE FIBROIDS

TEACH ME TOPIC #1: UTERINE FIBROIDS

WHAT ARE FIBROIDS?

Fibroids are benign tumors of the muscle layer of the uterus known as the myometrium.  Fibroids afflict approximately 60% of reproductive aged women and 80% of women during their lifetime.  They are very common tumors in women and likely have a genetic predisposition. They are stimulated to grow by estrogen, a common hormone in women.

WHAT ARE THE SIGNS AND SYMPTOMS OF FIBROIDS?

The majority of fibroids don’t have symptoms, which is why many women may not realize they have them. If fibroids don’t cause any symptoms they don’t need to be treated, conservative management is advised. Fibroids may cause symptoms in women depending on their size, the number present and their location within the uterus. (see picture)

 

Common signs and symptoms of fibroids include:

  • Heavy vaginal bleeding
  • Bleeding in between menstrual periods
  • Anemia (low blood ocunt)--may result in fatigue, lightheadedness
  • Pelvic pressure
  • Pelvic pain
  • Urinary frequency, urgency, or difficulty urinating
  • Constipation
  • Pain during sexual intercourse
  • Miscarriage

WHAT ARE THE GOALS OF TREATING FIBROIDS?

  • Eliminate bothersome symptoms
  • Fertility-sparing
    • Most women with fibroid-related symptoms are of reproductive age and desire future pregnancy. Some of the  treatment options available for fibroids (myomectomy) allow for future pregnancy, and, in some cases, the treatment may improve chances of successful pregnancy.
  • Uterine preservation

PREGNANCY AND FIBROIDS

Size and location matter: When fibroids are small and either in the wall of the uterus or in the outermost layers of the uterus, the majority do not cause pregnancy specific complications. Intracavitary fibroids (inside the womb) may cause increased rates of miscarriage, abnormal location of the placenta, or affect the position of the fetus such that delivery may be complicated or require c-section. Large fibroids (>5cm) of any location may result in increased pain during pregnancy, pre-term labor, and increased bleeding immediately after delivery.

 

Before you get pregnant: If you are considering pregnancy and know you have fibroids, you may consider having them removed before pregnancy, even if they are not causing symptoms now, especially if they are large.

 

Delivery after fibroid treatment: Depending on the number and location of fibroids removed prior to pregnancy, future cesearan section may be advisable. Your fibroid surgeon will typically be able to advise you best if you are a good candidate for vaginal delivery versus c-section after fibroid treatment.

MEDICAL TREATMENT OPTIONS

Medications may be used to reduce heavy bleeding and painful periods. Medications, such as birth control pills and progesterone treatments are common options, although they do not permanently shrink fibroids or prevent them from future growth. Some women may have decreased pain and bleeding with medical therapy, but the fibroids will remain. If symptoms persist, other treatments may need to be considered.

SURGICAL AND INTERVENTIONAL TREATMENT OPTIONS

  • Myomectomy: This is the surgical removal of the fibroids only, while leaving the uterus intact.  It is an option for women who want to maintain the uterus for future pregnancy. However, new fibroid tumors commonly grow again after myomectomy. There are multiple possible surgical approaches to myomectomy including endoscopic (hysteroscopic), traditional open surgery, laparoscopic and robotic. If you are considering fibroid surgery, Dr. Shirazian will advise you regarding which approach might suit you best.

 

  • Hysterectomy: The removal of the uterus and the fibroids within. Because the ovaries are not typically removed,  hysterectomy does not mean the beginning of menopause. Fibroids cannot regrow after this procedure, and therefore it is the most definitive option of all the fibroid therapies. In women who no longer desire future childbearing, hysterectomy should be strongly considered. Because fibroids can recur in up to 70% of women within 5 years of initial treatment, hysterectomy may avoid the need for additional treatment for many women in whom fertility is no longer desired. Hysterectomy is in fact a faster surgery with less blood loss than myomectomy. Recovery time and blood loss is typically less than for a myomectomy.

 

  • Endometrial ablation: temporarily destroys the lining of the uterus. It can be used to treat bleeding in women who have heavy menstrual periods and small (less than 3centimeters) intracavitary fibroids.  There are several ways to perform endometrial ablation. Most of them use some form of energy, such as heat, to destroy the uterine lining. Two commonly used methods are a heated balloon and microwave energy. Dr. Shirazian performs an ablation using a device called NOVASURE, a thermal technique that can be performed in the office.

 

  • Uterine artery embolization:  A procedure performed by an interventional radiologist who inserts a catheter into an artery in the groin in order to access the blood vessels that supply the uterus. During the procedure, the blood vessels to the uterus are blocked (embolized) usually with special protein particles, stopping the blood flow that allows both the fibroids and the uterus to grow. Pain is the most common side effect of this procedure, and approximately 20% of women may require a second procedure for bleeding within 2 years of having it performed. It may require and overnight stay in the hospital.

 

  • MRI guided ultrasound therapy: In this approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging (MRI). This procedure may require multiple treatments for even very small fibroids. Whether or not this approach provides long-term relief of fibroid-related symptoms is currently being studied.

MYTHS ABOUT FIBROIDS

Medications can shrink fibroids: There are no medications that shrink fibroids permanently. Certain medications called GnRH agonists can shrink fibroids temporarily and are often used in preparation for surgery. However, if the medication is used and then stopped, the fibroids will regrow. GnRH agonists also have the side effect of causing hot flashes for most women.

 

If I want a less invasive surgery, myomectomy will be better than hystectomy: For women who don’t desire future childbearing, the hysterectomy is a faster surgery, with less blood loss and faster recovery. For women who are good candidates, laparoscopic removal of the uterus may even permit outpatient surgery with no overnight hospital stay.

 

If I choose a hysterectomy, I will become menopausal and age quickly: A hysterectomy means removal of the uterus only. The ovaries control hormone function and can be left intact, meaning you won’t go into menopause and also libido (sexual desire) and sexual function should not change. Hysterectomy should not affect aging.

|    © 2014-2018 copyright Taraneh Shirazian, MD

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Joan H. Tisch Center for Women's Health

207 E 84th Street

New York, NY 10028

Phone: 646-754-3300

 

Email: info@wwcofny.com