Heavy periods and pelvic pain aren’t ‘normal’ – uterine fibroids might be to blame | Women’s Health

Fibroids will begin to shrink right away; the goal is to reduce their volume by up to 50% over a few months. Recovery typically takes one to two weeks. Gynecologic surgeons at UT Southwestern now offer the Acessa procedure, which is approved by the U.S. Food and Drug Administration and typically only requires day surgery (outpatient) and a short recovery.   

3. Uterine fibroid embolization

Another minimally invasive procedure, uterine fibroid embolization essentially starves fibroids of blood so they shrink over time. An interventional radiologist inserts a thin, flexible tube called a catheter into a patient’s artery and guides it to the uterus. Then, tiny particles are passed through the catheter to the blood vessels in the uterus.

The particles wedge into the blood vessels, blocking blood flow to the fibroids so they can no longer thrive. Over a few months, the growths should shrink by 40% to 60%. 

4. Hysterectomy

This more permanent procedure removes the uterus and, in some cases, the fallopian tubes and ovaries. For uterine fibroid treatment, we typically recommend hysterectomy only for women who do not want to become pregnant in the future. Our surgeons can perform three types of minimally invasive hysterectomy – through the vagina, laparoscopic, or robot-assisted approaches – as well as traditional open hysterectomy when appropriate.

5. Medical management

Some women can manage their uterine fibroid symptoms with prescription medications or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Women with iron-deficiency anemia from heavy periods also might benefit from iron supplements. A gynecologist can recommend medications based on specific symptoms. If symptoms are not well controlled with NSAIDs, we frequently offer hormonal medications, such as birth control pills or other hormonal treatments that can help with symptom management Additionally, for patients whose main issue is bleeding, an oral medication called Lysteda (tranexamic acid) can be taken during menses to reduce menstrual blood loss.

Fibroids | Johns Hopkins Medicine

What are fibroids?

Fibroids are growths made of smooth muscle cells and fibrous connective tissue. These growths develop in the uterus and appear alone or in groups. They range in size, from as small as a grain of rice to as big as a melon. In some cases, fibroids can grow into the uterine cavity or outward from the uterus on stalks.

An estimated 20% to 50% of women of reproductive age currently have fibroids, and up to 77% of women will develop fibroids sometime during their childbearing years. Only about one-third of these fibroids are large enough to be detected by a health care provider during a physical exam, so they are often undiagnosed.

In more than 99% of fibroid cases, the tumors are not cancerous and do not increase the risk for uterine cancer.

What causes fibroids?

The cause of fibroids is not known. Research suggests each tumor develops from an abnormal muscle cell in the uterus and multiplies rapidly when encountering the estrogen hormone, which promotes the tumor’s growth.

Who is at risk for fibroids?

Women in their reproductive age are most likely to be affected by fibroids.

Other risk factors may include:

• Family history of fibroids
• Obesity
• Diet high in red meat
• High blood pressure

Black women are more likely to develop fibroids than other women, they are diagnosed at younger ages and they more often require treatment. It is not clearly understood why fibroids disproportionately affect Black women.

Fibroids Symptoms

It is common that women who have fibroids do not experience any noticeable symptoms. Other women with fibroids experience severe symptoms that interfere with their daily lives. Common fibroid symptoms include:

• Heavy or prolonged periods
• Bleeding between periods
• Abdominal discomfort and/or fullness
• Pelvic pain
• Lower back pain
• Bladder symptoms, such as frequent urination or difficulty emptying the bladder
• Bowel symptoms, such as constipation or excessive straining with bowel movements

Women with fibroids can also experience:

• Infertility
• Complications during pregnancy
• Pain during intercourse

Emergency Fibroid Symptoms

In rare cases, women with fibroids need emergency treatment. You should seek emergency care if you have sharp, sudden pain in the abdomen that is unrelieved with pain medication, or severe vaginal bleeding with signs of anemia such as lightheadedness, extreme fatigue and weakness.

How are fibroids diagnosed?

Fibroids are most often found during a routine pelvic exam. During this exam, your health care provider will press on your abdomen and may feel a firm, irregular mass that might indicate a fibroid.

To diagnose uterine fibroids, your doctor may order one of the following tests:

• Pelvic Ultrasound. A procedure during which a small instrument, called a transducer, is either inserted into the vagina or pressed over the abdomen to produce pictures of the internal organs using sound waves. The doctor can see the size, shape and texture of the uterus and evaluate any growths.
• Magnetic resonance imaging (MRI). This is a form of advanced imaging technology that provides highly detailed images of internal organs. These images help your provider determine the exact location and characteristics of fibroids and, if needed, plan minimally invasive treatments.
• Hysterosalpingography. This is a type of X-ray exam of the uterus and fallopian tubes. Your doctor will use a special dye to more easily visualize these organs and determine if the fibroids have blocked your fallopian tubes.
• Hysteroscopy. This is a visual exam of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

How are fibroids treated?

Since the growth of most fibroids slows as you approach menopause, your health care provider may simply suggest “watchful waiting” if your symptoms are tolerable. With this approach, the health care provider closely monitors your symptoms with frequent follow-up visits and ultrasounds to make sure there are no significant changes in your condition.

Treatment may be necessary if your fibroids cause significant symptoms. Treatment options include medicinal and surgical approaches. Your doctor will recommend treatment based on your symptoms, location and size of the fibroids, your age and medical history, and your health goals such as a desire for pregnancy.

In some cases, women also require treatment for iron-deficiency anemia due to heavy or prolonged periods, or because of abnormal bleeding between periods.

Medicinal Treatment Options

Anti-inflammatory painkillers such as ibuprofen or naproxen may reduce menstrual bleeding caused by fibroids and provide pain relief. This is the most conservative treatment method and is recommended for women with occasional pelvic pain or discomfort due to fibroids.

Hormonal treatment can include:

• Gonadotropin-releasing hormone agonists (GnRH agonists). This treatment lowers your estrogen level and triggers a temporary “medical menopause.” GnRH agonists are used to shrink the fibroid(s). They are also used to stop your period in preparation for surgery or to improve your blood count. Doctors will not typically administer this medication for longer than a year — and the medication’s effects are reversed once it leaves your system.
• Oral contraceptive pills (or a patch or vaginal ring) can help reduce bleeding associated with fibroids.
• Progesterone-containing agents — pills, implant, injection or intrauterine device (IUD) — may also control bleeding.

Procedural Treatment Options

Conservative surgical therapy. Myomectomy is a procedure during which the fibroids are removed but the uterus stays intact. This approach is recommended for women who want to preserve their fertility. There are three primary myomectomy methods:

• Traditional open myomectomy. The procedure is performed via an abdominal incision and carries some risks, including bleeding and scar tissue formation at the incision site and a longer recovery. This approach may be necessary depending on the size and number of fibroids.
• Laparoscopic or robotic myomectomy. This outpatient procedure uses small “keyhole” abdominal incisions and a laparoscope. This minimally invasive approach often results in less bleeding and a faster recovery, but it is not suited for all patients. Most patients go home the day of surgery and recover within a few weeks. Your doctor will determine if you are a good candidate for this procedure.
• Hysteroscopic myomectomy. During this outpatient procedure, your doctor uses a camera inserted through the vagina to shave off visible portions of the fibroid tumors. This method only treats fibroids that have formed inside the uterine cavity.

Uterine artery embolization (UAE), also called uterine fibroid embolization, is a newer technique. This minimally invasive procedure shrinks fibroids by cutting off their blood flow. An interventional radiologist performs UAE, using X-rays for guidance. Health care providers are looking at this procedure’s long-term implications regarding fertility and regrowth of the fibroid tissue.

Magnetic resonance guided focused ultrasound, also a newer technique, focuses sound waves on fibroids that are at the front of the uterus. The potential effects on fertility are not yet understood.

Radiofrequency ablation of fibroids is another newer technique, during which — under laparoscopic and ultrasound guidance — heat is applied into the fibroids to make them smaller and softer. The potential effects on fertility are not currently well understood.

Hysterectomy for Fibroids

During a hysterectomy, the entire uterus is removed. Fibroids are the #1 reason for hysterectomies in the U.S.

The procedure can be performed vaginally or abdominally via a large incision, laparoscopically or robotically, depending on the size of your uterus, location of the fibroids and your medical history.

Because a hysterectomy is a major surgery, it is only recommended to treat fibroid cases for women who are not interested in preserving their fertility. It is the most effective method of fibroid treatment because it eliminates the possibility of recurrence.

Fibroids and Pregnancy

Uterine fibroids can affect fertility in a variety of ways. If fibroids grow and block the uterus or fallopian tubes, they may make it harder to become pregnant. They may also have other negative effects on pregnancy including:

• Increased risk of miscarriage and preterm labor
• Abnormal attachment of the placenta
• Increased likelihood of delivery by cesarean section
• Postpartum hemorrhage

If you have fibroids and are experiencing infertility, consult a reproductive endocrinologist who specializes in treatment of women with fibroids. A fertility specialist can develop a treatment plan that maximizes your chances of a successful pregnancy. If surgery to treat fibroids is needed before pursuing fertility treatment, myomectomy is likely your best option.

Center for Menstrual Disorders in Rochester, NY

In this section, we will address the important issue of fibroids and your health.

WHAT CAUSES UTERINE FIBROIDS? WHAT INFLUENCES THEIR GROWTH?

Although no knows what causes fibroids there is increasing evidence that these tumors represent some genetically altered tissue. The abnormalities of many fibroids can be found in certain chromosomes–6, 7, 12 and 14. The exact mechanism by which these altered chromosomes produce a “fibroid” is unknown, however. We do know that fibroids are sensitive to a variety of hormones including estrogen, growth hormone and progesterone. Myomas generally begin producing symptoms during the reproductive years (ages 13 – 45). They can undergo dramatic growth spurts especially during pregnancy. Often, fibroids will grow to a certain size and remain stable and unchanged. Typically, myomas shrink—but do not disappear–with menopause.

CAN FIBROIDS BECOME CANCEROUS?

There has been a fair amount of media attention during the past year (2014-5) on fibroids and a type of cancer called leiomyosarcoma or uterine sarcoma. These are rare cancers whose incidence is estimated to be approximately one per thousand. The likelihood of leiomyosarcoma increases with age and is greatest in postmenopausal women of African American descent.

DO FIBROIDS CAUSE PAIN?

Only rarely do fibroids cause pain. When fibroids do cause pain it is usually in the form of very painful menstruation. Depending on the location of a fibroid it can cause difficult on painful intercourse. One of the common misconceptions we encounter in women who seek a second opinion is the belief that their fibroids are causing pelvic and abdominal pain. It is uncommon for fibroids cause pain other than during menstruation. The fact remains that pelvic pain is common in women and so are fibroids. However, there is not a strong “cause and effect” relationship between the two outside of menstruation. But, women with fibroids may also have other issues that can cause pelvic pain—pelvic endometriosis or pelvic adhesive disease.

DO FIBROIDS CAUSE HEAVY MENSTRUAL BLEEDING?

Yes and no—it depends where they’re located. Not all fibroids have the capacity to cause heavy menstrual bleeding. In general, fibroids that are not close to the central portion of the uterine cavity do not cause heavy periods while those that are near the center (see below under “submucous”) cause the heaviest menstrual periods and can even cause outright hemorrhage.

HOW DO SUBMUCOUS FIBROIDS AFFECT PERIODS?

Although there is no “typical bleeding pattern” with fibroids listed below are some of the changes that women with fibroids often report.

Regularity of cycles. Typically women with bleeding from fibroids experience heavy periods but their cycles (defined as the number of days from the first day of one period to the first day of the next) remain fixed—usually between every 25 and 35 days.

Frequent pad or tampon changes. Women who develop fibroids often report that their use of tampons and pads (or both) increases. It is not unusual for women with fibroids to report pad or tampon changes as often as every 45 – 60 minutes. Occasionally women report that during the worst days of flow they can barely leave the bathroom.

Passage of clots. Women who develop fibroids often begin to experience clotting for the first times in their lives or – if they’re already accustomed to clots—they report the clots to be larger. It is not unusual for women with fibroids to pass clots the size of a quarter, half-dollar or larger.

Cramps. The occurrence of cramps can be very variable in women with fibroids. Most women with heavy vaginal bleeding attributable to fibroids experience an increased intensity of menstrual cramps. Some women, however, note that while the bleeding can be frighteningly heavy they experience few if any cramps. These differences depend on a variety of factors include the blood supply to the fibroid.

Periods that interfere with your life. In extreme cases women with fibroids anticipate such heavy periods that they must plan for 3-7 days (or longer) during each cycle when they can rarely be far from a bathroom and must equip themselves with a large stockpile of pads and tampons.

Continuous or “non-stop bleeding”. Occasionally some women will suffer quite a long time with fibroids until they experience nearly continuous bleeding. Women sometimes report bleeding for 30-60 days in a row before seeking help.

