Treatment of symptomatic fibroids is the #1 reason why women have a hysterectomy
in the United States today.
Uterine fibroids are benign (noncancerous) tumors that grow on or within
the muscle tissue of the uterus. Approximately 20-40% of women 35 years
and older have fibroid tumors. Fibroids are more common among women of
African-American descent. Some statistics indicate that up to 80% of African-American
women will develop uterine fibroids. While some women do not experience
any of the symptoms of fibroids, the location and size of fibroid tumors
can cause symptoms that can affect a woman's quality of life.
Fibroids are hormonally sensitive so symptoms are likely to be cyclical,
like menstruation. As estrogen levels tend to increase prior to the onset
of menopause, this may cause the size of many uterine fibroids to increase.
This may cause an increase in the symptoms of fibroids as well. During
menopause the levels of estrogen decrease dramatically, causing fibroids
to shrink. However, women taking hormone replacement therapy (HRT) during
menopause may not experience any symptom relief because the estrogen contained
in this regime may cause fibroid tumors to enlarge and symptoms to return.
The size of fibroids range from very small (walnut size) to as large as
a cantaloupe or even larger. Typically, physicians measure uterine fibroids
in terms of the size of the uterus during pregnancy; for example, a very
large fibroid can cause the uterus to become the size of a six- or seven-month
pregnancy (24-28 weeks). Additionally, there can either be one dominant
fibroid or a cluster of many small fibroid tumors.
Who Gets Fibroids?
Uterine fibroids are the most common tumors within the female reproductive system, so all
women are at possible risk of developing them. During your annual internal
gynecological examination, or if you schedule a special visit to investigate
possible symptoms, your doctor will check the size of your uterus. If
it feels enlarged, your doctor may prescribe an abdominal or transvaginal
ultrasound, which can confirm the presence, location and size of fibroid
tumors. Other methods can be used to confirm uterine fibroids including
magnetic resonance imaging (MRI) or ultrasound. After identifying the
size and location of your fibroid(s), and also after other diagnostic
tests, your doctor may recommend ruling out other, potentially more serious,
conditions, and advise you of your options and a recommended course of
uterine fibroid treatment.
Furthermore, many clinical papers cite African-American women as especially
susceptible to developing uterine fibroids. It is believed that African-American
women develop symptoms quicker and in greater magnitude than other women.
It is estimated that between 50% and 80% of African-American women in
the United States will develop fibroids. Due to the prevalence of this
condition, it is essential for all women to understand fibroids, possible
symptoms, and the choices available for uterine fibroid treatment.
Most clinicians believe that instances of fibroids shrinking occur when
a woman goes through menopause. Consequently, the majority of uterine
fibroids are diagnosed and treated in women between the ages of 35 and
54. However, fibroids can and do occur in women under the age of 35, even
as young as the early 20's. In the United States, there are approximately
42 million women between these ages. In clinical literature, it is estimated
that between 20-40% of all women have fibroid tumors. This means that
10 million to 21 million women have fibroids in the United States alone.
From this group about 5.5 million will seek treatment each year. Between
200,000 and 300,000 hysterectomies performed every year are for symptomatic
Symptoms of Fibroids
Many women live with fibroid tumors and still maintain a good quality of
life. Some women may experience some
symptoms of fibroids, but can still manage to perform their daily activities. Many women who
suffer from symptomatic fibroids underestimate the severity of their symptoms
as they have become accustomed to excessive bleeding, pain, and the pressure
fibroids can cause. However, if the symptoms of uterine fibroids are so
severe that they affect your ability to maintain your day to day activities,
it is a good time to discuss with your physician all of the alternatives
available to help you manage these symptoms.
Common symptoms of fibroids include:
- Very heavy menstrual bleeding and prolonged monthly periods, sometimes
- Frequent occurrence of soiling events due to excessive menstrual bleeding
- Anemia (excessive fatigue due to low red blood count)
- Pelvic pain or pressure
- Pressure on the bladder which leads to a constant need to urinate or incontinence
- Pain in the back of the legs
- Pain during sexual intercourse
- Pressure on the bowel which can lead to constipation and/or bloating
- An enlarged abdomen which may be mistaken for weight gain or pregnancy
If you are experiencing any of these symptoms, you should go to your doctor
to confirm the cause of them. These may be symptoms of other problems
that need to be diagnosed by a medical professional.
