Fibroid Must Knows
What is a Uterine Fibroid Tumor?Fibroid tumors are benign (non-cancerous) growths that appear on the muscular wall of the uterus. They are the most common tumors of the body. You may hear them called other names like leiomyoma, leiomyomata, or myoma. They range in size from microscopic to masses that fill the entire abdominal cavity. In some cases, fibroids can be as large as a full term pregnancy. Uterine fibroids can affect women of all ages, but are most common in women ages 40 to 50. In most cases, there is more than one fibroid in the uterus. Fibroids consist of dense, fibrous tissue (hence the name ‘fibroid’) and are nourished and sustained by the uterine arteries in almost every case.
Uterine fibroids cause different symptoms depending on their number and where they are located in the uterus.
There are 3 different locations: intramural uterine fibroids, submucosal uterine fibroids and subserosal uterine fibroids.
Intramural Uterine Fibroids
Submucosal Uterine Fibroids
Are located inside the lining of the uterus and protrude inward. These cause heavy bleeding and heavy, prolonged periods.
Subserosal Uterine Fibroids
Are located outside of the lining of the uterus and protrude outward. They have less of an effect on your period, but may cause back pain or bladder pressure. The subserosal fibroid can also grow on a stalk attached to the uterus, in which case it is called ‘pendunculated.’ The stalk may become twisted and can cause severe pelvic pain.
What are the symptoms?While not cancerous, uterine fibroids can cause problems. Depending on size, location and number of fibroids, common symptoms include:
- Pelvic pain and pressure
- Excessive bleeding, including prolonged periods and passage of clots, which can lead to anemia.
- Abdominal swelling
- Pressure on the bladder, leading to frequent urination
- Pressure on the bowel, leading to constipation and bloating
Though very common, most fibroids don’t cause symptoms- only 10 to 20 percent require treatment. However, you may experience no symptoms or have mild symptoms, but still need treatment.
Why do I have them?
No one knows. Fibroids affect 40% of women over 35 years in America and have a higher incidence among African Americans. There is a link between uterine fibroid tumors and estrogen production. Fibroids can grow very large during pregnancy, when estrogen levels are high, and can shrink back down after pregnancy. They sometimes improve in menopause, when estrogen levels decrease.
How do I find out if I have fibroids?
Women usually will undergo an ultrasound to determine if fibroids are present. Magnetic Resonance Imaging (MRI) is also used to determine if fibroids can be treated with embolization and provide information about any underlying disease.
Uterine Fibroid Treatment
There are many treatments available if you have fibroids. If your doctor recommends a hysterectomy, you should seek a second opinion and be aware of all your options. Most women with symptomatic fibroids are candidates for Uterine Artery Embolization, but should consult with their doctor to determine if it is the right choice for them.
Uterine Artery Embolization is Non-Surgical
Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE) is an endovascular procedure, meaning it is done through the arterial system. It is non-surgical and minimally invasive. It does not require general anesthesia- the groin is numbed and the patient is sedated, but still conscious enough to respond to questions.
The surgeon first makes a small nick in the skin on the groin, above the femoral artery and inserts a catheter. Under real-time x-ray guidance, the surgeon identifies the uterine artery on both sides of the uterus. These arteries supply blood for the fibroids in most patients suffering from uterine fibroids. The doctor then injects tiny particles, about the size of a grain of sand, into the uterine arteries to block the blood supply to the uterus. These particles slow blood flow to the fibroids, causing them to shrink.
Recovery time after uterine fibroid embolization is usually an over-night stay in the hospital, mostly to monitor pain with pain medications. Most women return to light activities and work within one week. After embolization, bleeding stops immediately in most patients, and fibroids shrink gradually to about 50% within 6 months.
Uterine fibroids can be treated with surgery, including hysterectomy, which removes the entire uterus, and myomectomy, which removes the fibroids but leaves the uterus. Both are major surgeries that require 4 days in the hospital and a 6-week recovery period. Myomectomy can preserve fertility, but carries the additional risk of recurrence, since most women have multiple fibroids and it is impossible to cut them all out. Moreover, small fibroids will often grow into large ones with time.