Uterine Fibroids Health Article

You've found out that you have fibroids(myomas). Fibroids are very common and treatable. They are round muscle growths in your uterine wall. Fibroids are almost always noncancerous (benign) and harmless. They start as pea-sized lumps, but can grow steadily during your reproductive years. Many fibroids just need to be monitored. Others may require treatment if they become too large or cause symptoms. Fibroids tend to run in families, but no one knows why some women have them and others don't.

Potential Problems

Some fibroids may cause no symptoms. But others may cause:

• Excessive uterine bleeding, leading to anemia (lack of red blood cells)

• Achiness, heaviness, or fullness

• Back or abdominal pain

• Pain during intercourse

• Difficulty getting pregnant

• Frequent urge to urinate

• Difficult bowel movements

• Problems with pregnancy

• Infertility

Treatment Is Tailored for You

No two fibroids are the same. The type of treatment you will have depends on their number, size, location, and rate of growth. Your treatment decision also depends on the severity of your symptoms. There are many effective ways to treat fibroids. After your medical evaluation, your doctor will be able to discuss with you the best options to solve your particular problem.

Your Medical Evaluation

A medical evaluation can determine whether you have fibroids and rule out other problems. It can also help you and your doctor decide which treatment, if any, is best for you. Before a diagnosis is reached, your doctor will ask you questions about your medical history and perform a pelvic exam. Your doctor may also suggest that you have one or more diagnostic tests to help provide details on the size and location of any fibroids.

Medical History

To look for signs of fibroids and to begin to plan your treatment, your doctor may ask you about one or more of the following:

• The pattern of your menstrual bleeding

• When, if ever, you experience pelvic pain

• Your birth control method, if any

• Your family history of fibroids

• Your plans to have children

Pelvic Exam

During a pelvic exam, your doctor examines your reproductive organs. The tenderness, texture, and overall size of your uterus are checked. If you have abnormal bleeding, your doctor will also check your vagina and cervix for signs of infection or small breaks in the skin. Samples of cervical cells may be taken for closer examination (a Pap test) to check for infection or cancer. Since fibroids can grow on the back wall of your uterus, your doctor may also do a rectal exam.

Diagnostic Tests

Three common tests can provide close-up views of the inside or outside of your uterus and confirm the size and general location of fibroids. Ultrasound is quick and painless. Hysteroscopy and laparoscopy are slightly more involved procedures.

Ultrasound

Ultrasound is often used to check fibroid growth. A device placed on your lower abdomen or inside your vagina bounces sound waves off your tissues, creating a video picture. Other imaging tests may also be done to check fibroid growth and location.

Hysteroscopy

Hysteroscopy evaluates fibroids that extend into the uterine cavity. Your doctor looks directly at the inside of your uterus through a hysteroscope, a thin "telescope" with a light attached. This device is passed through your vagina and cervix.

Laparoscopy

Laparoscopy is used to look at the surface of your uterus. This procedure uses tiny incisions and special instruments to check for fibroids.

Your Treatment Options

How your fibroids are treated depends on the number, size, and location of the fibroids, how fast they're growing, and your symptoms. You and your doctor may decide to monitor them, remove them, or remove your uterus. But if your uterus is removed, you'll no longer be able to have children. Talk with your doctor about your plans to have a family, as well as the risks and benefits of your treatment options.

Keeping Your Symptoms in Check

Fibroids may change size or shape. If they shrink, symptoms may lessen or even go away. Also, fibroids often won't affect a woman's ability to have a healthy pregnancy. If your doctor thinks that your fibroids are likely to shrink, he or she may suggest simply monitoring them instead of removing them. To monitor your fibroids, your doctor may schedule you for regular ultrasound tests or pelvic exams. Monitoring your fibroids may be a good option if they're small or if you're nearing menopause (the end of menstrual cycles). At menopause, fibroids often shrink naturally, due to decreasing levels of the hormone estrogen.

Other things can affect the size, shape, number, and location of fibroids:

• Pregnancy. Fibroids may grow rapidly during pregnancy. But they may not cause serious problems. If you're thinking of getting pregnant, discuss this with your doctor.

• Birth control pills. Using birth control pills may change the size of your fibroids. Your doctor may change your birth control prescription to better control your fibroids.

• Hormone replacement therapy. If you are receiving this therapy, it may cause your fibroids to grow. If so, your doctor may suggest that you try a lower dose.

Removing the Fibroids

Fibroids can be removed either through the vagina with hysteroscopy or through an abdominal incision with abdominal myomectomy (open surgery). These procedures preserve your uterus and your ability to have children, but fibroids may later return. Your doctor may prescribe anti-estrogen medications to shrink the fibroids before surgery. During surgery, you'll also have either regional anesthesia (which numbs only part of your body) or general anesthesia (which allows you to sleep during the procedure).

• Some fibroids located inside the uterus may be removed through the vagina using hysteroscopic myomectomy.

• An abdominal myomectomy(laparotomy) removes fibroids through an abdominal incision.

• Small fibroids on the outside of the uterus may be removed through small incisions using laparoscopic myomectomy.

Before surgery, your doctor may prescribe medications to shrink the fibroids.

Removing Your Uterus

After a hysterectomy (removal of the uterus)), fibroids won't return. But you won't be able to have children. Depending on the fibroids and your symptoms, this surgery may be a good solution. The uterus is removed through an abdominal incision, through the vagina, or through a combination of both (LAVH). The ovaries are often retained to allow continued hormone production. Also, the cervix may be retained. Before having a hysterectomy, talk with your doctor about the option of keeping your ovaries and cervix.

Other Options to Treat Heavy Bleeding or Shrink Fibroids

• Endometrial ablation destroys the uterine lining with electric or laser energy to reduce heavy bleeding.

• Uterine artery embolization shrinks fibroids by cutting off their blood supply.

Your Future Checkups

Treating your fibroids is likely to relieve your symptoms. But your doctor will want to schedule regular checkups to monitor your progress and make sure your fibroids don't return. If you have had surgery, ask your doctor about any additional follow-up visits you might need.