Uterine Fibroid Dilemma
Katrina Davis M.D.,
Do you have heavy or
prolonged bleeding during or between your menstrual
periods? Do you have severe cramps during your period?
If you do, you may have uterine fibroids. Also known as
leiomyomas, fibroids are benign (non-cancerous) smooth
muscle tumors that can grow from your uterus. The uterus
or womb is a large muscle. Fibroids can grow on the
outside; within the wall; or inside of the uterus. The
location and size of the fibroids determines what
symptoms you may have.
In addition to bleeding
and cramping, fibroids can cause problems with pregnancy
such as miscarriage or preterm labor. They can even
cause problems with getting pregnant. Other possible
issues are pain and urinary problems such as leakage of
urine or frequent urination (more than 8 times a day).
If the fibroids grow large enough, they can increase the
size of the abdomen or block the ureters (tubes carrying
urine from kidneys to the bladder).
By some sources,
uterine fibroids occur in 20-25% of women. Most women
don’t have symptoms and therefore may not know that they
have them. Fibroids are most common among women of
childbearing age. African-American women are three times
more likely to get fibroids than other women and within
this group, fibroids seem to occur at a younger age,
grow more quickly, and are more likely to cause
Though uncommon, there
is a cancer of the uterus that can present like uterine
fibroids. This cancer is called leiomyosarcoma which is
an aggressive cancer that resembles a fibroid. This type
of uterine cancer is more common in older women and
African-Americans. Suspicion is increased in women with
suspected fibroids that rapidly increase in size since
this is not their typical growth pattern. For this
reason, sometimes it is recommended to repeat
ultrasounds or MRI’s periodically to watch for changes
in the size of fibroids.
Treatments are usually
focused on either the symptoms or removal of the
fibroids. There are various hormones and medications
that can be taken to treat bleeding. The goal can be to
make bleeding more regular; decrease the amount of
bleeding; or to stop the bleeding all together.
Another option aimed at
treating bleeding is uterine ablation. This is a
procedure where an instrument is used to heat or freeze
the lining of the uterus which decreases bleeding. There
are different methods available, but most can either be
done in the office or as an outpatient surgery.
embolization or UFE is a procedure performed through a
blood vessel in the patient’s leg and where small
particles are directed to blood vessels that feed the
fibroids. The particles cause a blockage in those blood
vessels and without good blood flow, the fibroids get
smaller or stop growing. This procedure is not usually
recommended for women who want the possibility of future
Another treatment is
myomectomy or the actual removal of fibroids. If the
fibroid is submucosal or within the lining of the
uterus, it possibly can be removed through the vagina
using a hysteroscope (camera to look inside the uterus).
No incision is made and there is little if any downtime.
In the past, this approach was limited to smaller
fibroids. With newer technologies, even larger
submucosal fibroids can be removed using a hysteroscope.
If fibroids are intramural (located within the wall of
the uterus) or subserosal (growing from the surface of
the uterus), they can be removed through a laparoscope
(camera placed through small incisions in the abdomen)
or a laparotomy (larger incision in the abdomen).
Finally, there is the
option of hysterectomy (removal of the uterus). This can
be performed through an incision in the vagina,
laparoscopy or laparotomy. Once again the size, number
and location of the fibroids effects the decision of how
to perform the hysterectomy. The patient’s body type,
prior surgeries, age and medical condition can also
influence the choice of procedure.
Cindy is a 35 year-old
who complained of irregular and heavy periods. She had
recently gotten married and wanted to have children. She
also was relatively new at her job and had very little
sick time. An ultrasound revealed a large submucosal
fibroid. She had a myomectomy using a hysteroscope and
was able to return to work in two days. One month later,
she became pregnant and has since then delivered a
healthy baby girl.
Fibroids are common and
often cause no symptoms. However, if you have been
diagnosed with them or think you may have them, seek
care as there are many options for treatment.
Call Central Florida
UroGynecology in Rockledge 321-806-3929 or check us
Marja Sprock, M.D
and Katrina Davis M.D. are board certified in OB/GYN and
Female Pelvic Medicine and Reconstructive Surgery (Urogynecology)
and are offering academic level medicine in a private
Florida UroGynecology where high tech and common sense