What Does Fibroid Pain Feel LIke? Everything to Know

If you’re experiencing heavy or uncomfortable periods, uterine fibroids could be the cause. Although this sounds alarming—the thought of an internal tumor is less than pleasant—with the proper medical care, uterine fibroids are totally manageable. Benign growths that pop up within the uterus, uterine fibroids can have a variety of symptoms ranging from minor to severe. Although some fibroids are undetectable and you won’t even know they’re there, others can contribute to cumbrous or painful menstrual periods. There are some studies that suggest uterine fibroids might also negatively impact fertility. Ahead, doctors discuss how to detect and treat uterine fibroids, as well as measures you can take to prevent them.

What Are Uterine Fibroids?

Uterine fibroids are benign tumors that form from the smooth muscle cells of the uterine wall. They affect reproductive-age women and may or may not cause symptoms. Typical symptoms include heavy bleeding, uterine pressure, and painful periods.

Ann Peters, MD gynecologist and surgeon in The Gynecology Center at Mercy Medical Center in Baltimore, Maryland says, “Uterine fibroids are like real estate. Their severity depends on location, location, location.”

Fibroids can complicate pregnancy depending on where where the pregnancy implants and size of the fibroid. “It’s not that much of a concern if it’s hanging off the uterus,” says Peters. “If a fibroid is sitting in the cervix, however, the cervix might not dilate correctly which could encumber a vaginal delivery. If it’s on the muscle wall of the uterus, it might not allow the uterus to contract properly and I’ll recommend removing it. The worse case scenario,” explains Peters, “is when a fibroid develops inside the cavity of uterus, where a pregnancy implants and the placenta forms. If the placenta shares the fetus with the fibroid it can cause preterm labor.”

Norbert Gleicher, MD, Medical Director and Chief Scientist at Center for Human Reproduction agrees with Peters’ assessment. “Most specialists will say that effects depend on the location of the fibroids within the uterus,” he says. “Everybody agrees that fibroids that protrude into the endometrial cavity harm pregnancy chances and increase miscarriage risk. The larger the worse; the more the worse. Some studies also suggest that fibroids, especially those found inside the uterus can negatively impact fertility.”

Gleicher adds that for the most part, “while many women do not experience any negative health outcomes as a result of their fibroids, some may develop iron deficiency anemia secondary to heavy bleeding.”

Adding an easily-absorbed iron supplement to your diet, like Floradix, can give you extra support if you experience heavy periods.

Detecting Uterine Fibroids

Until fibroids become symptomatic, you might not even know they’re there, explains Gleicher. “Often a woman has no idea, until a fibroid (or many fibroids, in combination) grows to a size that becomes symptomatic.”

If your periods become cumbersome—last longer than seven days, or contain clots —you should alert your doctor who will perform a sonogram to check for fibroids. “When we do the [annual pelvic] exam,” says Peters, “we examine the uterus and can feel fibroids unless they’re hidden inside the uterus wall. In that case, we would need to use an ultrasound to detect their presence.” Again, this is not cause for alarm, as Peters notes fibroids have to grow to a certain size in order to cause any symptoms. In other words, they will let themselves be known.

What Does Uterine Fibroid Pain Feel Like?

Although menstrual cramps can vary from period to period, if cramps suddenly become more uncomfortable than usual, this might be due to fibroids. Uterine fibroid pain often presents as pressure. Sometimes, contingent on size and location, the fibroid can push up against the bladder, bowel, or intestines. Constipation and frequent urination can indicate the presence of a fibroid if you’re experiencing pressure in the abdominal area. Gleicher says the sensations caused by uterine fibroids “can take all kinds of forms, from pressure—especially on the bladder with urinary symptoms—to sharp pains, especially when a fibroid outgrows its blood supply, which usually happens only in pregnancy.”

How to Treat Uterine Fibroids 

There are several options for treating uterine fibroids from medical treatments (which can include hormone therapy and anti-inflammatory drugs) to surgical treatments (more specifically, a procedure known as a myomectomy). “This depends on the ultimate goal and who the patient is,” explains Gleicher. “If she does not want any more children, she has many choices, including even a hysterectomy (removal of uterus). If she still is planning on pregnancies, required treatments become more selective to the case and may include embolization via catheter, or surgery.” Another option, he adds, is in some cases to just leave the fibroids alone and let the body correct itself. Of course, the safest bet is always to see your doctor, who will decide on a course of treatment (which might include letting the body correct itself).

Yelena Deshko, a naturopathic doctor and founder of The Timeless Clinic in Ontario incorporates acupuncture into her treatment of uterine fibroids. “In my practice,” she explains, “I commonly use acupuncture as an adjunctive treatment for fibroids. Of course the size of the fibroids plays an important role. In my clinical experience, a holistic approach incorporating dietary and lifestyle changes, herbal medicine, as well as acupuncture produces the best outcomes.”

How to Prevent Uterine Fibroids

It’s unclear what causes fibroids to present, making their prevention a bit tricky. “Although it is not well understood why some women develop fibroids, high levels of estrogen do contribute to their growth,” says Deshko. To this end, your diet and lifestyle can possibly play a mitigating factor if you’re already predisposed to fibroids. “Avoiding exogenous estrogen exposure as well as optimizing estrogen detoxification can be beneficial in controlling fibroids,” Deshko explains.

“While avoiding estrogen exposure all together may not be feasible, there are a couple of measures you can take.” Plus, she adds that optimizing liver detoxification can help “efficiently break down and excrete excess estrogens. Eating a diet rich in cruciferous vegetables such as broccoli, cabbage, kale and Brussel sprouts can help the liver break down harmful estrogens further. In my practice I also commonly recommend supplements and herbs such as DIM, Curcumin, Milk Thistle, and Inositol depending on the patient case.”

Genetics, according to Peters play a huge role in whether or not you’ll develop uterine fibroids. “We can’t turn off the ovaries until menopause,” she says. Although she agrees with Deshko adding that diet, weight, and lifestyle may be something a woman can try. “Estrogen drives the growth of fibroids, so women who are heavier or eat a lot of soy and red meat might be more at risk.”

Gleicher adds that race may also determine your risk for uterine fibroids. “Black women are at significantly higher risk to develop fibroids than Caucasian and Asian women,” although he says the reasons for this are unknown.

With medical intervention at the slightest sign of discomfort—you know your body best, and can gauge what’s uncomfortable or abnormal for you—you can keep uterine fibroids in check and their symptoms at bay.

Fibroids – HealthyWomen

Overview

What Is It?
A fibroid is a mass of muscle tissue, typically noncancerous, that develops within the wall of the uterus.

Fibroids are noncancerous masses of muscular tissue and collagen that can develop within the wall of the uterus. They are the most common benign tumor in premenopausal women. By the time women are 50 years old, 80 percent will have fibroids, but only 20 percent of women with fibroids will have any symptoms.

You may hear your health care professional call fibroids by other terms including uterine leiomyomas, fibromyomas, fibromas, myofibromas and myomas. They can be small or quite large.

While fibroids can cause a variety of symptoms, they may not cause any symptoms at all—so you may not even know you have one. Heavy bleeding is the most common symptom associated with fibroids and the one that usually prompts a woman to make an appointment with her health care professional. You may learn you have one or more fibroids after having a pelvic exam.

Fibroids may cause a range of other symptoms, too, including pain, pressure in the pelvic region, abnormal bleeding, painful intercourse, frequent urination or infertility.

What actually causes fibroids to form isn’t clear, but genetics and hormones are thought to play a big role. Your body may be predisposed to developing fibroids. They seem to grow or shrink depending on estrogen levels in your body, but researchers don’t know why some women develop them while others don’t.

Fibroids usually grow slowly during your reproductive years, but about 40 percent of fibroids increase in size with pregnancy.

At menopause, fibroids shrink because estrogen and progesterone levels decline. Using menopausal hormone therapy containing estrogen after menopause usually does not cause fibroids to grow. Growth of a fibroid after menopause is a reason to see your gynecologist to make sure nothing else is causing the growth.

Progesterone and growth hormone are other hormones that may stimulate a fibroid’s growth once it has already formed.

A variety of treatments exist to remove fibroids and relieve symptoms. If you learn you have fibroids but aren’t experiencing symptoms, you usually won’t need treatment.

Who Is at Risk for Fibroids?

Your risk for developing fibroids increases with age. African-American women are more likely than Caucasian women to have them, and they are more likely to develop fibroids at a younger age. If women in your family have already been diagnosed with fibroids, you have an increased risk of developing them. You may also be at an increased risk if you are obese or have high blood pressure.

Types of Fibroids

Fibroids form in different parts of the uterus:

• Intramural fibroids are confined within the muscle wall of the uterus and are the most common fibroid type. They expand, which makes the uterus feel larger than normal. Symptoms of intramural fibroids may include heavy menstrual bleeding, pelvic pain, back pain, frequent urination and pressure in the pelvic region.
• Submucosal fibroids grow from the uterine wall into the uterine cavity. They can cause heavy menstrual bleeding with associated bad menstrual cramps and infertility.
• Subserosal fibroids grow from the uterine wall to the outside of the uterus. They can push on the bladder or bowel causing bloating, abdominal pressure, cramping and pain.
• Pedunculated fibroids grow on stalks out from the uterus or into the uterine cavity, like mushrooms. If these stalks twist, they can cause pain, nausea or fever, or extremely rarely can become infected.

Diagnosis

More than half of women who have fibroids never experience symptoms. When fibroids are symptom-free, they generally don’t require treatment. But even small fibroids can cause heavy or longer-than-normal menstrual bleeding and significant pain. Fibroids may also contribute to infertility.

The three most common symptoms caused by fibroids are:

• Abnormal uterine bleeding. The most common bleeding abnormality is heavy menstrual bleeding—menstrual bleeding that is excessively heavy or long. Normal menstrual periods last four to seven days. If you have abnormal bleeding from fibroids, your periods are likely to last longer or may be heavier. Instead of changing a pad or tampon every four to six hours, you may have to change one every hour and find that your periods greatly interfere with your daily activities. You may also experience breakthrough bleeding, or bleeding that occurs between periods.

• Pelvic pressure. You may experience pressure in the pelvic region. Many women with fibroids have an enlarged uterus. Pelvic pressure may be caused by either the increased size of your uterus or from the location of one fibroid in particular. Health care professionals usually describe the size of a uterus with fibroids in the same terms used for someone who is pregnant, such as a “12-week-size fibroid uterus.”

  You may also experience pressure on areas near your pelvis, including your bowel or bladder. Pressure against these structures can lead to difficulty or pain with bowel movements and constipation or increased urinary frequency and incontinence. Conversely, you may not be able to empty your bladder because the fibroid is in the way or you may get recurrent urinary tract infections.

• Reproductive problems. Fibroids also are associated with reproductive problems, depending on the number of fibroids present in the uterus and on their size and specific location. While having fibroids can cause complications with pregnancy, most do not have any impact. Fibroids in a uterus do not create a high-risk pregnancy. The risks from fibroids may include a higher risk of miscarriage, infertility, premature labor and labor complications.

Symptoms caused by fibroids can be similar to a number of other symptoms caused by a variety of other conditions, including reproductive cancers, sexually transmitted infections and bowel and bladder disorders. So, if you are having any unusual symptoms, be sure to make an appointment to discuss them with your health care professional.

The first step in diagnosing fibroids is usually a pelvic exam and a comprehensive medical history performed by your health care professional. He or she may be able to feel the fibroids in your uterus during the exam, because fibroids can make the uterus feel enlarged or irregular. If the uterus is enlarged enough, it may also be felt abdominally above the pubic bone.

To confirm the diagnosis, even if nothing is felt, your health care professional may recommend one or more diagnostic tests.

Ultrasound is probably the most common option used to confirm the diagnosis. It is important to note that imaging may find very small fibroids that don’t pose any medical problems, wouldn’t be felt on physical examination and may not be causing symptoms.

If you have heavy or prolonged bleeding or have had multiple miscarriages, your health care professional may recommend a more involved examination of your uterine cavity to see if you have a submucous fibroid, which might go undetected on a regular ultrasound. The assessment can be performed in one of four ways:

• Magnetic resonance imaging (MRI). MRI uses a magnet (not x-ray) to make an image of the uterus. It is the most accurate way to determine the positions, sizes and number of fibroids you have.

• Hysteroscopy. The uterus is expanded with a liquid or gas, and a hysteroscope (a small telescope) is inserted directly into the uterus through the vagina and cervix enabling your health care professional to see your entire uterus. Fibroids within the uterine cavity can also be removed during this surgery.

• Saline-infused sonography. A saline solution is injected into your uterus, and ultrasound is used to visualize the uterine cavity. Also called hysterosonography, this test is most useful in women who have prolonged or heavy menstrual bleeding but normal ultrasound results.

• Hysterosalpingography (HSG). A dye that shows up on an X-ray is injected into your uterus, enabling your health care professional to evaluate the structure of your uterine cavity and look for any abnormalities in the uterus or fallopian tubes. This test may be recommended if you are trying to get pregnant to check if your tubes are open, but it is not very accurate when looking for fibroids..

