All About Fibroids
A large number of women, about 30%, will develop uterine fibroids at some point in their lives, but in most cases won’t have noticeable symptoms or need treatment. But for the unlucky few, fibroids can cause extra-heavy menstrual bleeding, lengthy periods, chronic pain or pelvic pressure, difficulty voiding urine, and constipation. Because of the prolonged and heavy menstrual periods, there’s also a tendency for women with symptomatic fibroids to develop anemia.
Uterine fibroids aren’t cancer, but they are growths that can cause a great deal of trouble whether they occur inside or outside of the uterus. Those fibroids that grow inside the uterus are called submucosal fibroids and these can interfere with fertility. Those fibroids that grow outside of the uterus are called subserosal fibroids. Subserosal fibroids may exert pressure on the rectum, bladder, or the spinal nerves, causing all sorts of trouble.
Most women develop fibroids during their childbearing years. Experts believe this may be due to the higher levels of the female hormone estrogen, produced during these years. Fibroids also tend to have a genetic component—they seem to run in families, so if your mom had them, you might have them, too. Certain chemicals in the body may also cause fibroids, for instance insulin-like growth factor (IGF). Black women are more susceptible to fibroids than women of other races.
Until now, the treatment of choice for symptomatic fibroids was the surgical removal of the uterus (hysterectomy). Of the 600,000 hysterectomies performed every year in the U.S., around 30% are related to uterine fibroids. But there are other, less drastic solutions.
There are medications that can shrink the fibroids. These treatments serve to decrease the hormone levels that are at least partially responsible for fibroid growth. But no medication can get rid of the fibroids, so if symptoms are still a problem, your physician may try a minimally invasive procedure, such as a myomectomy, which is removal of only the fibroid tumor. This surgery can be performed several different ways: abdominally with a bikini-cut, laparoscopically via the belly button, or intravaginally (resectoscope myomectomy). However, with myomectomy, there is no guarantee that the fibroids won’t recur.
A newer procedure, myolysis, is a laparoscopic procedure that employs lasers or currents to obliterate the fibroid and shrink the blood vessels that feed them. In endometrial ablation, electric current, hot water, microwave energy, or heat are used to destroy the endometrium (lining of the uterus) and this cauterizes the area so bleeding stops. However, this procedure cannot prevent future fibroids from growing inside the uterine cavity.
Another procedure, uterine artery embolization, involves the injection of tiny particles into the uterus’ arteries. This technique cuts off the blood supply to the fibroids causing them to shrink.
Perhaps the most popular noninvasive treatment is MRI-guided focused ultrasound surgery (FUS). In this treatment, high-frequency sound waves target and destroy the fibroid tumor. So far, this treatment is yielding excellent results, but it’s too soon to know how FUS will fare as a treatment option for the long-term.