What Are Uterine Fibroids?
Uterine fibroids are noncancerous tumors that start in the uterine wall. Some fibroids remain small, while others grow to large sizes. Some women have only one fibroid, while others develop multiple fibroids. There is no specific factor that determines why some women develop uterine fibroids and others don't, but up to 80% of African-American women develop one fibroid in their lifetime.
Uterine Fibroid Symptoms
Most women don't experience any symptoms from their fibroids. In fact, they might not even know the fibroids are there. Some women, however, may experience fibroid symptoms such as:
- Heavy or irregular periods
- Pelvic discomfort from large fibroids
- Frequent urination
Fibroids don't typically cause infertility, but they may cause recurrent miscarriages. If the fibroid tissue dies, you may experience some intermittent pain.
Uterine Fibroids During Pregnancy
While fibroids do not typically affect your fertility, they may become more evident once you become pregnant. Fibroids may grow in size, somewhat significantly, mainly during the first trimester. Then, during the second and third trimesters, their size tends to stabilize. In rare cases due to the significant growth, the fibroids can undergo degeneration and cause episodes of pain.
In general, most patients with fibroids during pregnancy do not need any care or testing outside of routine prenatal care. We will monitor your fibroids, as they may increase the risk of preterm labor, premature rupture of membranes (water breaking) or malpresentation of the fetus, such as being breech. Unless absolutely necessary, we avoid uterine fibroid treatment during pregnancy so that there are no adverse effects on you or your baby. In some cases, we may monitor for adequate fetal growth.
Treating Uterine Fibroids
There is no specific fibroid size that requires treatment. Small fibroids inside the uterus can cause heavy bleeding, while large fibroids near the edges can go unnoticed.
If your uterine fibroid symptoms don't affect your quality of life, we will most likely leave them alone.
If you experience heavy bleeding or frequent discomfort from other fibroid symptoms, your primary care physician or gynecologist may refer you, or you may come to us to get second opinion. If you are trying to get pregnant, we may recommend removal to reduce the risk of miscarriage.
Our staff will help you gather your medical records and imaging results. We will try to schedule any new imaging at the time of your first appointment. During your visit, you will meet with a minimally invasive gynecologic surgeon and an interventional radiologist to determine the best fibroid treatment option for you.
We offer several uterine fibroid treatment options as an alternative to hysterectomy.
Medication options focus on relieving uterine fibroid symptoms, namely abnormal menstrual bleeding. Some options may reduce fibroid size. There are many types of hormonal medications, but they also act as contraception, so pregnancy is not possible during therapy. Nonhormonal medications allow you to get pregnant, with improvement of bleeding symptoms in many cases as well.
Uterine Fibroid Embolization (UFE)
UFE is a minimally invasive procedure to treat fibroid tumors. UFE is also called uterine artery embolization (UAE). A form of real-time X-ray called fluoroscopy is used to guide the delivery of small plastic beads into the arteries feeding the fibroids. The result decreases blood flow to the fibroids, causing them to shrink. Most women undergoing UFE report significant or complete resolution of their fibroid symptoms. Uterine fibroid embolization requires only a small nick in the skin. Unlike surgery, general anesthesia is not required. UFE recovery times are typically under two weeks.
The question of how uterine fibroid embolization affects pregnancy has yet to be answered, however many healthy pregnancies after UFE have been reported. Due to this uncertainty, physicians may recommend that women wishing to have more children elect another option to treat fibroids. If the other treatments aren't possible then UFE may still be an option.
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS)
MRgFUS uses ultrasonic pulses, or sonications, to heat up and destroy fibroid tumors. MR guidance is used to accurately target the fibroids and spare the healthy tissue. Unlike surgery, MRgFUS does not require an incision or general anesthesia. Most patients can return to normal activities after a couple of days. MRgFUS is a newer technique for treating fibroids, so there is no long-term data on fertility. Available data, however, supports using this treatment in women who want to get pregnant in the future.
This procedure consists of the surgical removal of uterine fibroids. Minimally-invasive approaches include hysteroscopy, laparoscopy or a combination of the two.
Hysteroscopy involves placing a telescopic camera through the cervix to visualize the uterine cavity, allowing the surgeon to remove fibroids contained in the uterus. Hysteroscopy alone has a one- or two-day recovery period.
During laparoscopy, the surgeon will place a telescopic camera and instruments into your abdomen through small incisions. Through these incisions, the surgeon removes the fibroids and repairs the uterus. Laparoscopy requires up to six weeks of restrictions, but most patients are back to work within one or two weeks.
Pregnancy is possible after a myomectomy from either approach.
A hysterectomy is the removal of the uterus (including all of the fibroids in it), and often the cervix. Pregnancy is not possible after a hysterectomy.
If the uterus is not enlarged due to the fibroids or other condition, the surgeon may use a vaginal approach with no abdominal scars. If the uterus is too large, a laparoscopy will has the similar benefit of a quicker recovery time.
Both options have similar recovery times with the ability to return to work after one or weeks. Restrictions remain in place for six to eight weeks after surgery. Most often, we don't remove the ovaries, allowing you to retain your natural hormones for health benefits.