Imaging tests, such as computed tomography (CT), may also be ordered but is not very accurate for the diagnosis of fibroids.

If you are experiencing abnormal vaginal bleeding as a result of fibroids, your health care professional may want to conduct other blood tests, including a complete blood count, to rule out other conditions.

Treatment

If you aren’t experiencing symptoms caused by your fibroids, you usually do not need any treatment. And, if your symptoms aren’t severe, you may decide you can put up with them. This may be especially true if you’re close to menopause—a time when fibroids shrink and symptoms resolve. It’s important to discuss all your options with your health care professional and consider his or her recommendations when weighing your treatment options.

You may want to try the “watch and wait approach,” where your health care professional periodically evaluates the size of your fibroids during routine pelvic exams and discusses how much discomfort you’re feeling or how the symptoms may be disrupting your lifestyle.

Fibroids that don’t cause symptoms rarely need therapy unless they get big enough to affect other structures in the pelvic area, such as the kidneys or the ureter (the tube that drains the kidney to the bladder).

The need for treatment and the type of treatment you choose depends on the size and position of the fibroids, as well as any symptoms they’re causing, your age and whether or not you want to have children in the future. Even with a variety of treatment options available, new fibroids may grow back to some degree in the years following most treatments. The need for repeat treatments ranges from 10 percent to 25 percent, depending on the number and sizes of the fibroids initially treated. No treatment—except hysterectomy—can guarantee that new fibroids won’t grow. The more fibroids you have, the more likely you are to have a recurrence after treatment.

If bleeding is your major symptom, some women opt for managing this symptom with medication before surgery or as a way to delay surgery if they’re close to menopause (because fibroids generally shrink and cause few or no problems after menopause).

Medical Treatment Options for Fibroids

• Oral contraceptives (OCs). While OCs do not treat fibroids, they may be recommended to manage heavy bleeding caused by fibroids or for women who experience irregular ovulation in addition to fibroids. OCs are the first treatment option for many women, often combined with a nonsteroidal anti-inflammatory such as ibuprofen. OCs do not make fibroids grow.
• Intrauterine device (IUD). The levonorgestrel intrauterine device (Mirena), which is usually prescribed for birth control, can help ease the heavy bleeding that accompanies some fibroids. The device won’t shrink the fibroids, however, and depending on whether or not the fibroids have distorted the inside of the uterus, it may or may not provide effective birth control. Although the levonorgestrel IUD is FDA-approved for heavy menstrual bleeding, it isn’t approved specifically for the treatment of fibroids, so if you are interested in this option, discuss it with your doctor.
• GnRH agonists. Gonadotropin-releasing hormone (GnRH) agonists, including leuprolide (Lupron), nafarelin nasal (Synarel) and goserelin (Zoladex), temporarily shrink fibroids by blocking estrogen and progesterone production; estrogen is thought to stimulate their growth. They are mainly used in women close to menopause or to shrink fibroids before removing them surgically or to correct anemia caused by heavy bleeding associated with fibroids. GnRH agonists are considered a short-term treatment because they block hormone production by the ovaries, thus triggering menopausal symptoms caused by estrogen depletion, such as hot flashes, vaginal dryness and bone loss. The usual course of treatment is three to six months, and it may be combined with estrogen and/or progesterone hormones to minimize menopausal symptoms. Once this medication is stopped, fibroids usually grow back to near pretreatment size or larger within several months.
• Antifibrinolytic medicines. Antifibrinolytic medicines are drugs that help slow menstrual bleeding by helping blood to clot. The drug tranexamic acid (Lysteda) is FDA-approved for heavy menstrual bleeding. Rare side effects include headaches, muscle cramps, or pain. Antifibrinolytic medicines do not affect your chances of becoming pregnant. They should not be taken with hormonal birth control without prior approval from a health care professional as the combination can cause blood clots. Antifibrinolytic therapies are relatively new and expensive—and often not covered by insurance. Check with your insurer if that is a concern.

Minimally Invasive Treatment Options

• Uterine artery embolization (UAE). UAE is a procedure that involves placing a small catheter (a thin tube) into an artery in the groin and guiding it via X-rays to the arteries in the uterus. Then, tiny particles similar in size to grains of sand are injected through the catheter and into the artery. As they move toward the uterus, they obstruct the blood supply to the fibroids. Without an adequate blood supply, the fibroids shrink. The uterus is spared, however, because an alternate blood supply develops to support it.

  UAE takes about one hour to perform and is typically performed by an interventional radiologist. It usually requires a one-night hospital stay. Most women are back to their normal activities in seven to 10 days.

  While this treatment option leaves your uterus intact, it’s not recommended for women who wish to become pregnant in the future.

  Potential complications include fever, passage of small pieces of fibroid tissue through the vagina after the procedure, allergic reaction and hemorrhage. Complications can also occur if blood supply to the ovaries or other organs becomes compromised.

• Endometrial ablation. This technique is used to treat small fibroids within the uterus or heavy periods caused by fibroids. Endometrial ablation uses electrical energy, heat or cold to destroy the lining of the uterus. It is performed on an outpatient basis and is only offered as a treatment option to women who have finished childbearing. It is not recommended for women who wish to preserve fertility. However, using a reliable form of contraception after having ablation is important.

Surgical Options for Fibroids

• Hysterectomy. A hysterectomy offers the only real cure because it completely removes the uterus.

  However, hysterectomy is major surgery, requiring between two and eight weeks of recovery, depending on the type of surgery performed. Hospital stays and recovery times can vary based on the type of procedure used and the extent of the surgery performed. Because your uterus and, sometimes, your ovaries, are removed, it is not an option if you want to become pregnant. If your ovaries do not need to be removed, you may want to keep your ovaries to maintain estrogen production.

  If you and your health care professional decide that a hysterectomy is the best choice for you, you may have several options about how the procedure is performed:

  • Abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. It is generally used for large pelvic tumors or suspected cancer because this procedure allows the surgeon to see and manipulate the pelvic organs more easily.
  • Vaginal hysterectomy, in which the uterus is removed through the vagina.
  • Laparoscopically hysterectomy, in which a surgeon uses a laparoscope (a small telescope) inserted through the abdomen to see inside your pelvis. Laparoscopic hysterectomy is less invasive than an abdominal hysterectomy, but more invasive than a vaginal hysterectomy.
  • Robotic-assisted laparoscopic hysterectomy, in which a robotic system assists in removal of the uterus in a laparoscopic hysterectomy. It may be helpful with some patients because of the flexibility it allows, but it also adds to the time and cost of the procedure.

• Myomectomy. This procedure removes only the fibroids, leaving the uterus intact, which can preserve fertility. The procedure is performed through an incision in the abdomen (a laparotomy), which requires general anesthesia, or by laparoscopy, which uses a few small incisions to insert an operative camera and surgical instruments. Robotic myomectomy is a variation of laparoscopic myomectomy during which the surgical procedure is aided with a surgical robot. A full recovery from laparotomy can take up to six weeks and two weeks from laparoscopy. Your health care professional will recommend which procedure to use based on the size of the fibroids, as well as whether they are superficial or deep (which is too difficult for laparoscopy).

  A hysteroscopic myomectomy is performed through the vagina and requires no incision. It is appropriate only for women whose fibroids are in the endometrial cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed through the vagina into the uterine cavity. A wire loop carrying electrical current is then used to shave off the fibroid.

  Blood loss may be slightly greater with a myomectomy than with hysterectomy, but surgeons use tourniquets and medications to control blood loss, so that transfusion rates are no greater than with hysterectomy.

• Magnetic resonance guided focused ultrasound. A more recent fibroid treatment option, magnetic resonance guided focused ultrasound surgery (MRgFUS or FUS) is a noninvasive treatment that takes place inside an MRI machine. The machine guides the treatment, which consists of multiple waves of ultrasound energy that go through the abdominal wall and destroy the fibroid. The procedure requires sedation but is usually performed on an outpatient basis. In the weeks and months that follow, fibroids shrink and heavy menstrual flow decreases. Pregnancy isn’t recommended after FUS, but it is possible to become pregnant following the procedure.
• Radiofrequency ablation. Acessa is a new FDA-approved laparoscopic surgical procedure that uses radiofrequency energy to destroy fibroids. The energy heats the fibroid tissue and kills the cells, which are then reabsorbed by the lymphatic system, decreasing fibroid size and symptoms. The procedure is minimally invasive, performed under ultrasound guidance during an outpatient pelvic laparoscopy. The early results regarding the safety and effectiveness of Acessa are good. On average, women returned to normal activities in nine days. The long-term risk of fibroid recurrence has not yet been determined, though a 12-month follow-up in one study showed good results.

Prevention

Fibroids can’t be prevented. If you are experiencing symptoms, such as heavy bleeding and pelvic pressure, contact your health care professional for an evaluation. If you have a family history of fibroids or have been treated for them in the past, you may want to be examined more frequently or investigate the various management strategies available to treat fibroids.

Facts to Know

1. Fibroids are not cancerous and they do not turn into cancer. They are balls of muscular tissue that grow inside the uterus, on the surface of the uterus or in the muscular wall of the uterus.
2. Up to 80 percent of women have fibroids, but not all of these women have symptoms. They are most commonly found in women in their 40s and early 50s.
3. African-American women are more likely to have fibroids than Caucasian women.
4. If there are women in your family who already have been diagnosed with fibroids, you have an increased risk for developing them.
5. Fibroids usually grow slowly during the reproductive years, but may increase in size with pregnancy. At menopause, fibroids usually shrink, because estrogen and progesterone levels decline. Estrogen replacement therapy may rarely interfere with this shrinkage after menopause.
6. More than half of the women who have fibroids never experience symptoms and require no treatment. In general, the severity of symptoms varies based on the number, size and location of the fibroids.
7. The two most common symptoms of fibroids are heavy menstrual bleeding and pelvic pressure. Normal menstrual periods last four to seven days, but if you have fibroids, your periods are likely to last longer. The bleeding might be so heavy that you may need to change your sanitary pads or tampons as often as every hour.
8. Fibroids may be associated with a handful of reproductive problems, depending on the number of fibroids in the uterus and their size and specific location. While fibroids can cause complications with pregnancy, most do not have any impact. Fibroids in a uterus do not create a high-risk pregnancy. The risk from fibroids may include a higher risk of miscarriage, infertility, premature labor and labor complications.
9. Oral contraceptives (estrogen and progestin and progestin-only) are sometimes recommended to manage heavy bleeding caused by fibroids, but they aren’t used to treat fibroids.
10. There are several treatment options available for fibroids, including medication, minimally invasive options and surgical options.

Questions to Ask

Review the following Questions to Ask about fibroids so you’re prepared to discuss this important health issue with your health care professional:

1. How do I know if I have abnormal or excessive menstrual bleeding?
2. What tests are needed to determine if I have fibroids?
3. What are my treatment options?
4. I want to get the best treatment possible to get rid of my fibroids, but I want to have children as well. What are the best treatment options for me?
5. When should hysterectomy be considered?
6. What’s uterine artery embolization and how is it performed?
7. What type of doctors perform the treatment options for fibroids?
8. How can I get a second opinion?
9. Does my insurance cover all the options we’re discussing?
10. Will my fibroids recur after any of these treatments?

Key Q&A

1. How do I know I have fibroids?
   More than half of all women who have fibroids have no symptoms. If you aren’t experiencing any problems, there’s usually no reason to treat the fibroids. The two most common symptoms of fibroids are heavy menstrual bleeding and pelvic pressure. Normal menstrual periods usually last four to seven days, but if you have fibroids, your periods are likely to last longer.

   If you have fibroids, the bleeding might be so heavy that you may need to change your sanitary pad or tampons as often as every hour. Bleeding between periods isn’t usually associated with fibroids, but it may occur in rare situations.

   You may also experience pressure in the pelvic region from an increase in the size of your uterus or from the location of one fibroid in particular. If you notice these symptoms, you should definitely seek a diagnosis from your health care professional.

