Fibroids by Evelyn Felluca, MD FACOG
Fibroids are growths in the uterus, which are benign in over 99% of the time. They are quite common, especially among African American women. Most of the time, women experience heavy and prolonged periods, resulting in anemia (low blood counts). This may result in the need for either iron or blood transfusions. In the U.S., 600,000 women have hysterectomies each year. Fibroids are the most common reason. Symptoms depend on their location and size.
Types of Fibroids
Subserosal (Serosal) fibroids grow on the outer layer of the uterus. Sometimes, these can grow quite large to the point that they mimic a pregnancy. Women describe an increase in size of the abdomen(tummy) despite exercising. If they are large, they feel like firm masses in the abdomen.
Intramural fibroids are in the walls of the uterus. As long as they are small, they don’t cause symptoms. As they grow, they can cause bleeding or pressure symptoms.
Pedunculated fibroids connect to the uterus by a stalk. They don’t cause bleeding, but as they grow, they can cause pain from rolling back and forth in the abdomen as you move.
Submucosal fibroids are located inside the uterus. These can cause daily, heavy abnormal bleeding, resulting in anemia.
Prolapsed fibroids fall through the cervix, the mouth of the uterus, resulting in pain and continued bleeding. These are rare and easily diagnosed during an office exam.
Diagnosis of Fibroids
Pelvic ultrasounds diagnose the size and location of fibroids. Treatment of these problems is dependent on the severity of the symptoms and the patient’s desire for future fertility (the possibility of having a baby). For patients who have minimal symptoms, repeat an ultrasound in 6 months to check for fibroid growth.
Women who want to preserve their fertility should have a myomectomy for the following reasons:
- heavy bleeding
- 5 cm or larger
- submucosal location
- recurrent miscarriages
A myomectomy is the removal of a fibroid while preserving the uterus. Patients who do not want pregnancies in the future should not have myomectomies. A woman with more than one fibroid has up to a 60% chance that others will grow.
I’m frequently asked, “Isn’t there a medicine that you can give me to get rid of these?” No, unfortunately not!
Depot Lupron injections shrink large fibroids and/or stabilize bleeding prior to surgery, but the effect is only temporary.
Uterine Fibroid Embolization (UFE)
Also known as Uterine Artery Embolization (UAE), a nonsurgical option that shrinks fibroids. An interventional radiologist places a catheter in the blood vessels that feed the fibroids. Inert substances injected into these blood vessels block the blood flow to the fibroids. The fibroid will shrink over several months from 30-60% and remain dead in the body. Women who want to have children should not have a UFE since it decreases the blood flow to the uterus.
Definitive surgery is the removal of the uterus with the fibroids which will result in no more bleeding, periods or pain. A total hysterectomy removes the uterus and the cervix, the mouth or entrance into the uterus however it does NOT mean removal of the ovaries. Keep the ovaries to avoid early menopause and have better heart and bone health, hence no hormone medications necessary.
Minimally invasive techniques allow trained surgeons to perform complex surgeries. These surgeries include large uterus removal, myomectomies, surgery after multiple prior surgeries, and surgery on patients with a high Body Mass Index (BMI). They are performed using very small incisions. Patients go home the same day.
Additional information can be found at ACOG FAQ’s
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