Uterine Fibroids
Most frequent questions and answers
Fibroids are growths of the uterus. The uterus is made of muscle, and fibroids grow from the muscle.They are also called uterine leiomyomas or myomas. Uterine fibroids are the most common type of non-cancerous tumors (neoplasms) of the female reproductive system. In fact, an estimated 80% of women will develop uterine fibroids at some point in their lives. Uterine fibroids often grow asymptomatically, in up to 70% of cases, and therefore are often diagnosed incidentally, during routine exams or when seeking medical care for other conditions. However, when fibroids do become symptomatic, it’s often during childbearing years, typically between the ages 25-40 because of high levels of female hormones (Estrogen & Progesterone). Teenagers can also develop fibroids that can be severely disruptive, both physically and socially. Consult today with Dr. Azer if you believe that you have fibroids symptoms.
Unlike normal tissue, uterine fibroids can grow in any location in and around the uterus. In very rare cases, the certain types of uterine fibroids”called parasitic fibroids” have even the ability to migrate and have been found in distant areas of the body, such as the bowel or even lungs. Although also rare, there have been reports of fibroids developing even after hysterectomy as well. Some women only develop one fibroid or just a few, while others may have hundreds of them. Fibroid size also varies widely, with some so small that can not be seen with the naked eye, while others grow as large as a grapefruit. The world’s largest fibroid on record weighed in at over 100 pounds.
The cause of fibroids is unknown. However, fibroids seem to respond to the level of the female hormones estrogen and progesterone, and researchers have identified several factors (such as age at first menstruation, specific genes, lifestyle, and number of pregnancies) that might influence a person’s risk.
However, it is possible for a person without any known risk factors to develop fibroids.
There are 6 main types of fibroids, classified by their location to the uterus:
- Subserosal fibroids Grow under the outside lining of the uterus
- Intramural fibroids Grow within the muscular middle layer of the uterine wall (Myometrium)
- Submucosal fibroids Grow under the inner top layer of uterine mucosa (endometrium) and protrude into the inside of the uterus
- Pedunculated fibroids Grow on a stalk off of the outside of the uterus
- Interligamentous fibroids Grow between the uterine ligaments
- Parasitic fibroids Move and attach to other organs besides the uterus such as bowel, omentum, diaphragm.
The majority of fibroids are small and do not cause any symptoms at all. However, some people with fibroids have very heavy and/or prolonged menstrual periods (more than seven days a month) or pelvic pressure or pain that interferes with their life.
Fibroids are more likely to cause symptoms if the fibroids are large, if there are many fibroids, or if the fibroid is located in certain places in the uterus. Fibroid symptoms tend to get better when a person stops having menstrual periods (at menopause).
Changes in menstruation
Fibroids distort the lining of the uterus and muscular wall of the uterus, which can lead to a variety of changes in your period, including:
- Periods lasting longer than 7 days
- More frequent periods
- Heavier than normal bleeding during your period (menorrhagia)
- On/off irregular bleeding throughout the menstrual cycle (menometrorrhagia)
- Painful periods (dysmenorrhea)
Pelvic pressure and pain
As fibroids grow, they can exhaust their blood supply, causing intense pelvic pain. The mass of the fibroids can also cause other painful symptoms including:
- Pelvic pain
- Abdominal pain
- Sudden or severe abdominal pain
- Fever (from dying fibroids due to inadequate blood supply, that release chemicals causing fever)
- Pain with intercourse (dyspareunia)
- Pain during menstruation (dysmenorrhea)
- Lower back and thigh pain
Larger fibroids can cause a sense of pelvic pressure or fullness in the abdomen and/or pelvic area, similar to the feeling of being pregnant. Sometimes the presence of fibroids can even make a person look pregnant when they are not.
Fibroids can also cause other symptoms, depending on the size and where they are located in or outside the uterus. As an example, if a fibroid is pressing on your bladder, you may feel like you need to urinate frequently. Similarly, a fibroid pressing on the rectum can cause constipation.
Problems with fertility and pregnancy
Most people with fibroids are able to get pregnant without a problem. However, if your fibroids are affecting the shape of the inside of your uterus, this may make it more difficult to get pregnant. Fibroids in the outer part of the uterus may have a mild effect on decreasing fertility.
Studies show that people with fibroids may be more likely to have miscarriages than people without fibroids.
If you have fibroids and are trying to get pregnant without success, consult with the expert Dr. Azer to discuss your options and to determine whether the fibroids are responsible for the problem as people with a large fibroid (greater than 5 to 6 cm) or many fibroids might have an increased risk of specific pregnancy complications.
Fatigue, Anemia
Some women with fibroids lose so much blood that they develop anemia (low red blood cell count). The most common symptom of anemia is fatigue (feeling tired or weak). Other common symptoms of anemia include dizziness, shortness of breath, chest pain, passing out, headache, cold hands and feet, sweating, fast heart rate, pale skin, just to name a few. These symptoms may arise because of iron deficiency and/or because your heart has to work harder to supply your body with the oxygen-rich blood that fibroids-related blood loss may have depleted. If you develop severe anemia, you might need blood transfusion, but this will not treat the cause of your bleeding and anemia; you most likely will need intervention to treat your fibroids.
Request an appointment today with Dr. Azer to discuss your options.
At your initial consultation with Dr. Azer, he will take your comprehensive history, and actively listen to all your concerns and answer all your questions. After this, a detailed clinical, hysteroscopic, and histopathological assessment of the fibroids will be performed. Most commonly, fibroids are first diagnosed by pelvic exam. In the bimanual examination, Dr. Azer usually can feel enlargements, nodules, or an overall irregular contour to the uterus, which are consistent with signs of fibroids. Dr. Azer’s exam can also determine the size of your uterus and fibroids and this will help with choosing the appropriate route for your fibroids removal surgery.