2. Are fibroids hard to diagnose?
   Not usually. A health care professional should be able to feel some kind of irregularity in your pelvic region during a regular office pelvic exam. If fibroids are suspected, more detailed tests may be conducted to confirm the initial diagnosis. These may include ultrasound, magnetic resonance imagery (MRI), hysteroscopy, saline-infused sonography or hysterosalpingogram (HSG), a test that involves injecting a special dye into the uterus and then taking an X-ray of the area. Ultrasound is the most common option used to confirm the diagnosis, and MRI is the most accurate.
3. Does the location of my fibroids really make a difference in how they’re treated?
   The symptoms you experience may vary depending on where the fibroids are located. However, the ultimate course of treatment for your fibroids will likely depend more on other factors, such as whether you plan to have children or how close to menopause you are. If preserving your fertility is a priority, several options won’t be recommended.
4. Is a hysterectomy really the only way I can get rid of my fibroids forever, or at least before I reach menopause?
   Yes. While other procedures are helpful because the existing fibroids are removed or shrunk, there is no guarantee that new fibroids won’t develop. There are newer surgical procedures, such as myomectomy, robotic myomectomy, magnetic resonance guided focused ultrasound surgery, and radiofrequency ablation (Acessa procedure), that are showing success in treating fibroids while sometimes preserving fertility. Your health care professional will recommend which procedure is best for you.
5. Is there anything I can do to protect myself from developing fibroids?
   Unfortunately, there isn’t. Fibroids appear to affect women mostly in their 30s and 40s. Genetics and hormones appear to play a role in who develops fibroids.
6. I’ve heard that estrogen and other hormones can make fibroids grow. Should I avoid taking birth control pills that contain estrogen?No, there is no evidence that oral contraceptives have any effect on fibroid size. In fact, health care professionals prescribe oral contraceptive pills for some women with fibroids to help control the prolonged or excessively heavy blood flow during menstruation.
7. Do I need to see a specialist other than my gynecologist to diagnose and treat fibroids?
   Your gynecologist should have adequate experience in diagnosing fibroids because they are so common. However, some gynecologists may have more experience or better success at treating fibroids. If you’re considering any of the more innovative treatments, whether surgical or medical, make sure you see a practitioner with a strong track record in treating fibroids, and ask about their success rates.
8. Are hormone therapy treatments for fibroids dangerous?
   GnRH agonists are one treatment option for fibroids. This treatment shrinks fibroids by blocking hormone production by the ovaries. Because estrogen production is suppressed temporarily, you will experience menopausal symptoms such as hot flashes and vaginal dryness. Treatment is usually limited to three to six months.

   To offset hot flashes and other uncomfortable menopausal symptoms caused by GnRH agonists, your doctor may add estrogen and/or progesterone therapy.

   Ask your health care professional to review the risks associated with menopausal hormone therapy and how they may or may not be relevant to your treatment needs for fibroids.

Lifestyle Tips

1. Regularly track your menstrual cycle
   If you have fibroids, your bleeding may last longer than normal and be heavier than normal. If you already know you have fibroids, you should have regular pelvic examinations and ultrasounds. This monitoring enables you to keep tabs on the size of the fibroid and determine if any additional treatments are necessary.
2. Manage pain with over-the-counter drugs
   Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen can help ease menstrual pain. Along with helping with the pain, these drugs can also reduce inflammation. However, long-term use of such drugs can increase the risk of gastrointestinal bleeding and ulcers.
3. Think about adding iron to your diet
   You can develop anemia from iron deficiency if fibroids cause excessively heavy bleeding. Sometimes the smaller fibroids, usually the submucosal ones, are more likely to cause heavy bleeding than the larger ones. Some of the best foods for increasing or maintaining iron levels include clams, oysters, beef, pork, poultry and fish.

Organizations and Support

For information and support on coping with Fibroids, please see the recommended organizations, books listed below.

American Association of Gynecologic Laparoscopists (AAGL)
Website: http://www.aagl.org
Address: 6757 Katella Avenue
Cypress, CA 90630
Hotline: 1-800-554-AAGL (1-800-554-2245)
Phone: 714-503-6200

American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: [email protected]

American Society for Reproductive Medicine (ASRM)
Website: http://www.asrm.org
Address: 1209 Montgomery Highway
Birmingham, AL 35216
Phone: 205-978-5000
Email: [email protected]

CARE About Fibroids
Website: http://careaboutfibroids.org
Phone: 202-531-6949
Email: [email protected]

Center for Uterine Fibroids at Harvard Medical School
Website: http://www.fibroids.net
Spanish: http://www.fibroids.net/aboutfibroids-spanish.html
Address: Brigham and Women’s Hospital
77 Avenue Louis Pasteur, 160, New Research Building
Boston, MA 02115
Hotline: 1-800-722-5520 (ask operator for 525-4434)

Medline Plus Spanish Resource: Uterine Fibroids
Website: http://www.nlm.nih.gov/medlineplus/spanish/uterinefibroids.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: [email protected]

National Family Planning and Reproductive Health Association (NFPRHA)
Website: http://www.nfprha.org
Address: 1627 K Street, NW, 12th Floor
Washington, DC 20006
Phone: 202-293-3114
Email: [email protected]

National Uterine Fibroids Foundation
Website: http://www.nuff.org
Address: P.O. Box 9688
Colorado Springs, CO 80932
Hotline: 1-800-874-7247
Phone: 719-633-3454
Email: [email protected]

Responsum for Fibroids
Website: https://responsumhealth.com/fibroids/
Phone: 949-264-2277
Email: [email protected]

Society of Interventional Radiology
Website: http://www.sirweb.org
Address: 3975 Fair Ridge Drive, Suite 400 North
Fairfax, VA 22033
Hotline: 1-800-488-7284
Phone: 703-691-1805
Email: [email protected]

The White Dress Project
Website: https://thewhitedressproject.org/
Address: 1075 Peachtree Street NE, Suite 3650
Atlanta, GA 30309
Phone: 678-796-TWDP
Email: [email protected]

Books

A Gynecologist’s Second Opinion
by William H. Parker, Rachel L. Parker

Fibroid Tumors & Endometriosis
by Susan M. Lark

Uterine Fibroids: What Every Woman Needs to Know
by Nelson, M.D. Stringer

What Your Doctor May Not Tell You About Fibroids: New Techniques and Therapies–Including Breakthrough Alternatives to Hysterectomy
by Scott C. Goodwin, David Drum, Michael Broder

Yale Guide to Women’s Reproductive Health: From Menarche to Menopause
by Mary Jane Minkin, Carol V. Wright

Uterine Fibroids

This summary discusses:

Fibroids

Uterine Fibroids are common non-cancerous (benign) tumors of the uterus and are the most frequent reason for recommending a hysterectomy. They grow from the muscular wall of the uterus and are made up of muscle and fibrous tissue. Many women over 35 have fibroids, but usually have no symptoms.

In some women, however, fibroids (myomas) may cause heavy bleeding, pelvic discomfort and pain and occasionally exert pressure on other organs. These symptoms may require treatment. Treatment may take the form of medication to control pain and bleeding, hormone therapy to shrink the tumor, surgery to remove the tumor or occasionally a hysterectomy. There are promising new experimental drugs that may temporarily shrink the tumors. These drugs may have serious side effects and are generally very costly. There is a type of abdominal surgery (myomectomy) that removes the myoma without removing the uterus (see Alternatives for additional information). These treatments may be sufficient or they may offer temporary relief and enable a woman to postpone having a hysterectomy, especially if she still wishes to bear children. In most severe cases a hysterectomy may be recommended.

Some women choose to do nothing since fibroids will often shrink in size as a woman goes through menopause.

What is a fibroid?

A fibroid is a non-cancerous growth (tumor) made up of mostly fibrous tissue, like muscle. Fibroids grow in or around the uterus (womb). They are the most common type of growth in a woman’s pelvic area (the pelvis is the bony structure at the bottom of the spine).

Uterine Fibroids

According to the U.S. National Institutes of Health (NIH), 20-25% of women of reproductive age have fibroids. By the age of 50, up to 80% of black women and up to 70% of white women have fibroids. Uterine fibroids are most common in women who are in their 40s and early 50s, although some women may develop fibroids at a younger age. At least 25% of women have uterine fibroids which can cause problems. Many women with fibroids never have a problem and never know they have a fibroid.

Uterus – Womb

The uterus (womb) is a pear-shaped organ located in the lower part of a woman’s body. It is made up of the muscle wall, endometrium (lining) and the cervix (opening). In women who are not pregnant, the lining is shed monthly as part of the menstrual cycle (period). In women who are pregnant, the uterus is where a fetus will grow and develop.

Figure 1. Female Reproductive System

Are there different types of fibroids?

A fibroid can be very small, the size of a seed, or large, the size of a grapefruit. The medical term for a fibroid is a leiomyoma or myoma. A woman may have one fibroid or many. A fibroid may be inside the uterus (submucosal), outside the uterus (subserosal), or in the wall of the uterus (intramural). Most fibroids grow in the wall of the uterus. Fibroids can also grow out from the uterus on stalks called peduncles.

Figure 2. Illustration of Uterine Fibroids from the US Health and Human Women’s Health Web site

What causes fibroids?

Fibroids begin when cells overgrow in the wall of the uterus. However, the cause of uterine fibroids is not known. Researchers have many ideas of what may cause fibroids, but none of these are seen as definite causes of fibroid tumors. Some of these ideas include:

• Fibroids may be genetic (runs in families).
• Female hormones, estrogen and progesterone, cause fibroids to grow.

Fibroids grow rapidly during pregnancy, when hormone levels are high and shrink when anti-hormone medicine is used. Fibroids also stop growing or shrink once a woman reaches menopause.

Can fibroids turn into cancer?

Fibroids are usually benign (not cancerous). Having fibroids does not increase a woman’s risk of developing cancer. In less than 1 in 1,000 cases a cancerous fibroid will occur. A cancerous fibroid is called leiomyosarcoma.

Who usually develops fibroids?

Age, race, lifestyle and genetics may play a part in the development of fibroids. Here are the few known risk factors:

• Having a family member with fibroids increases the risk. If a woman’s mother had fibroids, her risk of having fibroids is about 3 times higher than average.
• African-Americans are 2-3 times more likely to present with symptomatic (problems such as pain or bleeding) uterine fibroids and will often develop fibroids at a younger age than the rest of the population of women with uterine fibroids.
• Asian women have a lower incidence of symptomatic uterine fibroids.
• Obesity is associated with uterine fibroids. The risk of obese women developing fibroids is 2-3 times greater than women of average weight.
• Eating beef, red meat (other than beef), and ham has been linked with having uterine fibroids, while eating green vegetables seems to protect women from developing fibroids.

What are the symptoms of fibroids?

For most women fibroids do not cause symptoms. At least 25% of women who have uterine fibroids do have symptoms which may include:

• Heavy bleeding or painful periods
• Bleeding between periods
• Cramping
• Bloating of the lower belly (abdomen or pelvic area)
• Feeling of fullness in the pelvic area
• Pain during sex
• Low back pain
• Frequent urination

Fibroids can also cause infertility (being unable to get pregnant), miscarriages, or premature labor (labor before 37 weeks of pregnancy).

How do you know you have a fibroid?

You may not know if you have fibroids if they are not causing any problems. A health care provider may find a fibroid on a routine exam, or you may see your health care provider if you are having symptoms. The health care provider may:

• Do a physical exam of your uterus (pelvic exam) to check the size of your uterus (womb), and may feel the fibroid as a lump on your uterus during the pelvic exam.
• Send you for a procedure to get a “picture” of your uterus.
• Do blood tests to check your blood count for anemia (low iron in your blood due to heavy periods or bleeding between periods) or for other problems.

The pelvic exam and the tests help your health care provider find out if you have fibroids, where they are and how large they are.

What kind of procedures may be done to find out if you have fibroids?

Your health care provider can do an imaging examination to produce a picture to confirm that you have fibroids. These might include:

• Ultrasound (US) – uses sound waves to produce a picture to see if you have fibroids. An ultrasound probe can be placed on the abdomen or it can be placed inside the vagina during the ultrasound.
• Magnetic Resonance Imaging (MRI) – magnets and radio waves are used to produce the picture.
• X-rays – uses a form of radiation to produce the picture.
• Cat Scan (CT) – takes many X-ray pictures of the body from different angles for a more complete picture.
• Hysterosalpingogram (HSG)
• Sonohysterogram – an ultrasound test that uses saline and ultrasound to look at the uterus and pelvic area.

You might also need additional procedures to know for sure if you have fibroids. There are two types of procedures to do this:

• Diagnostic Laparoscopy or Gynecologic Laparoscopy – surgery in which the doctor makes a cut into the abdomen and inserts a thin lighted tube with a small camera attached. This allows the doctor to see inside the abdomen to look at the uterus, ovaries and pelvic area.
• Hysteroscopy – The doctor passes a long, thin tube with a light through the vagina and cervix into the uterus. The hysteroscope has a light and camera attached to it so your doctor can see the inside of the uterus on a video screen.

Will I have trouble getting pregnant if I have fibroids?

In some cases, fibroids are severe enough to prevent a woman from becoming pregnant (infertility). If a woman is pregnant, fibroids can cause problems (complications) during pregnancy, labor and delivery. Since fibroids are controlled by hormone levels they grow rapidly during pregnancy. Hormone levels are high during pregnancy.

What kinds of problems will fibroids cause in pregnancy?

The most common complications caused by fibroids during pregnancy are:

• Labor does not progress – this can happen if the uterus (womb) does not contract as it should and the baby does not move out through the birth canal to be born.
• Baby is breech – the baby is coming out bottom first. The usual position of a baby is for the head to come out first, but breech babies are in the bottom or feet-first position.
• Placenta abruption – the placenta pulls away from the uterus (womb) before delivery.
• Preterm delivery – the baby is born before 37 weeks of pregnancy.
• Cesarean section (C-section) – a cut (incision) is made in the mother’s abdomen (belly) and uterus (womb) and the baby is lifted out.

