By: Diana Barnes-Brown for Fibroids1General Overview
Uterine fibroids, often just called “fibroids,” are benign (noncancerous) tumors in the uterus, fed by blood flowing to the uterus from the uterine artery. They are among the most common health complaints in women of reproductive age, and can cause a variety of painful and bothersome symptoms, from heavy bleeding to urinary and digestive symptoms to miscarriage.
A Closer Look
Uterine fibroids tend to occur in women in their late reproductive years, generally between the ages of 35 and 50. Some medical experts estimate that they affect as many as one in three women before menopause, while others think the number of women who develop fibroids at some point in their lives may be over 70 percent, with most cases going undiagnosed because they are not symptomatic or are confused with other health problems.
For those who are diagnosed, symptoms are often inconvenient, painful, and disruptive of daily life. They can include menorrhagia (unusually heavy periods), dysmenorrheal (painful periods), spotting, unexpected bleeding, dyspareunia (pain during sexual intercourse), digestive and urinary problems, back pain, and abdominal pain, cramping bloating and swelling. Fibroids may also be to blame for conditions such as anemia, as well as miscarriage or infertility.
There are three main types of fibroids. Intramural fibroids grow on or in the uterine wall, submucosal fibroids grow inside of the uterus, and subserosal fibroids develop outside of the uterine cavity. Some fibroids are only about the size of a pea or a pencil eraser, while others can grow to be as big as a clenched fist or even a grapefruit. Fibroids may fit into multiple categories, especially if they are large, and their location often dictates the type of symptoms they cause, as well as appropriate treatments.
Uterine fibroids can be diagnosed with transvaginal or abdominal ultrasound (use of sound waves to create a “picture” of internal structures), exploration of the uterus with a laparoscope (a small, telescope-like device that can be inserted through the cervix and allows doctors to see inside of the uterus), and, in the case of especially large fibroids, may be detected when a doctor presses down on the abdomen to examine it for abnormal masses.
Treatment Options
Previously, the standard recommendation for women who had problematic fibroids was hysterectomy, or the complete removal of the uterus. However, in recent years, doctors and patients have come to reject this extreme and invasive mode of treatment, which has a long and painful recovery time, destroys a woman’s chance of bearing children, causes a forced menopause, and can also have negative sexual and emotional results for patients.
There are a number of treatments available for uterine fibroids that do not involve hysterectomy, and are minimally invasive, meaning that they require only small incisions or can be done through the cervical opening. Some involve killing the tissue so that the body can break it down and absorb or expel it, while others focus on removing the fibroids completely. Still others aim at shrinking fibroids by stopping the hormone processes that help them to grow. Cryomyolysis works by applying extreme cold to freeze and kill fibroid tissue. Myolysis does the same thing using a laser or electrical current. Some doctors advocate hormone therapies to shrink fibroids before more hands-on treatment.
Recently, two breakthroughs have caught the attention of doctors and fibroid sufferers alike. The first of these is uterine fibroid embolization, or UFE. Uterine fibroid embolization involves the injection of a solution containing tiny plastic particles into the uterine artery. From there, the particles flow up to the branches that feed the fibroid, effectively cutting off blood supply and causing tissue death and reabsorption or expulsion. Another newer treatment involves the use of specially engineered ultrasound equipment to send high-intensity ultrasound waves through the skin to fibroids targeted for treatment, heating them and destroying the tissue.
There are also surgical options for fibroid removal, which may be preferable for women who hope to preserve their fertility, because they completely remove the fibroid or fibroids, rather than leaving them in the womb to be slowly broken down by the body. One of the latest techniques for surgical removal is robotic myomectomy, which uses a robotic arm capable of greater precision than the human hand to cut away fibroids via a small incision in the abdomen.
Women who think they may have uterine fibroids are urged to seek advice from their medical caregivers as soon as possible, as early detection can simplify treatment. Also, since many of the symptoms of fibroids are similar to symptoms of other disorders of the female reproductive tract – including potentially life-threatening infections, ectopic pregnancy, and certain cancers – it is advisable to seek medical help so that other illnesses can be ruled out or treated.
