Gynecology

Uterine Fibroids (Leiomyomata)

Uterine fibroids are common benign tumors that develop in the uterus (womb) of many women. Up to 75% of women may develop fibroids. Fibroid growth seems dependent on the estrogen hormone. Fibroids tend to temporarily grow larger during pregnancy, when estrogen levels are high, and tend to slowly grow during childbearing years, but begin to shrink after menopause, when estrogen levels decline.

Symptoms
Fibroids can be microscopic, but can also grow to be quite large. Most women with fibroids have no symptoms, and their fibroids may be discovered incidentally on an imaging study or during a physical exam. The most common symptoms, for women who have them, are heavy menstrual bleeding, bleeding in between menstrual periods, pelvic pain or cramping, pelvic pressure, and pain with intercourse. Heavy menstrual flow can result in anemia. Fibroids can cause complications with pregnancy in some cases, can be responsible for infertility, and, very rarely, can turn into a cancer called leiomyosarcoma.

Evaluation
When suspected on physical exam by an irregular, lumpy, or enlarged uterus, fibroids can be confirmed by an ultrasound study. They can also be seen on MRI or CT scan of the pelvis.

Management
The course of treatment is based on symptoms, degree of anemia, and desire for future pregnancies. Expectant management is usually chosen if symptoms are minimal or nonexistent.
Hormonal treatments and iron can be used to treat heavy menstrual bleeding/anemia. Nonsteroidal anti-inflammatory drugs such as ibuprofen are often used to treat pain/cramping.
If the symptoms of fibroids cannot be controlled with medications, various other treatments are available:

Hysteroscopic resection of fibroids: a small camera and instruments are inserted through the cervix to remove a fibroid growing within the uterine cavity. This procedure is usually done on an outpatient basis, with a quick recovery.

Uterine artery embolization: This procedure is done by an interventional radiologist, who places small beads in the uterine arteries, cutting down the blood supply to the uterus, which is able to shrink bulky fibroids. This procedure may not help long-term with heavy menstrual bleeding, is not recommended for women who want future childbearing, and has a chance of hastening the onset of menopause.

Myomectomy: This procedure removes the fibroids to reduce fibroid bulk or to increase the chance of conception if fertility has been a problem, and is often chosen for women who want to maintain their childbearing potential. The procedure can be performed laparoscopically in some cases, but in many cases is performed with an open abdominal incision, requiring a hospital stay. Other fibroids can continue to grow following a myomectomy, and the procedure can make having a vaginal delivery more dangerous depending on where the removed fibroids are located.

Hysterectomy: This procedure removes the uterus and any fibroids within it. Hysterectomies can be done vaginally, laparoscopically, robotically, or with an open abdominal incision depending on the situation. A hysterectomy will require a hospital stay and will make future childbearing impossible.

Magnetic Resonance guided Focused Ultrasound: this new treatment for uterine fibroids uses ultrasound energy to heat and destroy fibroid tissue without a surgical incision, only used for women who have completed childbearing.