Fibroids
Causes
To date the cause of fibroids is unknown. It is known that their growth is estrogen dependent.

Symptoms
Most women have no symptoms. The doctor discovers fibroids on physical examination. The most common symptom is abnormal bleeding. This may include heavy bleeding (saturating a maxi pad in one hour) with periods, bleeding in between periods, or continuous spotting. If bleeding is heavy and persistant, signs of anemia such as fatigue or weakness may develop. Pelvic pain from a degenerating fibroid may be another presenting symptom. Pelvic, bladder, or rectal pressure may occur depending on the location of the fibroid.

Evaluation
Fibroids are usually diagnosed by physical exam and confirmed by sonogram. Occasionally, if the fibroids are small and bleeding is the primary symptom, then the diagnosis may be made by hysteroscopy (an instrument which allows visualization of the inside of the uterus) or hysterosalpingogram (evaluating the uterus and fallopian tubes by injecting dye and watching it pass through on x-ray). When bleeding is one of the main complaints a complete blood count will be obtained.

Possible Problems
Anemia may result from heavy bleeding. Pregnancy complications such as spontaneous abortions, obstruction of labor, placental separation and preterm labor can be associated with fibroids. Frequent urination may develop depending on the location of the fibroids. On rare occasion they may cause infertility or become malignant.

Management
The course of treatment is based on symptoms, degree of anemia, and desire for future pregnancies. Expectant management may be elected if symptoms are minimal or nonexistant. After the initial evaluation the patient is asked to return in 3 to 6 months for re-evaluation of the size of the uterus. If the exam is unchanged, then she may resume her annual exam schedule. Call the office in the interim if you develop any of the above-mentioned symptoms.

If bleeding is a symptom and the patient is not anemic, she may be treated with nonsteroidal antiinflammatory drugs, low dose birth control pills, or progestins. Iron supplements will be started.

If bleeding is unbearable and/or the patient is severely anemic a more definitive treatment may be required. The surgical approach will depend on whether or not the patient wants to maintain fertility. If she wants future pregnancies then a myomectomy may be performed. A myomectomy is removal of the fibroids. Recurrent abortions may be another reason to perform a myomectomy. When children are not desired a hysterectomy is considered. When fibroids are extremely large your physician may consider administering Lupron prior to surgery to reduce the size of the fibroids and the risk of bleeding.

There are more advanced technologies that are sometimes offered, so please ask your doctor for more information.

Fibroids are common. They can usually be managed successfully. It is important to express your concerns and desires as they can influence the course of management.