What are the treatments for fibroids?

If a woman is having heavy bleeding which could cause a low blood count, or is experiencing severe cramping, painful periods, infertility or bladder or bowel problems, she will need treatment.

Before deciding on a treatment, it is important to talk with your health care provider to get more information. Ask your health care provider:

• How many fibroids do I have and will they grow bigger?
• Where are they located and will they cause problems?
• Do I need treatment if I am not having any problems?
• What are my choices for treatment?
• Can I try other options such as medications or hormone therapy before I try surgery?
• What are the treatment options other than hysterectomy?
• What are the risks and benefits of these treatment options?

If you need more information before deciding on a treatment, you can ask your health care provider to refer you to another doctor for a second opinion to be sure you are making the best decision.

There are many options for treatment of uterine fibroids including:

Medications

For occasional mild to moderate pain or discomfort, an over-the-counter medication such as ibuprofen or acetaminophen can be taken. Over the counter nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen, if used during early pregnancy, may cause miscarriage.

For symptoms of heavy bleeding, which can cause anemia, taking an iron supplement and an iron-rich diet can help to prevent anemia or treat anemia. More serious symptoms may require stronger drugs available by prescription from your health care provider.

Hormone Therapy

Birth control pills (oral contraceptives) can be used to treat the bleeding symptoms of fibroids. Low-dose birth control pills or progesterone-like injections (such as Depo-Provera) do not make fibroids grow and can help control heavy bleeding. An intrauterine device (IUD) which contains a small amount of progesterone-like medication (such as Mirena IUD) can also control fibroid symptoms and provide birth control.

Gonadotropin-releasing hormone agonists (GnRHa)

Some fibroids are treated with GnRHa, a hormone that reduces the amount of estrogen to shrink the fibroids and control symptoms. Sometimes GnRHa is used before surgery to make fibroids easier to remove. Most women can take GnRHa without any problems, but using GnRHa causes menopause-like side effects such as:

• Hot flashes
• Depression or mood swings
• Decreased sexual interest
• Insomnia (not being able to sleep)
• Headaches
• Bone thinning
• Joint pain

The side effects go away when the GnRHa is stopped, and once you stop taking the drugs the fibroids often grow back quickly. Most women don’t get a period when taking GnRHa. This can relieve the symptoms of heavy bleeding and improve the low blood count (anemia) which can happen with heavy bleeding. Since GnRHa can cause bone thinning, it is generally used for six months or less.

Surgery

There are three surgical treatments for fibroids:

• Myomectomy – cutting fibroids from the uterus,
• Endometrial Ablation – removing or destroying the lining of the uterus, or
• Hysterectomy – removing the entire uterus (womb).

The surgical method used depends on the size, location, and number of fibroids.

Myomectomy

Myomectomy is removing fibroids without taking out the uterus, which makes pregnancy possible for some women. A woman who has had a myomectomy can have problems with the placenta or can make a cesarean delivery more likely if she becomes pregnant. Fibroids may also develop again, even after a myomectomy.

Myomectomy can be done by:

• Laparoscopy – making one or more small cuts in the abdomen and inserting a lighted viewing instrument to remove the fibroids through the small cuts,
• Hysteroscopy – using a lighted viewing instrument going through the vagina and into the uterus to remove the fibroids, or
• Laparotomy – major surgery done by making a larger cut into the abdomen and the uterus.

The type of operation done for the myomectomy depends on the size and location of the fibroids.

Endometrial Ablation

Endometrial Ablation is when the lining of the uterus is removed or destroyed by using laser, wire loops, freezing or other methods to control very heavy bleeding. This procedure is usually considered minor surgery and can be done on an outpatient basis. A woman having this procedure will be unable to have children. Complications can occur, but are not common.

Hysterectomy

A hysterectomy an operation to remove the uterus (womb). The only absolute cure for uterine fibroids is a hysterectomy. This procedure results in permanent infertility; a woman will be unable to have children. A hysterectomy is major surgery. All of the possible risks of surgery listed above are the same for hysterectomy.

Embolization

Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE) – a nonsurgical procedure that blocks blood flow to fibroids in the uterus. Embolization is done with local anesthesia, and there are no incisions or cuts in the skin. A thin flexible tube is threaded into the blood vessels that supply blood to the fibroid; a solution is then injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. Fibroids treated with embolization shrink by half or more. Normal uterine tissue usually remains unharmed, because it is supplied by other arteries.

Pregnancy is possible after embolization, but the risks to pregnancy after embolization are not fully known. Embolization is a procedure for women who do not want to have children in the future.

Women who are considered the best candidates for embolization are women who:

• Have fibroids that are causing heavy bleeding
• Have fibroids that are causing pain or pressing on the bladder or rectum
• Don’t want to have a hysterectomy
• Don’t want to have children in the future

Complications of embolization are not common, but can occur. They are:

• Infection – the most serious, potentially life-threatening complication of embolization. See your doctor immediately if you have a high fever and feel ill or notice pus in your vaginal discharge. In rare cases, emergency hysterectomy is needed to treat an infected uterus.
• Loss of menstrual periods
• Premature menopause
• Scar tissue formation

It is important to note though that all women are different and treatment may vary. Only your health care provider can provide you with the best options to treat uterine fibroids.

Are new treatments for uterine fibroids being developed?

There are several new ways of destroying fibroid tissue or removing fibroids. These methods are not yet standard treatments so your health care provider may not offer them and your health insurance may not pay for them.

If your doctor offers one of these procedures, ask:

• How many of the procedures he or she has done,
• How successful they have been,
• What kinds of problems can result, and
• Whether your insurance covers the procedure.

Myolysis

Myolysis is the destruction of muscle tissue. Myolysis is generally recommended for smaller fibroids. It is not recommended for women who hope to have children. These treatments can cause serious pregnancy complications, such as uterine scarring and infection; these can be dangerous to both mother and fetus.

• Laser (myolysis) – usually done by laparoscopy. A laser is used to remove the fibroid or clot the blood supply to the fibroid, causing the fibroid to shrink and eventually die.
• Cold (cryomyolysis) – usually done by laparoscopy. Liquid nitrogen is used to freeze the fibroid.
• Electric current – Myoma coagulation (myolysis) – usually done by laparoscopy. An electrical needle is passed directly into the fibroid delivering high-temperature energy to destroy both the fibroid and the blood vessels feeding it.
• High-frequency focused ultrasound – Using a high-intensity ultrasound beam, the Magnetic Resonance Imaging (MRI) scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy it.

New Medications

New anti-hormonal drugs and other medications are being studied for treatment of fibroids, but none are yet available or Federal Drug Administration (FDA)-approved for us in the US.

It is important you talk with your health care provider to fully understand your options for uterine fibroids that are causing you problems. If your health care provider is recommending a hysterectomy, be sure to ask why other options are not right for you. Remember, you can ask for a second opinion to be sure the treatment option is right for you.

Additional Information About Uterine Fibroids:

Pain, Pain, Go Away! How to Handle…

By Lynn Pattimakiel, M.D.

Few women are untouched by uncomfortable periods. As with most painful events, the severity of pain is a subjective experience. There are numerous reasons why a woman may experience menstrual pain, such as:

A thorough history, physical examination and ultrasound might be required to determine the cause of the menstrual pain in some case. Many women may require simple solutions to pain relief, such as nothing more than over-the-counter medications.

Fibroids are found in 80 percent of women. They are benign growths formed of muscle and tissue from the uterine wall, and their cause is unknown. They can be as small as a pea or as large as a watermelon. Most fibroids occur in women of reproductive age, and according to some estimates, are diagnosed in black women far more often than in white women.

Luckily, most women have no symptoms. The symptoms of fibroids may differ according to their location within the uterus. The most common symptoms of fibroids are:

• Change in menstrual bleeding (intensity, quantity and duration)
• Cramps
• Infertility
• Cosmetic effects (such as a markedly enlarged abdomen)
• Urinary frequency
• Constipation
• Pelvic pain/pressure

As you can imagine, there are many conditions that can mimic fibroid-related symptoms. It is best to check with your doctor to determine if fibroids are the culprit for symptoms. We believe “if fibroids do not bother you, we do not bother them.”

An ovarian cyst is a collection of fluid within a thin membrane that is found within an ovary. Unlike fibroids, ovarian cysts are found within the ovaries of almost all pre-menopausal women. They can also be tiny, or as large as a baseball. In most cases, they appear during the childbearing years and are made monthly.

This is normal. Cysts are usually not cancerous and are small. Some ovarian cysts cause problems, such as bleeding and pain. When they enlarge more than five centimeters doctors may advise birth control pills and a repeat transvaginal ultrasound to determine if the cyst resolves. In the case of larger ovarian cysts, surgical removal may be necessary.

Endometriosis is a condition where the tissue of the uterine lining grows outside the uterus. That tissue still behaves as the tissue still within the uterus does, except that after the usual menstrual cycle of building up and eventually breaking down of uterine lining, the tissue normally expelled as a period has nowhere to go. This can cause pain, scarring and even infertility. Endometriosis occurs in about five to 10 percent of women.

Most women have menstrual pain or cramps with menstrual cycles. If the pain is not easily relieved with over-the-counter medications such as Aleve, Motrin, or Tylenol, or if you are unable to participate in work, travel, hobbies, or sports as a result of the discomfort, then you should see your physician. One of these simple-to-diagnose conditions may be the cause!

Uterine fibroids

Presentation “Uterine fibroids”

Uterine myoma (leiomyoma) is a benign, hormone-dependent tumor of the muscular membrane of the uterus (myometrium). Myoma of the uterus occurs in 15-17% of women over 30 years old.

The development and growth of uterine fibroids has not yet been fully studied. It has been reliably established that sex steroids play a specific role in the development of fibroids: estrogens stimulate tumor growth, progesterone suppresses it.In the cells of the myometrium, the content of estrogen-binding receptors increases, and the relationship between progesterone-dependent receptors and the corpus luteum hormone itself is damaged.

There is a theory according to which myoma of the uterus is not a tumor, but an overgrowth (hyperplasia) of the myometrium. The triggering mechanism of the process is oxygen starvation of the muscular elements of the uterus, as a result of which they acquire the ability to grow against the background of physiological secretion of sex hormones.The constant unregulated proliferation of muscle fibers contributes to the formation of fibroids.

Varieties of uterine fibroids

Myoma is distinguished by the location of the nodes: 95% – in the body of the uterus, 5% – in the cervix.

In relation to the muscle layer:

1. intermuscular (interstitial, intramural) – located in the thickness of the uterine wall;

2. submucosal (submucous) – the growth of the node occurs in the uterine cavity;

3. subperitoneal (subserous) – fibroids grow towards the abdominal cavity.

Myoma can be located retroperitoneally (isthmus and cervical nodes) and intraligamentary (between the wide ligaments of the uterus).

Clinical manifestations

Often, uterine fibroids are asymptomatic, i.e. there are no complaints and menstrual dysfunctions. The clinical picture depends on the patient’s age, duration of the disease, location and size of the tumor.
The main symptoms of uterine fibroids are pain, menstrual dysfunction, dysfunction of adjacent organs.
Pain syndrome. The pain is usually localized in the lower abdomen and lower back. Constant aching pains are observed with subserous nodes and are caused by stretching of the peritoneum or compression of the nerve plexuses of the pelvis, and are also associated with the rapid growth of the tumor. Acute pain occurs when the blood supply to the node is disturbed, the progression of which can lead to the development of a clinical picture of an acute abdomen. Cramping pains during menstruation accompany the submucosal localization of the node.
Bleeding is the most common symptom of uterine fibroids.Abundant and prolonged menstruation is characteristic of submucous fibroids. Acyclic uterine bleeding is more common in interstitial and subserous fibroids.
Dysfunction of adjacent organs is observed, as a rule, with a low location of nodes and / or with large sizes of uterine fibroids. The function of the urinary system and the large intestine may be impaired.

Diagnostics

Diagnosis of uterine fibroids is primarily based on complaints, medical history, and gynecological examination data.An important additional method for identifying and confirming the diagnosis is ultrasound scanning. If submucous growth of uterine fibroids is suspected, diagnostic hysteroscopy is an obligatory stage of the examination, which, with a high degree of accuracy, allows you to study the state of the uterine mucosa, its relief, the presence of a fibroid node in the cavity, its location, size, depth of location in relation to the myometrium. In addition, hysteroscopy makes it possible to clarify the indications for surgical intervention, its volume.

Less commonly, hysterosalpingography (differential diagnosis between submucous uterine myoma and adenomyosis), computed tomography and MRI, angiography (if uterine sarcoma is suspected) are used to diagnose uterine fibroids.

Diagnostic laparoscopy, as a rule, is used to clarify the diagnosis, differential diagnosis in some situations and determine further tactics of treatment of patients with uterine myoma, including surgical.

Treatment

Uterine fibroids is the most common benign tumor in women, but the treatment of this disease is still a complex and complex problem that requires further close study.Unfortunately, until now, the only time-tested method of treating uterine leiomyoma is surgical – hysterectomy or myomectomy with various approaches.

