Uterine fibroids are benign tumors that grow in the uterus, causing complications such as heavy bleeding, pelvic pain, and pregnancy issues. Treatment options include surgery or less invasive techniques such as uterine artery embolization or endocoagulation. The cause of fibroids is unknown, but estrogen levels affect their growth.
Uterine fibroids are tumors, usually benign, that grow in the uterus from the surrounding muscle tissue. They are also known as leiomyomas or myomas of the uterus. Uterine fibroids can grow in or on the uterine wall, push the uterus to one side, or force it to grow abnormally. They can be as big as a basketball or as small as a pea.
Complications of uterine fibroids occur when larger fibroids put pressure on the intestines or bladder, causing constipation, frequent urination, heavy menstrual bleeding, and pelvic pain. This abnormal growth can lead to back pain, an uncomfortable pressure or feeling of fullness in the lower abdomen, and problems conceiving. Uterine fibroids can cause pregnancy complications when large fibroids block the opening of the uterus, necessitating a cesarean delivery.
30% of women of childbearing age have fibroids, most commonly in the 50- to 50-year age group. African American women are three times more likely to develop uterine fibroids than white American women. Those at lower risk include athletic women, smokers, and women who have had two or more children vaginally.
No one knows the exact cause of uterine fibroids. Fluctuations in estrogen levels affect the growth of fibroids; high levels, such as during pregnancy, promote the growth of fibroids. During and after menopause, when estrogen levels are significantly lower, fibroids shrink or almost disappear.
During regular pelvic exams, your doctor feels your uterus for abnormal size and growth. The presence of uterine fibroids can make the uterus lumpy. An ultrasound is usually done to rule out cysts or malignancies.
Treatment of uterine fibroids depends on the severity of the symptoms. Most uterine fibroids are not treated unless they have a major impact on a woman’s life. When deciding on treatment, a doctor takes into account bleeding and pain during menstruation, the woman’s age, and how fast the fibroids are growing. In addition to estrogen-lowering drugs, which may help shrink fibroids but lead to menopause-like symptoms, there are two main surgical options.
The first option is a myomectomy, in which the fibroids are removed, leaving the uterus intact and viable for future pregnancies. With this option, there is a 25% uterine fibroid recurrence rate. The second surgical option is hysterectomy, in which the uterus is completely removed along with the uterine fibroids. This option is reserved for women in menopause, women who do not intend to have children or those with particularly severe symptoms. These are both quite invasive options that can have lifelong repercussions.
There are a couple of less invasive options for treating uterine fibroids. The first is called uterine artery embolization (UAE). This is a newer technique, which has been in use since 1995, and is performed by a radiologist. Doctors pinpoint the exact location of the fibroids and surrounding blood vessels using X-rays or other imaging technologies. He or she then blocks the surrounding blood vessel, thus cutting off the blood supply to the fibroids. Rather than major surgery, this doesn’t involve an incision, just a small puncture with a needle and an overnight stay in the hospital.
Endocoagulation uses a similar theory to treat fibroids. It’s an experimental technique that involves inserting a needle into the fibroid and cauterizing it, cutting it off from its blood supply.
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