Fibroids – What Are They and What Can be Done About Them
Many women have fibroids. This article is an overview of them and the most recent methods of their treatment, if a woman feels that they impact on her life seeks to have them decreased in volume or eliminated.
What is a fibroid?
Uterine fibroids are noncancerous tumors which develop from the muscle tissue of the uterus (womb). These can be very tiny or grow to the size of a grapefruit or larger. You may have one fibroid or many. The majority of fibroids are not cancerous. These tumors affect women in their 40s and 50s most often and can cause heavy bleeding and pain. They can even grow so large as to make you appear pregnant. Fibroids can cause debilitating symptoms and often require consultation with an expert.
Which women get fibroids?
Fibroids most commonly occur in women 30 to 50 years of age. They are more prevalent in African American women, but any woman can get them. While the cause is unclear, research suggests fibroids develop from misplaced cells present in the body before birth. Hormonal drugs like birth control pills may contribute to fibroid growth, and fibroids can grow to massive size.
Do fibroids have symptoms?
For many women, fibroids often cause no symptoms. Other women suffer severe symptoms that significantly impact their quality of life. In women who experience symptoms, the most common include prolonged periods, heavy menstrual bleeding, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, constipation, backaches, leg pain and infertility. In rare cases, fibroids may cause acute pain, nausea, fever and swelling of the abdomen.
Should I see a doctor?
You should see a doctor if you experience pelvic pain that doesn’t go away, spotting or bleeding between periods, excessively heavy or painful periods, pain with intercourse, difficulty emptying your bladder or moving your bowels. Seek immediate care if you have the sudden onset of sharp pelvic pain or severe vaginal bleeding – saturating a “super” pad or tampon in less than one hour.
Treatment Options
Treatment Options
In general, most women with fibroids do not have any symptoms or complications and therefore, do not need treatment. If symptoms do develop, doctors may recommend watchful waiting. A doctor and patient may consider treating fibroids depending on the symptoms, the size of the fibroids, location of the fibroids, age, and whether a patient wants to get pregnant.
Medications: Most medications are given to treat the symptoms of fibroids rather than the fibroids themselves. Over-the-counter medications, such as ibuprofen (such as Motrin) an anti-inflammatory, or acetaminophen ( such as Tylenol), may be given to help relieve pain. Birth control pills may be prescribed to help alleviate symptoms and regulate the menstrual period.
Gonadotropin releasing hormone (Gn-RH) agonists, such as leuprolide (Lupron, Eliguard, nafarelin (Synarel), and goserelin (Zoladex), may help decrease the size of fibroids. They are often given before surgery to make fibroids smaller and easier to remove. Gn-RH usually triggers a new menstrual cycle, while Gn-RH agonists do the opposite. Gn-RH agonists cause estrogen and progesterone levels to fall, which causes menstruation to stop and fibroids to shrink. Hot flashes and depression may occur because of the drop in estrogen.
Mifepristone is an anti-hormonal agent that may help stop or slow the growth of fibroids. This agent only provides temporary relief of symptoms.
Danazol is a man-made androgen, or male hormone, known to relieve fibroid symptoms. It may help decrease uterine size, stop menstruation, and reverse anemia. However, this is not commonly used among women because it can cause facial hair growth, weight gain, acne, headache, and deepening of voice.
Are there different surgical options for fibroid removal?
In short, there are two main surgical approaches for fibroid removal, myomectomy and hysterectomy but more recent research and treatment option will be discussed later in this article. Myomectomy is surgical removal of the fibroid(s) leaving the uterus in place. This option is frequently recommended for women who still want to have children. Myomectomy does not prevent new fibroids from growing and more surgery may be necessary in the event of a recurrence. The second surgical approach is hysterectomy, the only proven permanent solution for fibroids. The vast majority of women are able to retain the ovaries, responsible for hormone production.
What’s the least invasive surgical treatment?
Modern gynecologic surgery offers minimally invasive options for virtually all major surgeries. We are definitely living in a new surgical landscape. Historically, surgeons performed most operations with large incisions across the abdomen, resulting in trauma to the body, pain and a long healing process. Not so today.
