Fibroids

• Fibroids are also known as "myomas" or "myomata".
• Fibroids are very common, non-cancerous (benign) smooth muscle tumors of the uterus (womb).
• Fibroids can occur as a single growth or multiple growths and can vary in size from as small as a pea, to the size of a grapefruit, or even to the size of a full-term pregnancy.
• Fibroids can grow on the surface of the uterus, within the walls of the uterus, or inside the uterine cavity. 
• Fibroid typically grow larger over time, until menopause when they stop growing or regress in size. 
• Fibroids are generally estrogen dependent tumors. 
• Fibroids occur in 20-50% of women, depending upon age and race.  African-American women are three times more likely than Caucasian women to have fibroids.  Black women also have larger and more numerous fibroids at the time of diagnosis. 
• Fibroids are the most common cause of non-emergency uterine bleeding.
• Fibroids are the reason given for most hysterectomies.  It is estimated that fibroids are responsible for 66% of the 600,000 hysterectomies per year in the US (400,000 hysterectomies per year).  AHRQ estimates that fibroids account for 30% of hysterectomies in white women and 50% of hysterectomies in black women.
• AHRQ estimates that the cost of treating fibroids in the US in 1997 was more than $2 billion.
• The actual incidence of fibroids is not known, because most fibroids don't cause symptoms.  The Agency for Healthcare Research and Quality (AHRQ) estimates that the cumulative incidence of fibroids in women aged 25 to 45 is 30%.

• Depending on size, number and location, fibroids can cause no symptoms or they can be responsible for changes in the menstrual cycle, pain in the abdomen or lower back, pelvic pain, pain during sex, difficult or frequent urination, constipation, miscarriage, infertility, or anemia (due to excessive menstrual bleeding).  Fertility problems are attributable to fibroids that block the fallopian tubes or prevent implantation of a fertilized egg in the uterus. 
  
  
• There are three different types of fibroids:
  
  
  • Submucosal fibroid - grows from the uterine wall into the uterine cavity, sometimes distorting it.  This may lead to pain, abnormal bleeding, or infertility.
  • Subserosal fibroid - grows from the uterine wall to the outside of the uterus and can cause pressure on the bladder, bowel and intestine.  These fibroids can cause bloating, abdominal pressure, cramping and pelvic pain.
  • Intramural fibroid - remains confined within the uterine wall and causes symptoms similar to the submucosal and subserosal fibroids.
    
    
• Diagnosis of fibroids:
  
  
• Many fibroids are diagnosed during routine pelvic exams, but in order to rule out other uterine conditions that can be mistaken for fibroids (e.g., ovarian tumors, bowel masses or pregnancy), several diagnostic tests can be performed.
  
  
• Ultrasound - high frequency sound waves are used to create a picture of the pelvic region.  In a specialized ultrasound called sonohysterogram or salin infused sonography, a small amount of saltwater solution may be infused into the uterus, through the vagina and cervix, to improve visibility.  Ultrasound can be performed without anesthesia, and is an office procedure.
  
  
• Hysterosalpingography (HSG) - using a special dye, an X-ray is taken of the inside of the uterus and tubes to outline abnormalities.  No anesthesia is used.  HSG is performed in a radiology suite.
  
  
• Diagnostic hysteroscopy - the uterine cavity is viewed using a telescope-like instrument called a hysteroscope that is inserted in the uterus through the vagina and cervix.  Hysteroscopy can be performed as an office procedure under a local anesthetic, or as an outpatient surgical procedure using local or general anesthesia.  Once diagnosed, fibroids can sometimes be removed using a hysteroscope (see myomectomy description below).
  
  
• Treatment options for fibroids and polyps
  
  
• Drug therapy:  Treatment involves long-term use of hormone therapy that can shrink the fibroid and minimize symptoms.  The fibroids may regrow, however, and the symptoms often return after treatment is discontinued.  In addition to being costly, hormone therapies can have adverse side effects, such as those associated with induced menopause (i.e., hot flashes, insomnia, depression).
  
  
• Surgical Options:
  
  
• Myomectomy is a surgical procedure that removes only the fibroid, leaving the uterus intact.  Drug therapies are often recommended as a pre-surgical treatment to shrink fibroids before removal.  Myomectomy can be performed either through an open incision in the abdomen or through less-invasive techniques:
  
  
• Laparoscopic Myomectomy - fibroid is removed using a laparoscope inserted through the abdomen. A surgical instrument called a tissue morcellator may be used to cut up and remove the fibroids through a tiny incision.
  
  
• Hysteroscopic Myomectomy - fibroid is removed using a telescope-like instrument called a hysteroscope that is inserted through the vagina and cervix into the uterus.  With this approach, the fibroid can be removed intact or a targeted electric current shaves away or vaporizes the fibroid.
  
  
• Uterine Artery Embolization is an investigational, nonsurgical method of treating uterine fibroids.  During an embolization, the blood supply to the fibroid is blocked so that over time the fibroid shrinks.  This procedure is performed by a physician who specializes in radiology.
  
  
• Hysterectomy, the surgical removal of the uterus, is the only way to guarantee that fibroids will not recur.  A hysterectomy is major surgery; woman should consider other less invasive options first.   If a woman and her physician decide hysterectomy is the best option, there are less invasive approaches to performing the procedure that may lessen post-operative pain, recovery time and scarring, compared to the traditional "open" approach.

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Created: 11/2/2001  -  Donnica Moore, M.D.