Uterine Fibroids & Treatment
What are uterine fibroids?
Uterine fibroids (also called uterine leiomyomata) are benign tumors of the uterus. They form from smooth muscle tissue, usually during a woman's child-bearing years. Because they develop from the same type of cells as the uterine lining, these growths can cause problems for women trying to conceive or carrying a pregnancy to term.
They range from small, pea-sized lumps to larger grapefruit-sized growths that crowd the menstrual flow and all but obliterate the uterine cavity. Fibroids do not usually interfere with the ability to conceive, but they may cause infertility by blocking the uterus so that an egg can't be released or making it difficult for a fertilized egg to implant in the uterus.
Imaging & Interventional Specialists offer FDA-approved treatments (non-surgical alternatives).
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What do symptomatic fibroids feel like?
Since fibroids are made of muscle, they contract and relax along with the rest of the uterus. This causes pressure and pain as they grow larger or as your body changes during your menstrual cycle. They can also cause heavy bleeding, which leads to anemia and other symptoms.
What are the symptoms of uterine fibroids?
In some cases, fibroids have no symptoms. But symptomatic uterine fibroids can cause:
- Pelvic pressure or pelvic pain even severe pain
- Frequent urination, especially at night
- Pain during sex
- Backache or leg pain
- Heavy menstrual periods with clotting and cramping
- A feeling of fullness in the lower abdomen or rectal pressure
These fibroids require treatment.
Where in the uterus are fibroids located?
There are three types of uterine fibroids:
- Intramural Fibroids: These grow within the wall of the uterus and can vary in size. They tend to be smaller than sub-serosal fibroids and sometimes they do not cause any symptoms.
- Submucosal Fibroids: These grow on the inside of the uterus and can bulge into the cavity. They are often associated with heavy bleeding and can cause fertility problems.
- Subserosal Fibroids: These grow on the outside of the uterus and can vary in size. They can sometimes cause pressure on surrounding organs, such as the bladder or rectum.
Some fibroids grow on a stalk out of the uterine walls, outside(subserosal) or inside(submucosal) the uterus. These are called pedunculated fibroids because a long stalk attaches them to the uterus. Pedunculated subserosal fibroids can affect fertility.
How big do they get?
A fibroid tumor is rarely cancerous, but it can grow very large. Fibroids are often classified by size—less than 5 centimeters (1 inch) to more than 20 centimeters (8 inches)—and also by how they affect the uterus:
What are risk factors for fibroids?
Risk factors are certain factors that increase your chance of getting a disease or illness.
- African-American women are 1.5 times more likely to be affected by fibroids
- Women with early onset of menstruation (before 12 years old) have a greater chance of developing fibroids later in life.
- family history: If you have a mother or sister with uterine fibroids, you're at higher risk of developing the tumors than women without any history in their family
- age: Fibroids usually grow during the childbearing years between 20 and 40 years old
- obesity: Fat tissue produces estrogen so obesity increases your risk for developing fibroids because fat cells produce the female hormone estrogen.
How many women have fibroids?
The exact number of women who get uterine fibroids is difficult to determine because not all women with fibroids have symptoms. However, it has been estimated that up to 70% of American women older than 35 years old have these growths.
How do you develop fibroids?
Though more research is necessary, some studies indicate that estrogen plays a major role in the development of uterine fibroids. A woman may be born with a predisposition for developing uterine fibroids due to genetics and/or environmental factors such as diet and hormonal influences on her uterus. Once she starts menstruating, high levels of estrogen, over time, may encourage the growth of smooth muscle tumors in her uterus. Indeed, uterine fibroids shrink after menopause when estrogen levels are low.
When do they start?
It is difficult to pinpoint the exact time that uterine fibroids will begin to grow because each woman develops them differently. While some women may not develop these tumors until their child-bearing years, others may have noticeable growths as early as 13 years old. However, it is possible for a woman of any age to acquire either type of fibroid tumor or to develop new ones during her child-bearing years or postmenopausal period.
What are uterine fibroids treated?
Not all fibroids need treatment. For these watchful waiting and monitoring may be appropriate. Treatment options include:
- surgical procedures
- non surgical treatments
What medications are there for fibroids?
Medication options for uterine fibroid treatment may include:
- medications to shrink the size of your fibroid (such as gonadotropin-releasing hormone or GnRH agonists like Lupron, Zoladex, Buserelin);
- medications to relieve pain (such as nonsteroidal anti inflammatory drugs like ibuprofen);
- medications to help control heavy bleeding (such as birth control pills, progestin-releasing IUDs like Mirena, or antifibrinolytic drugs like tranexamic acid);
What are surgical options for fibroids?
