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Fibroids

Uterine leiomyomata, or fibroids, are benign (non-cancerous) tumors of uterine

muscle. Fibroids cause heavy menstrual bleeding (periods) and pelvic pressure

as well as painful periods and painful intercourse. Some women experience a

negative effect on fertility or childbearing, including recurrent miscarriages.

 

Diagnosed by a pelvic exam and an ultrasound, fibroids are the most common

reproductive tumor in women, affecting 70-80o/D of all US women by age 50. They

are the most common reason for hysterectomy in the United States.

 

The good news is that not all fibroids need to be treated. Many women have only

mild or even no symptoms. These women, in general, can just “monitor” their

fibroids until menopause. Other women are significantly affected by bleeding.

pressure, pain, or fertility problems. Nearly one half of women with fibroids will

need treatment at some point to restore their quality of life. Besides the presence

and type of symptoms. there are several important factors in deciding on a

treatment course: the number, location, and size of the fibroids, a woman’s plans

for fertility or her desire to keep her uterus1 and patient characteristics such as

obesity. diabetes, and a history of other surgeries such as a cesarean section.

 

Treatment decisions can be complex and therefore should be individualized

during a thorough evaluation and planning session with a doctor.

 

Many women wilt first be offered a simple “trial” approach with medication to

retieve symptoms. Birth control pills or hormones taken by mouth can help

control heavy menstrual bleeding in some women. A progesterone-containing

intrauterine device (IUD) can reduce fibroid-related menstrual bleeding by

keeping the menstrual lining thin and dry. Medications such as ibuprofen can

reduce menstrual cramping and works best if taken on a schedule during the

worst few days of cramping.

 

Fibroid symptoms not relieved by simple measures usually require a procedure

or surgery for treatment Women who have completed childbearing are often best

served by a hysterectomy. Having a hysterectomy for fibroids provides the best

return to health-related quality of life when compared to the other major

treatments techniques. Most hysterectomies today can be performed with

laparoscopic, robotic, or vaginal technique allowing women to have a short «24

hours) hospital stay, faster recovery, less infection risk, minimal blood loss and

less pain than traditional surgery. Menstruation stops after hysterectomy but,

unless the ovaries are also removed, hormone production continues until natural

menopause.

 

For women who want to pursue a pregnancy but have severe symptoms,

myomectomy is the recommended approach. Depending on the size and number

of fibroids, myomectomy can be done with robotic surgery, or with a small

abdominal incision (mini-laparotomy), or through intrauterine (hysteroscopic)

surgery with no incision at all. Most women considering a myomectomy win

benefit having an MRI to examine the uterus in detail, allowing the best plan for

surgery.

 

Some women choose to avoid hysterectomy or myomectomy, even if they are no

longer pursuing pregnancy. Others should avoid surgery due to risks such as

severe internal scarring or severe medical problems preventing safe anesthesia.

 

Uterine fibroids are a very important women’s health problem. Unfortunately,

many women suffer quietly for years before seeking and receiving helpful

treatment. We now have effective, minimally-invasive treatments for women with

symptomatic fibroids. Most of these treatments can be done with small or no

incisions, reducing pain and recovery time and returning women to the good

quality of life they deserve.