Hysterectomy for uterine leiomyoma is a relatively safe and effective operation, but the complication rate is 1-2% and the mortality rate is 0.1%, and, most importantly, the intervention irreversibly leads to infertility.

Myomectomy is an operation in which menstrual and childbearing functions are preserved, but a high percentage of tumor recurrence (15-25%) requires continuation of treatment and, as a rule, repeated surgery.Also, with myomectomy, depending on the number, localization and size of myomatous nodes, the duration of the operation increases, especially with laparoscopic access, and the risk of significant blood loss and the formation of postoperative adhesions increases, which, in turn, reduces fertility.

It should be noted that there is a group of patients who are contraindicated for surgical treatment and (or) endotracheal anesthesia due to concomitant pathology of various organs or systems of the body, and some patients categorically refuse surgery due to fear of surgery, loss of sexual attractiveness, etc.n. or due to unrealized reproductive function. For such patients, it is possible to use an alternative method of treatment, which is uterine artery embolization.

Historical background

Embolization of the uterine arteries (UAE) has been successfully used in obstetrics and gynecology for more than 20 years to stop postpartum and postoperative bleeding. Since 1990, Jacques Ravina in France has used uterine artery embolization as a preparatory step before hysterectomy to prevent intraoperative blood loss.At the same time, it was noted that the majority of patients with uterine fibroids after embolization had symptoms that worried them, because of which some refused to undergo surgery altogether. The observed clinical effect allowed the authors to use uterine artery embolization as an alternative to surgical treatment, first in patients with an extremely high operational risk, and then in the rest of the category of patients.

In our country, for the first time, embolization was carried out in the early 80s of the last century in the gynecological department of the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, together with specialists from the Institute of Surgery named afterA.V. Vishnevsky in a patient with massive postpartum hemorrhage. This case was published in the newspaper “Izvestia” in the article “Marina was saved by everyone.” Further embolization was performed in patients with pelvic angiodysplasia.

At the moment, interest in this type of operation is steadily growing. The active use of uterine artery embolization in the treatment of uterine fibroids is observed in the UK and the USA. To date, more than 30,000 embolizations have been performed worldwide.

Indications and contraindications

Indications for uterine artery embolization are similar to those for surgical treatment.Embolization in a patient with fibroids should be performed after prior discussion with the attending gynecologist and the patient herself.

Ideal candidates for uterine artery embolization are women with symptomatic fibroids, with realized generative function, in premenopausal women who refuse hysterectomy. Other indications for UAE may be the submucous or interstitial location of the myomatous node, the size of the myoma node is more than 2 cm, the ineffectiveness of conservative treatment, the woman’s unwillingness to lose the uterus due to her or religious beliefs, contraindications to general anesthesia and (or) surgical treatment.

The main contraindications to UAE are conditions that make it difficult or impossible to perform endovascular intervention: severe anaphylactic reactions to X-ray contrast agents, uncorrected coagulopathy, severe renal failure, malignant tumors of the uterus and ovaries. UAE is also contraindicated in pregnant women, patients with acute infectious diseases of the uterus and appendages, after previous radiation therapy of the pelvic organs, with autoimmune diseases of the connective tissue.

EMA technique

Carrying out interventional X-ray surgical vascular interventions, in particular embolization of uterine vessels, includes a number of general sequential steps:

patient preparation,

processing of the operating field,

local anesthesia,

puncture and catheterization of a vessel (artery),

arterioscopy (to confirm the correct intravascular position of the catheter in the lumen of the artery),

Conventional catheter serial angiography (pelvic),

selective, superselective catheterization and arteriography of the uterine arteries,

Directly catheter embolization of the uterine artery (metal coils, PVA particles, hydrogel, acrylic microspheres),

control arteriography,

removal of a catheter from an artery,

hemostasis.

The main goal of the procedure is to embolize the vessel feeding the myomatous node, where the average size of the artery is about 500 microns. In some cases, it is recommended to use smaller particles of 150-300 microns, however, most works describe the use of larger particles: 355-500 and 500-700 microns.

The procedure is considered complete after obtaining a satisfactory angiographic effect from embolization – the effect of “stop-contrast” in the proximal parts of the uterine artery and the absence of contrast in the distal segments of the artery.

The duration of the symptoms of postembolization syndrome is from 3 to 14 days with a progressive decrease in the severity of symptoms. A repeat visit to the gynecologist is scheduled 1-4 weeks after the procedure.

Side effects and complications

The most common occurrence after embolization of the uterine arteries is the occurrence of pain in the lower abdomen in the first hours after the intervention. This pain is associated with the cessation of blood flow in the fibroid and indicates the effectiveness of embolization.All patients during this period receive adequate pain relief. In most cases, within 10-15 hours after the intervention, the pain subsides. As a rule, the next day after embolization, patients are discharged from the hospital.

Full recovery takes 3-7 days. Another feature of the postoperative period is a slight increase in temperature within 5-10 days after embolization (manifestation of a systemic reaction of the body to embolization). This phenomenon is safe and does not require specific therapy.Complications after UAE are extremely rare, in no more than 1% of patients; this is significantly lower than the frequency of serious complications after myomectomy and hysterectomy. The most common complication is the formation of a hematoma (bruise) at the puncture site of the artery. As a rule, this does not require additional treatment and goes away on its own within 10-15 days. Complications such as infection (endometritis) and temporary amenorrhea occur in no more than 0.3% of cases, and are most often successfully eliminated by conservative therapy.

Materials used for EMA

According to the literature, as embolizing substances in the treatment of uterine fibroids, the following are most often used: polyvinyl alcohol (PVA), gelatin particles, acrylic microspheres, a mixture of a contrast fat-soluble substance and antibiotics.

The embolizing substance hydrogel (poly-2-hydroxyethyl methacrylate) is produced in Russia and has a permit for use. This drug is successfully used to stop pulmonary, uterine and urological bleeding, embolization of small aneurysms, shutdown of the spleen function or ischimization of kidney, liver, and bone tumors.

Uterine artery embolization for the treatment of uterine fibroids has been used worldwide for the past several years, although the procedure itself is not new. For more than 20 years, it has been used to treat massive postpartum hemorrhage.
After fibroid embolization, a stay in the clinic is usually required for 1-2 days to administer the necessary anesthetic drugs, since pain occurs quite often (in 70-95%). Sometimes there is an increase in body temperature, which requires the use of antibiotics and / or non-steroidal anti-inflammatory (NSAID) drugs.The recovery period usually takes 1-2 weeks, but it may take longer.

Frequently Asked Questions

How effective is uterine artery embolization? Studies in the United States of America and Europe have shown that 78-94% of women who underwent this procedure experienced significant or complete disappearance of pain and other symptoms associated with fibroids. The procedure is effective even for multiple fibroids.Women who have been seen for several years after the procedure do not have a recurrence of symptoms.

Is there any risk of fibroid removal? Embolization of fibroid nodes is considered a fairly safe procedure. But, of course, there is a certain risk, as with any other medical procedure. Most women experience moderate to severe pain and cramping for several hours after the procedure. Some may experience nausea and fever.All of these symptoms are controlled by appropriate medication. It is also reported that in 1% of cases there is a risk of damage to the uterus (necrosis), which could potentially require a hysterectomy. In some patients over the age of 45, there were cases of the onset of menopause. However, the relationship of embolization with the cessation of menstruation has not been proven, since the age of 45-55 years is the age of the natural shutdown of menstrual function.

Myomectomy and hysterectomy also carry serious risks, including infection and bleeding requiring blood transfusion.Patients after myomectomy may experience adhesions in the abdominal cavity, and as a result, infertility.

Each specific method of treatment that you choose can cause certain side effects and complications. When making a choice, everything should be discussed with your gynecologist.

Can pregnancy occur after UAE? There is currently no sufficient data on the negative effect of embolization on reproductive function. Since most of the women who went through this procedure did not plan to have children in the future.However, cases of pregnancy and childbirth have been described in patients with fibroids after the embolization procedure.

What is the cost of UAE? In most clinics, the UAE procedure is performed on a commercial basis. The specific cost of treatment depends on the amount of instruments and medicines used, as well as on the conditions of stay provided by the clinic. The cost of UAE, including instruments, consumables and medicines, does not exceed the cost of surgical treatment methods, also provided on a commercial basis.At the same time, UAE allows you to do not only without incision and anesthesia, but also significantly reduces the time spent in the hospital and the subsequent recovery period.

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Clinical Hospital | Uterine fibroids of various localization

Leiomyomas are the most common benign tumors in women. Leiomyoma grows in size during pregnancy and regresses after menopause.

Clinical manifestations of leiomyoma

Although most leiomyomas are diagnosed in women without symptoms as a result of routine examination of the pelvic organs, severe symptoms are sometimes observed, consisting of pelvic pain or discomfort, soreness during intercourse, heavy menstruation, often with clots, intermenstrual bleeding, dysfunction of the direct bowel or bladder (constipation, increased urination), miscarriage, infertility, or “habitual” abortion.

Typical symptoms of uterine fibroids are:

• profuse menstruation and intermenstrual bleeding
• Pelvic pain mainly manifests itself as a vague sensation of heaviness in the lower abdomen, caused by the large size of the fibroids and compression of nearby organs
• fibroids located in the uterine cavity can cause cramping pain associated with contractions of the muscle layer of the uterus, as if trying to push the fibroid
• acute pain may occur when the blood supply to fibroids is disturbed
• Often in patients with large leiomyomas, dense, irregularly shaped, mobile, nodular, painless tumors located in the midline can be detected by palpation of the abdomen

If at least one symptom appears, a visit to a gynecologist, the necessary clinical and laboratory examinations and ultrasound examination of the pelvic organs, and, if necessary, the abdominal cavity are indicated!

Speaking about the symptoms of uterine fibroids, it is imperative to pay attention to the presence of dysfunctions of the cardiovascular system, which are caused by the presence of obvious or latent anemia, i.e.That is, a decrease in hemoglobin content. It is with this factor that the appearance of the syndrome of chronic fatigue, fatigue, decreased mood and performance is associated. Increased blood loss in patients with uterine myoma, acquiring a chronic character, rather quickly leads to disturbances in various body systems, in particular the coagulation and hematopoietic systems, and contributes to the development of a state of chronic lack of oxygen in the tissues of the body (hypoxia).

Studies in leiomyoma

Examination of the pelvic organs is the simplest way to confirm the diagnosis of uterine leiomyoma.Nodular, dense, painless tumors located in the midline of the abdomen are most often the uterus affected by myoma.
When examining with mirrors, fibroids that are born through the cervical canal can be detected. Such cases are usually accompanied by massive bleeding.

Diagnosis of leiomyoma

The diagnosis of uterine fibroids is usually made on the basis of the results of an objective examination of the abdomen and pelvic organs. Additional diagnostic studies may be needed only in order to exclude other causes of the appearance of tumor-like formations located in the midline of the abdomen.

Hysteroscopy may be helpful in diagnosing fibroids, especially in determining the cause of uterine bleeding or infertility. Ultrasound echography is used to clarify the number and location of myomatous nodes, and to assess the condition of the uterine appendages. Repeated ultrasound examinations are often required at intervals of several weeks.

Leiomyoma treatment

The management of patients suffering from asymptomatic fibroids requires, first of all, monitoring them, this is especially true for women during the premenopausal period, since fibroids usually regress after menopause.Young women should be reexamined at 6-month intervals. It is necessary to pay attention to the state of the menstrual cycle. If there is a lengthening or shortening of the cycle, you should consult a doctor for examination and treatment. Patients with rapid growth of fibroids, with uterine fibroids exceeding the size corresponding to 10-12 weeks of pregnancy, are usually subject to surgical treatment, because in such cases it is difficult to accurately assess the condition of the uterine appendages, and as the tumor grows, the conditions for surgical treatment become more complicated.

If the patient has uterine bleeding, , then first of all, their cause should be established. It is necessary to exclude cancer of the body and cervix by examination, biopsy or diagnostic curettage of the mucous membrane.

Patients, insisting on the preservation of the uterus , in the presence of uterine bleeding can be treated by cyclic administration of progestins. It is unlikely that such treatment will stop bleeding in submucosal or large fibroids, but it may be effective in anovulatory bleeding.Anemia due to bleeding is treated with a special diet and iron supplements. If these initial measures do not give positive results, then either surgical removal of myomatous nodes or removal of the affected organ – the uterus (hysterectomy) is indicated, despite the patient’s desire to preserve the ability to bear children.

For patients suffering from infertility or repeated spontaneous abortions , the best treatment would be myomectomy (removal of mimatous nodes), which can be performed laparoscopic access or using hysteroresectoscopy.Establishing the cause of infertility should be done only after correcting all other pathological disorders. After myomectomy, the pregnancy rate is 30-50%.

