By Shyama S. Mathews, M.D.
Uterine fibroids affect up to 80 percent of American women, according to the American College of Obstetricians and Gynecologists.
Although they are considered benign, fibroids can cause heavy bleeding, prolonged or irregular periods, pain, and even fertility issues.
Fibroids can run in families, and so, many women accept their symptoms as normal without consulting their doctor. Moreover, reluctance to take hormonal medications or concern about recovery after surgery can make women hesitant to seek treatment.
However, once properly diagnosed, fibroids can be easily and effectively treated through a number of treatment options.
What are uterine fibroids?
Fibroids are benign or noncancerous tumors arising out of the muscular portion of the uterus and varying, in size, shape and location. They can range in sizes as small as a seed or larger than a grapefruit. A woman may have just one fibroid or she may have multiple. They can be on the outer surface of the uterus, within the uterine muscle wall, or pushing into the inner cavity of the uterus.
What causes fibroids?
It is unclear what causes uterine fibroids, but certain factors may increase the risk for their development, including:
- Age. Most fibroids are diagnosed in women between the ages of 40 and 44, though they can present at any age.
- Race. As many as 80 percent of African American women and 70 percent of Caucasian, Hispanic and Asian women develop fibroids by the time they are 50.
- Family history of fibroids.
- Early onset of menstruation.
- A diet high in red meat and low in green vegetables.
- Alcohol use.
What are signs and symptoms?
Not all women with fibroids will have symptoms. In fact, some women with multiple fibroids may not have any signs at all, while another woman with just one fibroid may experience symptoms that are debilitating. The location of the fibroid may be the most important factor regarding symptoms.
Common symptoms of fibroids include:
- Heavy periods
- Irregular bleeding.
- Prolonged periods.
- Pain or pressure in the pelvic region.
- Frequent urination and difficulty emptying your bladder.
- Low back or leg pain.
When fibroids cause heavy bleeding, they can increase the risk for anemia. In patients with severe anemia, iron or blood transfusions may be necessary. Moreover, some fibroids may interfere with a woman’s ability to achieve or maintain a pregnancy.
If you experience signs of fibroids, see your doctor for diagnosis and treatment that can help relieve symptoms.
How are fibroids diagnosed and treated?
The first step in diagnosing fibroids is a pelvic exam, which is usually followed by an ultrasound to see where the tumors are growing. Other imaging tests such an MRI can also help determine the precise location of fibroids.
Treatment for fibroids largely depends on the severity of symptoms and the goals of the patient. Options range from doing nothing to medical management to surgery.
Medical options include low dose hormonal birth control pills or a progesterone intrauterine device (IUD) that can significantly reduce bleeding. There is also an injection called leuprolide acetate that may shrink fibroids by blocking estrogen, similar to what happens in menopause.
The surgical removal of fibroids is called myomectomy, which is a procedure to remove the fibroids while leaving the uterus in place. This preserves the ability to carry a pregnancy. While fibroids do not regrow after being removed, new ones can develop over time. For women who are not interested in future pregnancies, a hysterectomy – the surgical removal of the uterus – may be an option.
At Penn Medicine Princeton Medical Center, both myomectomy and hysterectomy can often be performed by minimally invasive surgery, through just a few small incisions using the da Vinci Xi Surgical System. This is commonly referred to as robotic surgery.
The da Vinci system enables surgeons to perform complex gynecological surgeries such as myomectomy and hysterectomy with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and positive clinical outcome.
Many women with large fibroids are unsure if they are candidates for minimally invasive surgery. Speak to your doctor to find out and consider seeking the opinion of a surgeon who has advanced training and experience. For women with extremely large or numerous fibroids, however, open surgery may still be necessary.
It’s important to note that having hysterectomy does not require removing the ovaries too. Typically, the ovaries can remain in place so early menopause can be avoided.
To learn more about uterine fibroids, their signs and symptoms, and treatment options, visit the Princeton Health On Demand UStream channel at http://www.ustream.tv/princetonhealth where you can watch a pre-recorded video to learn more about uterine fibroids.
To find a physician with Princeton HealthCare call 888.742.7496 or visit www.princetonhcs.org.
Shyama S. Mathews, M.D. is a board certified gynecologist, fellowship trained in minimally invasive gynecologic surgery, and a member of the medical staff at Penn Medicine Princeton Medical Center.