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:
WHAT ARE THE GOALS OF TREATING FIBROIDS?
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
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.
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| © 2014-2018 copyright Taraneh Shirazian, MD