There are a variety of ways to surgically remove or shrink fibroids, including:
* Myomectomy: Removal of the fibroid tumor through an incision in the uterus. This is recommended for women who want to preserve their fertility. Surgical treatments for uterine fibroids can cause scar tissue in the uterus to thicken. This can make it harder to get pregnant or carry a baby to term.
* Hysterectomy: Removal of the entire uterus and cervix through an incision in the abdomen is a total hysterectomy. A partial hysterectomy leaves the cervix. This operation can be done abdominally or vaginally depending on your surgeon's preference and/or your anatomy. A second incision may also be made in your belly button or in a lower abdominal crease to access the uterus from below if it cannot be reached from above. A hysterectomy will sometims be performed with a BSO - a total hysterectomy with bilateral salpingo-oophorectomy - where your fallopian tubes are also removed
Hysterectomy: Removal of the entire uterus. This is considered a permanent solution and is only recommended for women who are no longer interested in bearing children or for those who have persistent, severe symptoms that cannot be controlled with other methods.
* Laparoscopic hysterectomy: Removal of the entire uterus and cervix through several small incisions in the abdomen with the use of a laparoscope, which is inserted into one or two of these incision sites to allow for visualization of the procedure from inside your belly button and/or lower abdominal crease incisions.
What are the surgical complications of a hysterectomy?
There are a number of complications that can occur with either a laparoscopic or abdominal hysterectomy. Some of the complications associated with a uterine fibroid operation include:
* bleeding – any amount – from your vagina, bowels, bladder, uterus or surgical incisions;
* damage to bowel and/or bladder which may require repair during surgery by using instruments passed through an additional incision in the abdomen near the belly button;
* dangerously low blood pressure requiring re-operation within 48 hours to reconnect your veins and arteries that have been cut during the procedure;
* infection inside your abdomen from its connection to the outside environment and bacteria (it is not uncommon for this postoperative complication to cause fever and discomfort);
* small bowel obstruction which may require re-operation within 48 hours to resolve;
* damage to vital organs, including the bladder, uterus and blood vessels. Other complications associated with a hysterectomy with BSO include:
* chronic bleeding from your vagina or bowels that requires repeated examination by your surgeon or gynecologist;
* infection in the surgical incision site(s) that requires additional surgery to drain it and/or reopen it for further cleaning out (this can be done without removing your sutures);
* lymphedema of your legs due to lymphatic vessel damage during surgery caused by cutting through tissues containing these vessels too close to the skin surface resulting in fluid build up inside muscles of your legs;
* bowel obstruction from a cut in the colon during surgery, leading to recurrent abdominal pain requiring hospitalization and emergency surgery to resolve.
Does a myomectomy affect fertility?
A myomectomy is surgery that involves removing abnormal uterine fibroid tumors. According to one study, the fertility rate following a myomectomy was 92 percent among women who had no increased risk factors for infertility. Although removing these non-cancerous growths will not affect fertility, there are still risks associated with this surgery.
Myomectomies are performed most often by abdominal incision or through the vagina. The surgeries are usually performed laparoscopically but may be open procedures depending on the size of the fibroids and location in the uterus. There are concerns about whether a hysterectomy is required along with the myomectomy . Some doctors believe that any surgery which removes part of the uterus will negatively affect the pregnancy rate in the future. However, others believe that removing uterine fibroids is beneficial to fertility; this method results in no effect on future childbearing. According to one study, " Myomectomy for fibroids was not associated with an increased risk of secondary infertility or hysterectomy ."
So what are the risks involved with myomectomies?
First, there are concerns about whether a hysterectomy may be necessary at the same time as removing fibroids. A hysterectomy is surgery that involves removal of all or part of the uterus. If part of a woman's uterus were removed during a myomectomy, it could reduce her chances for pregnancy in the future. Although some studies suggest that hysterectomy is not required if the uterus is large enough to allow adequate blood flow, other studies indicate that removing part of an enlarged uterus will reduce uterine size and improve fertility. Another study found no significant difference between women who had a myomectomy compared to those who had their fibroids removed by D&C (diagnostic curettage).
There are also risks concerning anesthesia, which can include breathing problems or an adverse reaction to medications given.
Myomectomies are considered safe for most women with non-cancerous growths in the uterus. However, there are still possible complications associated with the surgery including damage to internal organs. It is best to talk with your doctor about the best way for you to treat your uterine fibroids.
What are complications of a myomectomy?
If a myomectomy fails to remove all of the fibroid or other abnormality, there may be:
- re-growth of the fibroids and need for repeat surgery. The time frame within which this can occur is 30% within 5 years, 10% between 5 and 10 years, and 2% at more than 10 years. The risk increases as patient age increases beyond 35 years.
- recurrent heavy menstrual bleeding/ menorrhagia due to inadequate removal of the internal uterine lining (endometrium). This can occur in approximately 7–8% of cases and usually requires further surgery through a hysterotomy (opening up) to remove the endometrium.