Excessive Menstrual Bleeding
One of the most common symptoms of fibroids is prolonged and excessive
menstrual bleeding. The passage of clots is also another symptom commonly
related to heavy menstrual bleeding, which in many cases can cause frequent
soiling events. Prolonged bleeding over a long period of time can cause
anemia and fatigue, which may result in the need for transfusions.
Pelvic Pain and Pressure
fibroid tumors grow in size, they may put pressure on surrounding organs; causing
pain and discomfort. In other instances, fibroids may be accompanied by
other conditions, such as adenomyosis (components normally in the endometrium
are within the myometrium) and endometriosis (endometrial tissue is generally
found outside of the uterus), which can cause pain and other complications.
It is important to ensure that you have a complete gynecological evaluation
to properly diagnose all of the conditions causing symptoms.
Urinary Incontinence and Frequency
In conjunction with pelvic pain and pressure, growth of fibroid tumors
can put pressure on surrounding organs, such as the bladder. This pressure
can cause urinary incontinence or more frequent urination. It is very
common for women with fibroids to feel the need to urinate many times
throughout the day and night.
Once you have been diagnosed with fibroids, your doctor will discuss with
you the various fibroid tumor treatments available. These fibroid treatments
range from "watchful waiting" to pharmaceutical therapy for
fibroids that may have recently been diagnosed or may have some associated
symptoms, but do not interfere with daily living.
However, many patients may require additional fibroid treatment options
to manage more severe symptoms. Your physician may advise you of minimally
invasive, uterus-sparing therapy, such as UFE, to surgical interventions,
such as hysterectomy and myomectomy. It is important to be sure to discuss
all of these fibroid treatment options with your physician to see what
is the best option for you.
Diagnosis and Watchful Waiting
If your fibroids do not cause symptoms, there is no need to treat them.
Your doctor may want to watch them and monitor for any fibroid growth
at each of your annual examinations. Some women may have fibroids, but
not experience symptoms.
If you begin to experience, of have been experiencing, some or many of
the symptoms of fibroids previously indicated, there are several other
fibroid treatment options that may be available to you. These include
drug therapies; minimally invasive non-surgical options; and surgical
options. Your doctor should discuss all the alternatives with you based
on your condition.
Pharmaceutical Fibroid Tumor Treatments
Birth control pills - many physicians will prescribe birth control pills as a means of controlling
excessive menstrual bleeding caused by fibroids. Other non-steroidal anti-inflammatory
agents (NSAIDs) may be prescribed for pain relief. Birth control pills
effectively trick your body into thinking it is pregnant. There are several
potential side effects of the use of birth control pills, including risk
of high blood pressure, development of blood clots, increased risk of
heart disease, and/or liver disease. Data suggests that fibroids may re-grow
after this treatment ends.
GnRH Agonists - can be prescribed by physicians when the symptoms of fibroids are not
controlled by birth control pills, or can be prescribed as a first attempt
in controlling fibroid symptoms. GnRH agonists are used to decrease the
production of estrogen in the ovaries, which may reduce the size of fibroids
and help manage the associated symptoms. Because of the decrease in estrogen
production, there may be some side effects, such as hot flashes or mood
swings. Furthermore, there may be some bone loss associated with prolonged
use of GnRH agonists. In addition, data suggests that fibroids may re-grow
after this treatment ends.
Non-surgical Option: Alternatives to Hysterectomy
Uterine fibroid embolization, also known as artery embolization, is a procedure where an interventional radiologist uses a catheter to
deliver Embosphere® Microspheres that block the blood supply to the
fibroids. This is a minimally-invasive, non-surgical therapy that treats
all fibroids. This fibroid treatment usually takes less than one hour.
Clinical data suggests that patients treated with Embosphere Microspheres
return to work and daily activities on average within 11 days. Patients
treated with other embolic agents return to work and daily activities
between 13 and 16 days. Potential benefits of UFE include:
- Preservation of the uterus
- Decrease in menstrual bleeding from symptomatic fibroids
- Decrease in urinary dysfunction
- Decrease in pelvic pain and/or pressure
- No surgical removal of the uterus and possible need of hormone replacement
- Virtually no blood loss
- Covered by most insurance companies
- Out-patient procedure (generally 10 to 23 hours)
- More confidence with less chance of soiling events
- Overall significant improvement in patient's physical and emotional
UFE is a safe procedure for treating symptomatic fibroids with minimal risk.