Surgical treatment is carried out for uterine fibroids, if the size of the tumor exceeds the size of the uterus during a 12-week pregnancy; if you suspect the presence of tumors emanating from the uterine appendages; with uterine bleeding that does not respond to treatment; with severe pelvic pain or rapidly growing uterine fibroids.Myomectomy can be offered to patients suffering from infertility, as well as those who insist on preserving the uterus. Hysterectomy is the treatment of choice for patients with uterine fibroids who do not seek fertility preservation. The decision to remove the ovaries depends on the patient’s age, her condition and wishes.

90,000 Uterine fibroids. Symptoms Treatment. Prevention – health articles

Table of contents

Uterine fibroids are one of the most common tumors of the female reproductive system.This tumor is found in 15-20% of women over 30 years old, in 40% of women over 40 years old, although at present the age of uterine fibroids is “younger” – cases of this pathology being detected in young women under 30 years old with unrealized reproductive function have become more frequent.

Myoma (leiomyoma, fibroids) – benign hormone-dependent tumor of the uterus. The development of fibroids, as a rule, occurs slowly: one muscle cell for unknown reasons begins to divide and creates tumor muscle cells, which form a node in the uterus – fibroids.

Until now, there is no consensus on the causes of the development of uterine fibroids. There are several reasons that contribute to the development of uterine fibroids, these include:

• Disorders in the production of sex hormones
• Chronic inflammatory diseases of the female genital tract (chronic salpingo-oophoritis, sexually transmitted infections)
• Abortion, intrauterine contraceptives
• Diseases of the endocrine glands: thyroid gland, adrenal glands, etc.d.
• Genetic predisposition to uterine fibroids

Fibroids classified by location:

• Typical arrangement of nodes in 95% of the body of the uterus – intramural (the tumor is located in the thickness of the uterine wall), submucous (fibroid growth occurs towards the uterine cavity, causing deformation of the uterine cavity) and subserous (fibroid growth occurs towards the abdominal cavity)
• Atypical arrangement of nodes in 5% – in the cervix – cervical form, intraligamentary (interconnectional arrangement of nodes)

Clinical picture of uterine fibroids

With uterine myoma, the clinical picture is very diverse, depending on the age of the patient, the duration of the disease, the location and size of the tumor, and the presence of concomitant pathological processes.

The main symptoms of uterine fibroids are:

• Uterine bleeding (profuse, prolonged menstruation), often leading to anemization of the woman (decrease in hemoglobin)
• Drawing pains, heaviness in the lower abdomen. Pain can be sharp and cramping, worse during menstruation 90 170
• Dysfunction of adjacent organs, for example, frequent urination
• Stool retention, which leads to compression of the nodes of adjacent organs

Myoma of the uterus can be the cause of infertility, miscarriage.Uterine fibroids are often combined with endometriosis of the uterine body – adenomyosis.

Diagnosis of uterine fibroids

• Gynecological examination
• Pelvic ultrasound – transvaginal and transabdominal examination. Ultrasound examination of the uterus (ultrasound) reveals an increase in the size of the uterus, as well as a node of uterine fibroids even in the early stages of the development of the disease, when the size of the fibroid does not exceed 1 cm in diameter 90 170
• MRI of the small pelvis (if necessary)
• Hysteroscopy (with submucous fibroids), hysterosalpingography

Treatment of uterine fibroids

So how to treat uterine fibroids? Treatment of uterine fibroids depends on the woman’s age, the size of the uterine fibroids, and the woman’s reproductive plans.In some cases, the treatment of uterine fibroids is carried out with the help of hormonal drugs, in other cases, surgical intervention is necessary (removal of the tumor – myomectomy, removal of the uterus – hysterectomy, etc.)

Conservative treatment of uterine fibroids

Conservative treatment of uterine fibroids prevents an increase in the size of fibroids and helps preserve the uterus, allowing you to give birth to a child in the future. Conservative treatment of uterine fibroids is possible in the case of small fibroids (up to 12 weeks), slow growth rates of fibroids.

The main principles of the treatment of uterine fibroids without surgery are the use of hormonal drugs, as well as symptomatic treatment (treatment of anemia, elimination of pain, etc.). In the treatment of uterine fibroids, hormonal drugs are used: combined oral contraceptives, gestagens, agonists of gonadotropic releasing hormones, antigonadotropins.

Surgical treatment of uterine fibroids

Surgery for uterine fibroids is indicated for large fibroids (more than 12 weeks), rapid growth rates, severe symptoms of uterine fibroids (profuse uterine bleeding, abdominal pain, etc.)).

There are several types of operations for uterine fibroids:

• Laparoscopic myomectomy – removal of uterine fibroids using a laparoscope (an instrument inserted into the abdominal cavity through small incisions in the anterior abdominal wall). Benefits of laparoscopic myomectomy: preservation of the uterus and the possibility of getting pregnant in the future, quick recovery after surgery
• Hysteroscopic myomectomy – removal of uterine fibroids using a hysteroscope (an instrument inserted into the uterine cavity through the vagina).Hysteroscopic myomectomy is indicated for submucous uterine myoma (myoma that grows into the lumen of the uterine cavity) 90 170
• Removal of the uterus or hysterectomy is a surgical method for the treatment of uterine fibroids, which involves the complete removal of the uterus. The operation to remove the uterus is indicated for women who do not want to give birth to children in the future, as well as for large uterine fibroids, fast-growing fibroids, the presence of several large fibroid nodes 90 170
• Embolization of the uterine artery – implies the introduction into the uterine artery of a special substance that stops blood flow through this artery, which stops the supply of uterine fibroids and leads to the death of the tumor.The disadvantages of this method of treating uterine fibroids are the possibility of infectious complications, as well as severe pain in the first few days after surgery 90 170
• FUS-ablation (FUS-ablation) of uterine fibroids is a relatively new method of treatment of uterine fibroids, which consists in the use of focused ultrasound waves. With the help of FUS-ablation of uterine fibroids, it is possible to achieve a reduction in the size of fibroids without surgical intervention. Contraindications to FUS-ablation of uterine fibroids are: a woman’s desire to become pregnant in the future, more than 5 myomatous nodes on the uterus 90 170

Prevention of uterine fibroids

Prevention of uterine fibroids consists in regular visits to the gynecologist, performing ultrasound of the pelvis, adherence to diet, sleep and rest, and reducing stressful situations.An important method for the prevention of uterine fibroids is timely pregnancy and childbirth.

90,035 90,000 Uterine fibroids: symptoms and treatment

A uterine fibroid is a benign tumor that develops in the uterus. Knots range in size from a pea to a melon. They are also called leiomyomas or fibroids.

Uterine fibroids are very common and occur in about 20-50% of all women. Most often it is detected in women aged 30 to 40 years, in many it is hereditary.Myomatous nodes can grow during the reproductive period, but in some cases they remain the same for many years. Fibroids stop growing after menopause.

NB! If the nodes continue to enlarge after menopause, you should definitely consult your doctor!

Fibroids usually do not cause any symptoms and do not require treatment. But if symptoms do occur, you should seek medical attention.

Symptoms of uterine fibroids:

• Bleeding – Heavy or prolonged menstrual bleeding is the most common symptom.Women have to change sanitary napkins almost every hour, they are forced to be at home on the most plentiful day of menstruation. As a result, anemia develops, which can cause fatigue, dizziness, headache and decreased performance.

NB! If your periods are more profuse than before, you should definitely see a doctor.

• T Basic discomfort. Women with large nodules may feel heaviness or pressure in the lower abdomen or pelvis.This is often described by patients as pelvic discomfort rather than acute pain. Sometimes the discomfort is aggravated in the prone position, when the body bends.
• Pelvic pain. A less common symptom is acute and severe pain. Degeneration of the myomatous node occurs, i.e. violation of his blood supply. Pain is usually localized to a specific location. Chronic pelvic pain may occur. This type of pain is usually less intense, but persistent and limited to a specific area.
• Problems with the bladder. Frequent urination is the most common urinary tract symptom. A woman may wake up several times at night to empty her bladder. Sometimes women are unable to urinate despite a full bladder.
• Pain in the lower back. Occurs when myomatous nodes are localized on the back of the uterus and are pressed against the muscles and nerves of the lower back, which causes pain.
• Rectal pressure. Myomatous nodes can press against the rectum and cause a feeling of fullness, difficulty in emptying the bowel, pain during bowel movements. Sometimes uterine fibroids can lead to the development of hemorrhoids.
• Discomfort or pain during intercourse. Pain occurs only in certain positions or during certain periods of the menstrual cycle.

Diagnosis of uterine fibroids:

Usually, uterine fibroids are found during a routine pelvic exam, which allows the doctor to determine the size and shape of the uterus.If it is enlarged, has an irregular shape, a bumpy surface, uterine fibroids can be suspected. Or, you may notice new symptoms appear and inform your doctor.

After a pelvic exam, there are several ways to confirm the diagnosis. The main method is pelvic ultrasound. Other methods are more specialized and performed only when needed. Below is a brief description of each study.

Ultrasound is a safe and reliable way to detect fibroids. As a rule, transabdominal and transvaginal examination is used. In the first case, if there is a full bladder, the sensor is placed on the patient’s abdomen; in the second, when the bladder is empty, a special vaginal sensor is used and the uterus and ovaries are examined.

Go to the page “Ultrasound in gynecology”

Magnetic Resonance Imaging (MRI) – Gives a detailed picture of the number, size and exact location of fibroids.Not all women with fibroids require an MRI.

Hysteroscopy – a procedure to examine the uterine cavity, which allows you to identify nodes growing into the cavity (submucous, or submucosal fibroids). The study is performed on an outpatient or inpatient basis.

Uterine fibroids | Expert advice | Thematic pages

Myoma of the uterus

WHAT IS UTERINE MYOMA?

Uterine fibroids is a tumor that develops from muscle fibers and connective tissue of the uterus.Myoma of the uterus is a rather large elastic seal, usually round in shape. According to recent studies, its appearance and development depends on the state of the immune and hormonal systems of the female body. At the same time, myoma does not contain cancer cells and is a benign tumor that can be successfully treated.

HOW OFTEN DO UTERINE FIBROUS MEET?

Uterine fibroids are diagnosed in 25-30% of women over the age of 35, and among 45-year-olds – in 50-62%.During preventive gynecological examinations, the tumor is first detected in 1–5% of women. Fibroids come in different sizes: from a very small seal, which can only be fixed using an X-ray of the uterus, to a large tumor that weighs about a kilogram and is easily palpable through the abdominal wall. Sometimes several fibroids in one woman can be located in different places of the uterus, and each of them develops in its own way.

WHY DOES UTERINE FIBIOMA Occur?

Uterine fibroids are rare in girls before puberty, as well as in women after menopause.In postmenopausal women, the growth of myomas stops, and in the future, their reverse development is observed. Most studies confirm the fact that the development of fibroids is associated with hormonal disorders in the female body, including hyperestrogenism (increased levels of estrogen). Under the influence of this hormone, the synthesis of muscle fibers of the uterus, as well as their tone, increases (while the growth rate of endometrial cells also increases). However, uterine fibroids also occur in women with a normal menstrual cycle, that is, without hormonal disorders.

IS UTERINE MYOMA DANGEROUS?

Heavy menstrual bleeding is the most characteristic symptom of uterine fibroids. Bleeding gradually increases, which in many cases can lead to anemia (a decrease in the amount of hemoglobin in the blood) in a woman. Pain in uterine fibroids occurs in cases of a complicated course of the disease: when twisting the leg of the fibroid or necrosis of the uterine fibroids node.

HOW DOES UTERINE MYOMA manifest?

Women need to know that at the onset of the disease, uterine fibroids practically do not manifest themselves in any way.It can be detected only with a periodic preventive examination by a gynecologist (the doctor reveals a denser and enlarged uterus). As uterine fibroids develop, alarming symptoms begin to appear, which a woman should definitely pay attention to and schedule a consultation with a gynecologist. First, you should be alerted by the increase in the number of menstrual flow and the very duration of menstruation. In scientific language, this is called menorrhagia. Bleeding becomes more and more profuse over time, and many women begin to take it for granted, although they should immediately contact a gynecologist.The danger of menorrhagia is that it can lead to anemia. An increase in the number of menstrual flow indicates that due to fibroids, the muscles of the uterus are contracting worse and worse. Against the background of menorrhagia, there may be another alarming symptom of uterine fibroids – acyclic (extraordinary) uterine bleeding (metrorrhagia). With metrorrhagia, it is not the tumor itself that bleeds, but the mucous membrane of the uterus due to the proximity of the tumor. Along with bleeding, uterine fibroids are characterized by pain, and their nature can be very different.They are usually concentrated in the lower abdomen and lumbar region. When the disease reaches the stage of circulatory disorders in the myoma (myomatous node), the pain becomes sharp, sudden. With a large tumor and its slow growth, a woman experiences an aching pulling pain, and usually throughout the entire menstrual cycle. Cramping pains occur when the tumor grows in the lining of the uterus. With the development of uterine fibroids, the work of neighboring organs – the bladder and rectum – is disrupted.If the uterine myoma grows in the direction of these organs, the patient has a feeling of constriction of the bladder, urination becomes difficult and becomes frequent. Chronic constipation associated with fibroid pressure and rectal compression is not uncommon. Fibroid pressure on the bladder or rectum causes dysfunction of these organs. Sometimes the nutrition of the fibroid node worsens, which can lead to its necrosis (necrosis). This is accompanied by a feeling of fatigue, fever, severe pain, often forcing a woman to stay in bed.