Advances in technology have revolutionized the surgical world, opening up new opportunities to replace large incisions with tiny ones. This is the basic concept of minimally invasive surgery or MIS. Small incisions minimize pain, cause much less trauma and allow for speedy recoveries. The new gold standard for removal of fibroids is via MIS, yet less than 40% of women in the US are aware of this option, and the majority of surgery continues to be performed with large incisions due to lack of advanced surgical training and expertise.
MIS procedures incorporate the use of endoscopic equipment such as a laparoscope to view the internal organs of a patient on a video monitor.
While robotic surgery has received a fair amount of attention lately, its role in gynecologic surgery remains controversial. Recent studies have revealed greater cost, longer surgeries, and more pain with robotic surgery as compared to laparoscopy. As an expert surgeon and educator in both techniques, Many doctors recommend the more patient friendly and cost effective laparoscopic approach for fibroids and robotic surgery for more complex cases involving cancer.
Myomectomy: The size, location, and number of fibroids a woman has will determine whether the surgery will be minor, performed in an outpatient setting, or major, requiring a patient to stay in the hospital for a few days. Because the uterus is left intact, fibroids may eventually grow back with this treatment. There is a 10-30% chance that fibroids will grow back. Some studies saw a 50% re-growth rate in African American women.
An abdominal myomectomy, in which the abdomen is opened up, is used in cases in which the fibroids are large and deep. A laparoscopic myomectomy, which uses a camera to locate the fibroids and a small instrument to remove the fibroids, is used for smaller fibroids and only requires small abdominal cuts. When fibroids are inside the uterus, a hysteroscopic myomectomy is conducted. The doctor places a hysteroscope through the cervix and removes the fibroids with the aid of a camera. About 20-40% of women have complications from myomectomies. Minor complications include bruising, mild infection, and fever. Bleeding and abdominal pain is expected after these procedures until a full recovery is made.
Two variations of a myomectomy, myolysis and cyromyolysis, have also been used. These procedures do not remove the fibroid but cut off the blood supply causing the fibroid to shrink and die. Myolysis uses a needle and electrical currents to destroy the vessels of the fibroids, thereby cutting off their blood supply. Cryomyolysis is similar but uses liquid nitrogen to freeze the fibroids. There is a risk of uterine rupture, so this procedure is not recommended in patients that want to get pregnant. Fibroids may not shrink with these treatments, and in some cases, cryomyolysis may cause the fibroids to increase in size. The overall safety, effectiveness, and risk of recurrence have not been determined.
Hysterectomy: A hysterectomy is the complete removal of the uterus and the only complete and permanent cure for fibroids. It is an invasive surgery and should only be done when the patient is not planning on having children afterwards. Removal of the ovaries is uncommon for women with fibroids, but if the ovaries are removed, menopause will be induced and a patient may have to decide if she wants hormone replacement therapy. There are many side effects after a hysterectomy, including hot flashes, weight gain, urinary incontinence, osteoporosis, and low sex drive. It is important to consider the risks and benefits of a hysterectomy.
Other, Newer surgical interventions
Endometrial ablation: This surgery uses a hysteroscope and heat to destroy the inner lining of the uterus, known as the endometrial lining. This may help patients who have heavy bleeding, but it will not be effective for fibroids outside the uterine lining. Women are not able to have children after this procedure because the endometrial lining is needed to nourish a growing fetus.
The laser ablation of fibroids successfully decreased fibroid volume by 50% to 70% in symptomatic women via the hysteroscopic (submucosal fibroids) or the laparoscopic route (subserosal or intramural fibroids). Presently, this treatment of uterine fibroids is by neodymium: yttrium-aluminium-garnet (Nd YAG) laser under MR guidance. The reduction in fibroid volume was 31% at 3 months follow-up, and 41% at the one year follow-up.