Overall, 96% of patients indicated they were happy with their twelve month
outcome, and would recommend UFE to a friend. Most reported risk factors
and complications associated with UFE are transient amenorrhea, common
short term allergic reaction/rash, vaginal discharge/infection, possible
fibroid passage, and "post-embolization syndrome." For more comprehensive information see possible risks and complications
associated with UFE.
Hysterectomy is defined as the "surgical removal of the uterus" (womb). It
is one of the most common of all surgical procedures and can also involve
the removal of the fallopian tubes, ovaries and cervix. Following this
operation you will no longer have periods, nor will you be fertile or
be able to have any more children.
There are two main ways to perform a hysterectomy. The most common way
is to remove the uterus through an incision in the lower abdomen. The
second and less common way, is to remove the uterus through a cut in the
top of the vagina, where the top of the vagina is stitched. Each operation
lasts between one to two hours and is performed in the hospital under
a general anesthesia
There are different types of hysterectomy:
A "total hysterectomy" removes the complete uterus including
the cervix. This is the operation most commonly performed.
A "subtotal hysterectomy" removes the uterus leaving the cervix
in place. If you have this operation you will need to continue to have
Pap smear tests.
A "total hysterectomy with a bilateral or unilateral oopherectomy"
removes the uterus, cervix, fallopian tubes and both or one of the ovaries.
If you you have not had your ovaries removed and you have not gone through
menopause before your operation, there is a 50% chance that you will go
through menopause within 5 years of having this operation.
Physically there are a number of issues that are common to all women having
a hysterectomy. You will not have any more periods and you will not be
able to have any more children. If you have had your ovaries removed you
will go through menopause regardless of your age. Menopause is not related
to age, it is related to the production of the female sex hormone, estrogen.
Your physician should discuss Hormone Replacement Therapy (HRT) with you
to help you understand the pros and cons of HRT.
Myomectomy - is the surgical removal of the fibroids. While this procedure keeps
your uterus in-tact, it can be a surgically challenging procedure and
is not performed by all physicians. In addition, only certain fibroids
may be treated with this therapy. An abdominal myomectomy is performed
through a horizontal incision through the abdomen, similar to a "bikini
cut" used in a cesarean section. Most types of fibroids, even very
large ones, can be removed in an abdominal myomectomy. The recovery time
varies with each patient, but typically is 4-6 weeks in length. Pedunculated
and subserosal fibroids can be removed via a laproscopic myomectomy, which
is performed through three small incisions. When a resectoscope is used
to remove submucousfibroids, this is called a hysteroscopic resection.
The use of a resectoscope requires proper training by the physician prior to use.
Frequently Asked Questions:
What is Uterine Fibroid Embolization (UFE)?
- UFE blocks the flow of blood to the fibroids, causing them to shrink.
- Blood flow is blocked using tiny particles called embospheres. The material
used for the embospheres are well tolerated by the body.
How do I know if this is the right procedure for me?
Patients who are ideal for UFE include women who:
- Have symptomatic fibroids
- Do not intend to get pregnant
- Want to keep their uterus
- Do not want surgery
How do I know if my fibroids are symptomatic?
Fibroid symptoms may include:
- Heavy, prolonged monthly periods
- Lower abdominal or lower back pain
- Frequent urination
- Pain during sexual intercourse
Is it a surgery?
UFE is a procedure
- It is minimally invasive:
What kind of doctor does the procedure?
- UFE is performed by an interventional radiologist, a doctor who uses x-rays
to see inside the body and treat conditions without surgery.
How long does the procedure take?
- Typically, less than an hour.
- Requires an overnight stay
Will I be put completely to sleep?
- During UFE, you are sedated but remain awake. Most people do not remember
being awake for the procedure. You do not feel pain during the procedure.
How will I feel after the procedure?
Some women experience moderate to severe pain and cramping in the first
several hours following the procedure.
- Symptoms can be controlled with appropriate medications.Some experience
nausea and fever
- Some experience nausea and fever
How successful is the UFE procedure?
- Studies have shown that up to 90% of women will experience significant
or total relief of heavy bleeding, pain and other symptoms.
- The procedure is effective for multiple fibroids.
- Recurrence of treated fibroids is rare.
How long am I off of work?
- Patients return to work in an average of 11 days.
Will my health insurance cover this procedure?
- Most Health plans are currently covering this procedure.
How do I get an appointment?
- HMO plans will need a referral from your physician.
- PPO or Medicare may be self referred