HOW IS UTERINE MYOMA DIAGNOSED?

Diagnosis of uterine fibroids is quite simple. When the disease has reached a certain stage, the diagnosis can be made with the help of a routine gynecological examination, in which it is easy to identify an enlarged uterus of dense consistency, often having a bumpy surface. In some cases, especially if a woman complains of heavy menstrual bleeding, an ultrasound examination of the pelvic organs is required to clarify the diagnosis.The same method determines the location of the myomatous nodes, their density and size. With a submucous node, the diagnosis can be made using hysteroscopy. However, the referral for hysteroscopy is not given to all patients, since this operation has a number of contraindications and must be performed under intravenous anesthesia.

WHAT ARE THE TREATMENT AND PREVENTION METHODS OF UTERINE MYOMA?

Conservative (non-surgical) treatment includes a proper hygiene regimen, a diet with lots of raw vegetables and fruits, and preparations containing iron to fight anemia.To slow down the growth of the tumor, the doctor prescribes drugs containing norethisterone in cyclic mode for 3-6 months annually, courses of potassium iodide electrophoresis on the suprapubic area. When uterine fibroids are combined with the initial stages of internal endometriosis and / or endometrial hyperplasia, hormonal drugs are prescribed for 6-9 months with six-month intervals.

Main indications for surgical treatment uterine fibroids:

• large myomatous nodes;
• a sharp increase in the size of myomatous nodes in a short period of time;
• severe pain, which over time can lead to the loss of a woman’s ability to work;
• uterine fibroids in combination with endometriosis or ovarian tumor;
• malnutrition of the myomatous node, its necrosis;
• submucosal location of the node, which in itself serves as a serious reason for surgery, even without trying to use drugs to treat uterine fibroids.

There are several types of operations in the treatment of uterine fibroids:

• Radical methods: removal of the entire uterus (hysterectomy), after such an operation a woman will no longer be able to have children, despite the fact that her sexual function does not change. Radical operations are performed in cases where fibroids are combined with other diseases. The choice of access is made by the doctor individually (laparotomy, laparoscopy, vaginal access). Vaginal hysterectomy has its advantage: after it, there is less prolapse (prolapse and prolapse) of the genitals.The use of the laparoscopic approach is safe, effective and does not require a woman’s long hospital stay.
• Conservative surgical techniques (in particular, myomectomy) allow you to save the uterus. This method consists in exfoliation of myomatous nodes and is most suitable for their submucosal location. Such an operation preserves the patient’s ability to conceive, but does not guarantee the absence of repetitions (relapses) of the disease. With a submucosal location of uterine fibroids, most often surgeons perform hysteroresectoscopy, when a node under the control of an optical device inserted into the uterine cavity is cut off layer by layer with a special loop.Like any intrauterine manipulation, the operation takes place against the background of intravenous anesthesia through the dilated cervical canal and does not require penetration into the abdominal cavity.
• Among other methods of treatment, embolization of uterine vessels (when the vessels supplying the node are blocked) and ultrasonic vaporization of myomatous nodes (evaporation of the tissue of the node using an ultrasonic wave) have proven themselves.

To reduce blood loss in the patient, choose a less complicated method of surgery and injure the uterus as little as possible, in some cases the doctor prescribes hormonal drugs as a preparation before the operation (within 3-4 months).These hormonal drugs create the effect of drug menopause (stop menstruation) within 2–3 months. The ovaries seem to be asleep, so they do not produce their hormones that stimulate the growth of fibroids, the blood supply to the uterus deteriorates, and the nodes become smaller in size.

The doctor determines the type of surgery for uterine fibroids individually. It takes into account the patient’s age, her general physical condition and the state of the reproductive system, and draws attention to some other points. Before the direct removal of fibroids, a woman undergoes examinations, which do not take much time, but give the most complete picture of her health.This is the so-called preoperative preparation. Timely treatment of uterine fibroids relieves the patient from unwanted consequences.

Dispensary observation should be continued after surgical treatment (except for cases of complete removal of the uterus and its appendages).

Prevention of uterine fibroids: adherence to a rational hygienic regime, the use of modern contraceptives to exclude artificial abortions, normalization of hormonal disorders, effective treatment of complications resulting from childbirth, gynecological and other diseases.

Women should sunbathe carefully, do not lose a sense of proportion, reduce the time spent in the sun with age, and after 40 years, exclude exposure to very high temperatures (sauna and so on).

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90,000 Uterine fibroids – ProMedicine Ufa

Uterine myoma, as well as leiomyoma, fibroids is a benign tumor that has formed in the walls of the cervix or in the walls of the uterus itself. The size of myoma can be as small as a few millimeters or several centimeters.But most often, women develop multiple fibroids, when several neoplasms form at once.

For convenience in assessing the size of fibroids, gynecologists use the analogy of the size of the uterus in women during pregnancy, 4 weeks, 12 weeks, etc.

Given the location of the uterine fibroids, there are several terms in medicine: the uterus, under the membrane that separates the abdominal organs from the uterus. Intramuscular or interstitial myoma – in this case, the myoma is located inside the muscular wall of the uterus.

Submucosal or submucous myoma – when the tumor grows inside the uterus, right under the mucous membrane and goes into its lumen.

Pedunculated uterine myoma is not a separate gradation, since there may be subserous myoma on the pedicle and submucosa on the pedicle. Only the leg can be narrow or wide, that is, fibroids on a wide base.

According to the WHO, more than 25% of girls of reproductive age in our country are diagnosed with this tumor. Moreover, the figure is steadily increasing every year.The disease is observed in young people and patients in the climacteric period.

Reasons

The appearance of this ailment during the period of sexual formation is not excluded. But such cases are extremely rare. Basically, pathology appears after 30 years. The first signs of uterine fibroids are imperceptible, that is, the patient lives a normal life, without feeling discomfort and pain. The main provoking factor, according to experts, is hormonal imbalance (excess estrogen levels and progesterone deficiency, impaired function of the appendages).Usually, with such disorders, the girl has her periods late, and sometimes they are completely absent. Irregular sexual life (rare intercourse, dissatisfaction) plays an important role in the occurrence of myomatous nodes. In such a situation, blood flow is disturbed and congestion is observed. It is scientifically proven that the disease is genetic in nature. It affects those who have fibroids in the family along the female line. Inflammatory processes (adnexitis, endometritis, endometriosis), late childbirth, endocrine pathologies, numerous abortions, trauma and gynecological operations are also provoking factors.All this leads to hormonal fluctuations.

Symptoms

The main signs of uterine fibroids are menstrual irregularities, pain in the lower abdomen and lower back, and dysfunction of organs compressed by the growing uterus.

Menstrual irregularities are manifested in the form of menorrhagias and metrorrhagias. Menorrhagias are heavy, prolonged menstrual bleeding, and metrorrhagias are uterine bleeding that is not associated with the menstrual cycle. The duration and intensity of such bleeding can increase, this leads to chronic blood loss and the development of iron deficiency anemia.

Pain in the lower abdomen and in the lumbar region is usually aching and increasing over time. But sometimes the pain can be very severe – this is usually associated with a malnutrition of the tumor, when it squeezes the blood vessel that feeds it. Pain can also increase during sexual intercourse and various gynecological procedures, including when examined by a gynecologist.

The function of organs adjacent to the uterus changes mainly in the subserous form of myoma, which grows inside the small pelvis.If such a tumor grows towards the urethra, then sooner or later this will lead to urinary disorders. Stagnation of urine in the urinary tract can lead to the formation of stones or to the addition of infection – acute and chronic cystitis and pyelonephritis develop.

If the tumor grows towards the rectum, then the act of defecation is disrupted, there are constant constipation, a feeling of a foreign body in the anus, and sometimes pain if the nerve endings are compressed, of which there are a lot in the rectum.

Diagnostics

If, during the gynecological examination, uterine anomalies are found in the patient, the diagnosis is specified using the basic diagnostic program, which consists of: detailed blood tests; tumor marker test; coagulation analysis; analysis that determines the hormonal profile; hysteroscopy – visualization of the basal layer of the uterine membrane; endoscopy and X-ray; cervicoscopy, and culdoscopy; computed and magnetic resonance imaging.

Treatment

In some cases, conservative methods can be dispensed with. This treatment is used when it is possible to refuse the operation, based on the results of diagnostics, and is aimed at arresting the growth of the tumor. Positive results can be achieved if the patient is of childbearing age, and it is also used for older generations of women. Complex measures for the treatment of the disease are aimed at the entire area of ​​pathological changes. For therapeutic processes, hormonal drugs are used to make up for the lack of the hormone progesterone and activate its production in a natural way.

When conservative treatment does not give positive results, then a radical method is prescribed – an operation to remove uterine fibroids.

Embolization of uterine fibroids | University Hospital Freiburg

Uterine fibroids are the most common benign disease in women. It consists of dense fibrous tissue that feeds on blood vessels. According to medical statistics, fibroids requiring treatment occur in 25-30% of women between the ages of 30 and 50.

Varieties of uterine fibroids

Interstitial fibroids are most common. They arise in the muscular wall of the uterus and provoke increased menstrual bleeding, as well as pain in the back and pelvis, accompanied by a feeling of constriction.

Subserous fibroids are most often located on the wall of the uterus and usually do not affect the abundance of discharge during the menstrual cycle. However, they can provoke pain in the pelvic area, back, accompanied by a feeling of constriction.

Submucous fibroids can cause heavy and prolonged menstruation, even if the size is very small.

As a rule, women diagnosed with uterine fibroids have several fibroids at once. They can vary in size, from the size of a pea to the size of a melon. As part of the diagnosis, the extent of the disease is determined by comparing the size of the uterus with the typical size of the uterus during pregnancy. Large fibroids or multiple fibroids can increase the size of the uterus to a size typical of 6-7 months of pregnancy.

The causes of uterine fibroids are unknown. According to research, they can be caused by various factors, including age, genetic and hormonal factors. Thus, the incidence of uterine fibroids in women with dark skin is three times higher. Myoma of the uterus can grow at times in size during pregnancy. This is thought to be due to elevated levels of the female hormone estrogen. After delivery, the fibroid usually shrinks back to its original size. During menopause, estrogen levels decrease significantly, fibroids decrease in size, and symptoms become less pronounced.If a woman undergoes hormone replacement therapy during menopause, estrogen levels are maintained. Fibroids do not decrease in size and symptom relief is not observed.

Symptoms of uterine fibroids

• Heavy and prolonged menstruation with unusual discharge, sometimes with blood clots
• Severe pain during menstruation
• Pain and tightness in the pelvic region
• Pain in the back, sides or legs
• intercourse 90 170 90 169 Delayed passage of urine from the kidneys to the bladder 90 170 90 169 Frequent urination due to pressure on the bladder 90 170 90 169 Constipation and / or bloating due to pressure on the intestines 90 170 90 169 Abnormal enlargement of the abdominal cavity 90 170 90 179

  Myoma can be diagnosed as part of routine gynecological examination.Sonography or MRI is usually done to confirm the diagnosis.

  Treatment of uterine fibroids depends on the size and location of the fibroids and the severity of the symptoms. In the absence of symptoms, the doctor will most likely decide not to use any therapeutic measures, provided the annual follow-up is done. When symptoms are present, a variety of therapeutic, surgical and non-surgical treatments are used.

  Therapeutic methods

  As part of the therapy for uterine fibroids, medication may be prescribed to reduce symptoms.These include non-steroidal anti-inflammatory drugs, birth control pills, and hormone therapy (GnRH antagonists).

  Surgical methods

  There are two surgical methods for the treatment of uterine fibroids: myomectomy and hysterectomy. As part of a myomectomy, fibroids are removed and the uterus is preserved. Depending on the location of the fibroids, myomectomy is performed through the pelvic region or the vagina and cervix. With a hysterectomy, the uterus and cervix are surgically removed.In a supracervical hysterectomy, only the uterus is removed. As a result of these operations, women stop menstruating and lose the ability to bear children.

  Non-surgical methods : embolization

  Embolization of uterine fibroids is a minimally invasive procedure in which the uterus remains unaffected. Embolization is done by an interventional radiologist. During the intervention, the patient is conscious under the influence of sedatives and does not feel pain.A thin catheter is inserted into her artery in the groin area. The catheter is guided through the arteries to the uterus under real-time X-ray control (fluoroscope). Microscopic particles the size of a grain of sand are injected into the arteries supplying the fibroids with blood. Microspheres block the blood supply to fibroids. Over time, fibroids decrease in size, symptoms improve.

  Time to full recovery is approximately one week. After that, the patient can go back to work and lead a normal life.