Other, Newer surgical interventions
Endometrial ablation: This surgery uses a hysteroscope and heat to destroy the inner lining of the uterus, known as the endometrial lining. This may help patients who have heavy bleeding, but it will not be effective for fibroids outside the uterine lining. Women are not able to have children after this procedure because the endometrial lining is needed to nourish a growing fetus.
The laser ablation of fibroids successfully decreased fibroid volume by 50% to 70% in symptomatic women via the hysteroscopic (submucosal fibroids) or the laparoscopic route (subserosal or intramural fibroids). Presently, this treatment of uterine fibroids is by neodymium: yttrium-aluminium-garnet (Nd YAG) laser under MR guidance. The reduction in fibroid volume was 31% at 3 months follow-up, and 41% at the one year follow-up.
Uterine fibroid embolization (UFE): UFE is a newer, non-surgical procedure that an interventional radiologist performs. A catheter is placed into the artery that supplies blood to the uterus and the fibroids. Tiny particles are released and the blood flow to the uterus is cut off, causing the fibroids to shrink. The procedure takes about an hour and most women stay one night in the hospital. The patient is conscious, but sedated, during the procedure and given narcotics for the pain. UFE treats all types of fibroids and is a good option for women who do not want to undergo surgery. A complication of this procedure is infection, which may affect the ovaries. Infections are typically treated with antibiotics. UFE is only suggested to those women that do not want children because the effect it has on fertility is not known. However, there have been women who have had successful pregnancies following UFE. There is some evidence suggesting that fibroids will not grow back, but more long-term data are needed.
Focused ultrasound surgery: Ultrasound Treatment is referred to as knifeless surgery. This type of treatment has many advantages. It can be performed on an outpatient basis and does not require anesthesia. Not all fibroids can be treated using this method. To find out if you are a candidate for ultrasound treatment, your physician will order an MRI of your uterus. This test will provide him with the precise locations of your fibroids, which will determine if they can be reached by the ultrasound. The MRI images will also be used during treatment to help pinpoint the fibroids for ultrasound application.
Focused ultrasound surgery (FUS) uses a special MRI scanner to guide the doctor to the location of the fibroid. Currently, Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids (MRgFUS) has been broadly accepted as an option for the treatment of uterine fibroids.
With the recent reports of commercial treatment, with proper selection of patient population, the treatment volume is often more than 50%. It has been shown that the percent of nonperfused volume ratio in the 6-month follow-up was around 47%. Other reports indicate that the mean percent of the nonperfused volume ratio was 60% immediately upon completion of MRgFUS treatment, with the fibroids shrinking by about 39% at 6 months. Once the fibroids are found, high-frequency, high-energy sound waves destroy the fibroids, so no incision is needed. Women who wish to avoid surgery and to preserve their uterus may benefit from this option. One treatment may last up to several hours and the long-term effects are not known.
Obviously, the choice of whether to get fibroids removed and how is a personal decision for a woman and should be discussed with her physician. I can only suggest that you should seek more than one opinion and get recommendations for the type of surgery possible in your case.
Focused ultrasound surgery (FUS) uses a special MRI scanner to guide the doctor to the location of the fibroid. Currently, Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids (MRgFUS) has been broadly accepted as an option for the treatment of uterine fibroids.
With the recent reports of commercial treatment, with proper selection of patient population, the treatment volume is often more than 50%. It has been shown that the percent of nonperfused volume ratio in the 6-month follow-up was around 47%. Other reports indicate that the mean percent of the nonperfused volume ratio was 60% immediately upon completion of MRgFUS treatment, with the fibroids shrinking by about 39% at 6 months. Once the fibroids are found, high-frequency, high-energy sound waves destroy the fibroids, so no incision is needed. Women who wish to avoid surgery and to preserve their uterus may benefit from this option. One treatment may last up to several hours and the long-term effects are not known.
Obviously, the choice of whether to get fibroids removed and how is a personal decision for a woman and should be discussed with her physician. I can only suggest that you should seek more than one opinion and get recommendations for the type of surgery possible in your case.
via Blogger http://chiropractic-lane.blogspot.com/2013/08/fibroids-what-are-they-and-what-can-be.html
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