Uterine fibroids

Alternative names:

fibroids; fibromyoma; leiomyoma; myoma

Treatment:

Methods of treatment depend on the severity of symptoms, age, pregnancy status, desire for future pregnancies, general health, and characteristics of the fibroid(s). Treatment may consist of simply monitoring the fibroids, specifically their rate of growth, with periodic pelvic exams or ultrasound. This method is usually sufficient in pre menopausal women.

Hormonal treatment, involving drugs such as Nafarelin and Leuporlide, causes fibroids to shrink. This method is sometimes used in pre-menopausal women who desire to bear children, but have problems conceiving because of the tumors. If fibroids become large enough, they may block the fallopian tubes or fill the uterine cavity. The hormones produce an environment in the body that is very similar to that of menopause, thus, pseudo-menopause. The treatment spans over several months and during this time the reduction in estrogen concentration allows the fibroids to shrink. Since fibroids will begin to enlarge as soon as treatment stops, the woman is encouraged to begin attempting to conceive almost immediately.

For women who do not want to conceive, but also don't want to undergo surgery, hormone treatment is frequently an option. The side effects of this type of treatment usually include menopausal symptoms, which for some women may be rather annoying. If treatment is discontinued, fibroids will regrow and another method of treatment will need to be used.

A myomectomy, which is a surgical procedure to remove just the fibroids, is frequently the chosen treatment, especially for pre-menopausal women who want to bear more children. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids experience.

A total hysterectomy, which involves removal of the uterus, is another option.

Expectations (prognosis):

Prior to menopause, fibroids are likely to grow slowly. Women with known fibroids who choose to have children, may be counseled to become pregnant earlier in adulthood. As a general rule, fibroids don't interfere with fertility, however, on occasion a tumor will block the fallopian tubes and prevent sperm from reaching and fertilizing the egg. In some cases, fibroids may prevent the fertilized egg from implanting in the uterine lining. However, proper treatment may restore fertility.

After a pregnancy is established, existing fibroids will grow due to the increased blood flow and estrogen levels. These usually return to their original size after the baby has been delivered. Many women are able to carry their babies to term, but some of them end up delivering prematurely because there is not enough room in the uterine cavity to sustain full term. Cesarean section is often needed for delivery since fibroid tumors may block the birth canal or cause the baby to be positioned abnormally. After menopause, new fibroids rarely develop and those already present usually shrink.

Complications:

Fibroids may cause infertility because they interfere with conception or implantation. They may cause premature delivery because of decreased area within the uterine cavity. Severe pain or excessively heavy bleeding with fibroids may necessitate emergency surgery. Rarely, malignant changes may occur, however, these usually take place in postmenopausal women. The most common warning sign is rapid enlargement of a fibroid and definitive diagnosis is usually not made until the time of surgery.

Calling your health care provider:

Call for an appointment with your health care provider if gradual changes in your menstrual pattern occur (heavier flow, increased cramping, bleeding between periods); or if fullness or heaviness develops in your lower abdomen. Frequently there is associated pressure or discomfort and interference with normal urination frequency.

Picture:
P0523.pctReproductive anatomy - female
P0457.pctPelvic laparoscopy