What happens to your pelvic floor after a hysterectomy?
The pelvic floor is a group of muscles that support the bladder, uterus, and bowel. The pelvic floor musculature is attached to the walls of the pelvis through connective tissue known as fascia. There are four major fascial planes which support this complex network of muscles and these include posteriorly, inferiorly, anteriorly, and laterally (side to side). Any surgery involving entering your abdomen requires proper knowledge of where these support structures are to avoid cutting them during surgery. The upper end of your vagina is also attached to the front wall of your pelvis along with some supportive tissues that give it its shape. These tissues do not grow back after they have been severed during abdominal incisions for hysterectomy. As a woman ages and goes through childbirth, these pelvic floor muscles stretch and weaken which results in a drooping appearance to the vaginal opening. This condition is known as vaginal relaxation or pelvic prolapse and it can occur even if you have not had a hysterectomy. Women with substantial involvement of their vaginal musculature may require the placement of tension free vaginal tape (TVT) to provide proper support for their weakened tissues.
What other surgeries are done during a hysterectomy?
Whenever your abdomen is entered during surgery, there is always the possibility that additional unexpected abnormalities will be encountered such as:
--> adhesions (scar tissue) from prior surgeries;
--> enlarged ovaries
What are other less invasive surgical provedures?
Other less invasive surgical methods include:
- endometrial ablation
- radiofrequency ablation
Endometrial ablation involves removing the endometrium, which is the lining of the uterus. This can be done with a laser or electric current. You ill not be able to have children after this surgery.
Radiofrequency ablation uses heat to destroy the uterine tissue. This is done with a needle that goes through the skin and into the uterus. The needle is then heated to destroy the tissue. You may have some cramping during this procedure.
What is the leading non surgical procedure for fibroids (an alternative to hysterectomy)?
Minimally invasive procedures for fibroids include uterine fibroid embolization (UFE) also called uterine artery embolization (UAE). This a leading non surgical method to stop fibroid growth and to eliminate fibroids even larger fibroids.
What is uterine artery embolization (UFE)?
UFE (or UAE) is a non-surgical procedure designed to treat fibroids without surgery. It is a same day, minimally invasive, "pinhole" procedure that blocks the blood supply to fibroids. The outpatient procedure involves inserting a tiny catheter into an artery in your groin and advancing it through the iliac arteries into the target vessel - the uterine artery. These are important arteries that feed your uterus with oxygenated blood from which your fibroid tumors obtain their nourishment. Once the catheter reaches this area, it is then directed towards an optimal area and small particles are injected into the uterine artery. As these particles travel downstream they physically block off (occlude) these vessels so that normal blood flow to the fibroid is cut off. These particles are made of either tiny coils or special beads or special solid foam material block the artery and cause fibroid tissue to die and be absorbed by your body. The procedure is usually painless and you leave the same day with a band-aid.
Typical UFE cases take between 20 minutes to 1 hour depending on how many fibroids need to be treated along with their sizes.Blockages that form at the site(s) where these particles were injected tend to temporarily block off the blood vessels leading to the fibroids which results in their shrinkage over time. They are then gradually reabsorbed into your body or broken down by your immune system so that no surgery is required to remove them.
How are uterine fibroids diagnosed by Imaging & Interventional Specialists?
The diagnosis of fibroids involves a history and physical as well imaging tests.
1) Your doctor will ask you about your personal and family medical history, menstrual cycle and childbirth experience.
2) You'll be asked to answer a questionnaire that helps identify common symptoms associated with uterine fibroids such as:
--> Abnormal bleeding during menstruation;
--> Pelvic pain or pressure;
--> Frequent urination.
3) Ultrasound imaging will be obtained and reviewed. Ultrasound uses high-frequency sound waves to produce images of blood vessels, tissues and organs on a video monitor screen. It does not use ionizing radiation (x-rays). Fibroids are detected well with ultrasound .
4) Magnetic resonance imaging (MRI) uses radio waves and strong magnets to produce three-dimensional images on a computer screen. It creates more detailed images than ultrasound, but takes longer. MRI may be used for diagnosis or treatment planning. A pelvic MRI with gadolinium injection can help confirm uterine fibroids because the dye highlights abnormal tissue in the uterus. MRI is excellent in depicting fibroids and are used before and after uterine artery embolization to help guide the procedure and assess success.
Why choose Imaging & Interventional Specialists?
Imaging & Interventional Specialists are leaders in interventional radiology and experts in the minimally invasive procedures that will treat fibroids.
Using state-of-the-art equipment, our experienced board-certified specialists are focused on your best outcome.
At Imaging & Interventional Specialists board-certified physicians offer in-house testing to determine the cause and develop an individualized treatment program for your uterine fibroids