Uterine fibroids are tumors, usually benign, that grow into the uterus from the muscle tissue that surrounds it. They are also known as leiomyomas or myoma of the uterus. Uterine fibroids can grow within or on the uterine wall, push the uterus to one side, or force it to grow abnormally. They can be as large as a basketball or as small as a pea.
Complications from uterine fibroids occur when larger fibroids put pressure on the intestines or bladder, resulting in constipation, frequent urination, heavy menstrual bleeding, and pelvic pain. This abnormal growth can lead to backache, an uncomfortable pressure or feeling of fullness in the lower abdomen, and trouble conceiving. Uterine fibroids can cause complications in pregnancy when large fibroids block the opening to the uterus, necessitating a c-section delivery.
Twenty-five percent of women of childbearing age have fibroids, most commonly, the age group including 30 to 50 year olds. African American women are three times as likely to develop uterine fibroids as white American women. Those at lower risk include athletic women, smokers and women who have had two or more children vaginally.
Nobody knows the exact cause of uterine fibroids. Fluctuations in estrogen levels affect the growth of fibroids; high levels, such as during pregnancy, promote fibroid growth. During and after menopause, when estrogen levels are significantly lower, fibroids shrink or nearly disappear.
During regular pelvic exams, the doctor feels the uterus for abnormal size and growth. The presence of uterine fibroids can make the uterus feel lumpy. An ultrasound is usually performed to rule out cysts or malignant tumors.
Treatment of uterine fibroids depends on the severity of the symptoms. Most uterine fibroids are left untreated if they do not have a large impact on a woman’s life. When deciding on treatment, a doctor takes into account blood loss and pain during menstruation, the woman’s age, and how quickly the fibroids are growing. Besides estrogen lowering medications, which may help shrink the fibroids, but bring on menopausal like symptoms, there are two main surgical options.
The first option is a myomectomy, in which the fibroids are removed, leaving the uterus intact and viable for future pregnancies. With this option, there is a 25% rate of recurrence of uterine fibroids. The second surgical option is a hysterectomy, in which the uterus is completely removed along with the uterine fibroids. This option is reserved for women who are in menopause, women who aren’t planning to have children, or those who have particularly severe symptoms. These are both fairly invasive options that may have lifelong repercussions.
There are a couple of less invasive options for the treatment of uterine fibroids. The first is called Uterine Artery Embolization (UAE). This is a newer technique, in use since 1995, which is performed by a radiologist. The doctor pinpoints the exact location of the fibroids and surrounding blood vessels using x-rays or other imaging technology. He or she then blocks the surrounding blood vessel, thus cutting off the fibroids’ blood supply. Rather than major surgery, this does not involve an incision, only a small needle prick and a one-night stay in the hospital.
Endocoagulation uses a similar theory to treat fibroids. It is an experimental technique that involves inserting a needle into the fibroid and cauterizing it, cutting it off from its blood supply.