A variety of imaging modalities are also available if needed to aid in the diagnosis of fibroids, including:
- Transabdominal or Transvaginal Ultrasound – A probe over the abdomen or inside the vagina that can visualize the uterus and any masses within it.
- Transvaginal Doppler Ultrasounds – Using a Doppler ultrasound is preferred as it provides significantly improved detail of vascularization patterns.
- Sonohysterogram – Vaginal ultrasound is used after the uterus is distended with fluid. This allows visualization of the contour of the inside of the uterus. This makes it easier to diagnose small fibroids that can be missed by ultrasound alone.
- MRI (magnetic resonance imaging) – This imaging technique is very important in what we call “mapping of fibroids” which refers to accurate determination of the number, size and location of fibroids. It can also distinguish between fibroids and other types of growths.
- Hysteroscopy – This diagnostic technique is useful for diagnosing certain types of fibroids. Your doctor takes a camera and inserted it into your uterus through your vagina to visualize the inside of your uterus. Some fibroids can also be removed hysteroscopically.
- Laparoscopy – Your doctor takes a camera to visualize the inside of your belly. A diagnostic laparoscopy is more invasive than the other procedures, as it requires anesthesia. However, it is considered the gold standard for diagnosing fibroids. It is often used in combination with hysteroscopy. Fibroids can also be removed laparoscopically.
If your fibroids are not causing symptoms, you can choose not to have treatment. If you do have symptoms, your options include medication or surgical treatment. The best treatment depends on your symptom, the size, number, and locations of fibroids, as well as whether or not you might want to get pregnant in the future.
Medications for fibroid symptoms
Most medications aim to reduce the heavy menstrual bleeding that is common in people with fibroids. A few also shrink the fibroid, and some are focused on reducing pain or correcting anemia. Medications are often recommended before surgical treatments.
Iron and vitamins If you have anemia, your doctor will likely recommend a combination of iron supplements to restore your iron stores.
Nonsteroidal anti-inflammatory drugs (NSAIDs) Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Advil, Mortin, Naproxen, can help reduce menstrual cramps and decrease menstrual flow in some cases.
Hormonal birth control Hormonal methods of birth control include the pill, skin patch, vaginal ring, shot,subdermal implant, and hormonal IUD. These methods reduce bleeding, cramps, and pain during your menstrual period and can correct anemia. It might take three months or more for bleeding to improve after you start taking hormonal treatment.
Antifibrinolytic medications These medications do not contain hormones and can help to slow menstrual bleeding quickly. They work by helping blood to clot. These medications do not shrink fibroids or correct anemia. Tranexamic acid (brand name: Lysteda) is used worldwide and is also approved by the US Food and Drug Administration for the indication of heavy menstrual bleeding.
Gonadotropin-releasing hormone analogues Gonadotropin-releasing hormone (GnRH) analogues include GnRH “antagonists” and GnRH “agonists.” Both types of medication cause the ovaries to temporarily stop producing estrogen and progesterone and can reduce heavy menstrual bleeding and help to shrink your fibroids. If you are scheduled for surgery to remove your fibroids, your doctor might recommend that you first use GnRH agonists for three to six months to shrink the fibroids, which can make them easier to remove. This treatment is not routinely recommended for longer than six months in a row due to the risk of thinning bones when used for long periods of time. GnRH agonists do not work immediately. They first cause an increase in ovarian hormones that can cause an increase in symptoms for the first few weeks. This “flare” can be a problem for people with heavy bleeding who are severely anemic.
Other Medications also available, consult today with Dr. Azer to discuss your options.
Surgical Treatments of Uterine Fibroids
Myomectomy Myomectomy is a surgery done to remove fibroids, which can reduce both bleeding and size-related symptoms. Most people who have myomectomy are able to have children afterwards. However, there is a risk that fibroids will come back after myomectomy; between 10 and 25 percent of people who have myomectomy will need a second fibroid surgery. Myomectomy is often a good choice for people who might want to get pregnant in the future.
There are several ways to perform myomectomy; the “best” way depends on where your fibroids are located and the size and number of fibroids.
Abdominal myomectomy This surgery requires an incision (cut) in the lower belly to remove the fibroids.
Hysteroscopic myomectomy If the fibroids are inside the uterus, a doctor can insert instruments through the cervix to remove them. This approach might not be recommended if you have very large fibroids.
Uterine artery embolization Uterine artery embolization (UAE), is a treatment that blocks the blood supply to fibroids. This causes the fibroid to shrink within weeks to several months after the treatment and decreases other fibroid symptoms including heavy menstrual bleeding.
Other treatment modalities are also available such as Magnetic resonance-guided focused ultrasound or Ultrasound-guided radiofrequency ablation procedure
Hysterectomy Hysterectomy is a surgery that removes the uterus. The ovaries and cervix may be left in place when the hysterectomy is for uterine fibroids.
Hysterectomy is a permanent treatment that cures heavy menstrual bleeding and the bulk of related symptoms of fibroids. Dr. Azer is an expert in performing minimally invasive hysterectomy using both multiport and single site da Vinci assisted hysterectomy.
On rare occasions if your uterus is extremely enlarged with fibroids, Dr. Azer will recommend the traditional open hysterectomy.
Most studies show that benign fibroids only very rarely transform into their cancerous counterpart, uterine leiomyosarcoma, which is a cancer arising from the uterine muscular layer (myometrium). Uterine leiomyosarcoma tends to be an aggressive cancer with poor prognosis. One case of cancer is too much; please seek medical advice immediately if your fibroids are bothering you, rapidly growing, or if you have noticed a recent change in your periods or waist circumference.
