• Facts About Fibroids

    IMAGE Lesli Hicks complained to her gynecologist that her lower back hurt. She was told that she had probably lifted something incorrectly. She sought a second opinion and an ultrasound examination. At this time, ovarian cysts, endometrial tissue, and fibroids were discovered around Lesli's ovaries and were removed by laparoscopy. Over 10 years later, Lesli began experiencing problems again. This time the culprit was a tennis ball-sized fibroid above her uterus.

    Is a Fibroid Actually Considered to be a Tumor?

    Fibroids are tumors composed of smooth muscle cells wrapped in a fibrous covering. They are found in the wall of the uterus and sometimes on the cervix. If you held one in your hand, it would almost look like a little pink rubber ball, says Dr. Sheri Maxwell, Fellow of the American College of Obstetrics and Gynecology. Also called myomas, leiomyomas, or fibromyomas, these overgrowths of uterine tissue are rarely cancerous.
    Leslie was 34 years old when she was diagnosed with fibroids. This condition most often affects women over 30, especially those between the ages of 40 and 50. And researchers have found that black women are more likely to have fibroids than white women, but it is not clear why this is the case.

    What Are the Symptoms?

    Fibroids may produce wide-ranging symptoms, including:
    • None at all
    • Heavy and prolonged menstrual cycles
    • Backache
    • Pelvic pain
    • Urinary frequency and/or incontinence
    • A sensation of pelvic heaviness
    • Pain with sexual intercourse
    In some cases, fibroids have been associated with miscarriages and infertility.
    Fibroids can form inside or outside the uterus, or within the uterine wall. They can grow larger than a grapefruit or remain as tiny as a pea. "We grade fibroids in the same manner as you would grade gestational age of a fetus. Any gynecologist in the world understands when I say that my patient's fibroids are about 16 weeks in size," says Maxwell. "I have had women walk into my office who look seven months pregnant (from a fibroid)," she adds.
    Estrogen affects the growth of fibroids. Many fibroids are discovered during pregnancy because they tend to become larger as pregnancy causes an increase in estrogen. Conversely, as estrogen production tapers off during menopause, fibroids may shrink or even disappear.

    Diagnosis

    Fibroids are often discovered during a gynecologic exam. An ultrasound may be used to confirm the diagnosis. If the fibroid is large enough, you may be able to feel it yourself by placing your hand on top of it.
    If you are found to have fibroids, you will probably be monitored for a period of time to determine their growth rate. If they are not especially large or problematic and are not suspected as a cause of infertility, continued monitoring ("watch and wait") may be the right treatment for you.

    Treatment

    There are a number of treatment options available, including medicines and procedures. Again, small fibroids may just be monitored, rather than treated.

    Medicines

    If you have been diagnosed with fibroids, your doctor may prescribe medicine to control bleeding and/or shrink the fibroid. Commonly used drugs include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. "We have women take this medicine 24–48 hours before the onset of their menstrual cycle and take it throughout the cycle to help decrease uterine blood flow. Of course it may help decrease cramping too," says Maxwell.
    Another type of drug is often used to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonist drugs, such as leuprolide (Lupron), decrease blood flow to the uterus, thus depriving the fibroids of an important growth source. Fibroids can recur within several months after the GnRH drugs are stopped, though. Sometimes these medicines are used to shrink fibroids prior to surgery so that the procedure is less complicated.
    Other medicines that may be prescribed include hormone (progestin) supplementation and aromatase inhibitors.

    Surgical Options

    If drug therapies prove unsuccessful, surgery is an alternative. Individual fibroids can be removed using a procedure called myomectomy, which removes the fibroids, but retains the uterus. There are three approaches to this particular surgery:
    • Laparotomy—Incisions are made in the abdomen, and the fibroids are removed.
    • Laparoscopy—Small tools and a laparoscope (tiny camera) are inserted through small abdominal incisions. Fibroids are surgically removed through the laparoscope or destroyed by a laser.
    • Hysteroscopy—A hysteroscope (long, thin telescope) is inserted through the cervix and into the uterine cavity. Fibroids inside the uterus are located through the hysteroscope and can be removed with a wire loop device or a laser.
    Myomectomy does have risks, and some women have fibroids even after surgery. In severe cases, a hysterectomy may be recommended, which involves removing the uterus.
    Less invasive procedures are available, though, such as:
    • Endometrial ablation—The lining of the uterus is destroyed which can remove small fibriods found in the uterus.
    • Uterine fibroid embolization—The blood supply to the fibroid is cut off, which causes the fibroid to shrink.
    • Magnetic resonance imaging–guided ultrasound surgery—Sound waves are used to destroy the fibroid tissue.

    What Is Right for You?

    Your doctor will consider a number of factors (eg, age, overall health, fibroid symptoms) before recommending a treatment approach. Get as much information as you can about fibroids and do not be afraid to ask your doctor questions! It is your responsibility to learn more about your condition and explore your options.

    RESOURCES

    American College of Obstetricians and Gynecologists http://www.acog.org

    Women's Health.gov http://www.womenshealth.gov/

    CANADIAN RESOURCES

    The College of Canadian Family Physicians http://www.cfpc.ca/

    Womens Health Matters http://www.womenshealthmatters.ca/

    References

    Christiansen JK. The facts about fibroids: presentation and latest management options. Postgraduate Medicine. 1993;94:129-137.

    Dranov P. When the diagnosis is fibroids. American Health. 1993;12:68-70.

    DynaMed Editorial Team. Leiomyoma. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated April 18, 2011. Accessed May 20, 2011.

    Fibroids: symptoms and treatment. National Women's Health Report. 1996:1815.

    Hutchins FL. Uterine fibroids: diagnosis and indications for treatment. Obstetrics and Gynecology Clinics of North America. 1995;22(4):659-665.

    Uterine fibroids. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/. Accessed May 20, 2011.

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