What are Fibroids?
Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called Leiomyomas or Myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.
Who is most likely to have fibroids?
- Fibroids are most common in women aged 30–40 years.
- Black/African American women are more likely to develop fibroids.
- Having a family member with fibroids increases your risk.
- Overweight women have a higher risk of fibroids.
- Alcohol use and Diets high in beef and red meat can increase your risk.
What are the Symptoms of Fibroids?
Changes in your menstruation (Abnormal Uterine Bleeding)
- Heavier or longer periods (Menorrhagia)
- Worsening cramps with your period
- Bleeding in between your periods (Metrorrhagia)
- Anemia, Fatigue & feeling Tired from blood loss
Pain & Pressure
- Pelvic pain, lower back pain
- Pain during sex (Dyspareunia)
- Frequent urination and bladder pressure
- Constipation or persistent bloating
- Enlarging abdomen
- Bleeding during pregnancy
- Preterm labor and premature delivery
- Preterm contractions and abdominal pain
- Abnormal positioning of the baby
- Increased risk of Cesarean Delivery
- Worsening anemia
- Risk for blood transfusion
- Increased surveillance and ultrasounds during pregnancy
Fibroids can break down (degeneration) and cause pain, nausea, vaginal infections or fevers, but they can also grow rapidly and cause abdominal swelling. Fibroids also may cause infertility, and can complicate pregnancies and cause difficulty with prenatal care and delivery. When fibroids are thought to affect fertility or complicate a pregnancy, many women undergo treatment first, and then are able to become pregnant after they are treated.
Can Fibroids turn into Cancer?
Fibroids are almost always benign. Rarely <1/1000 a cancerous fibroid will occur. Having fibroids does not increase your chances of any other cancer.
How are Fibroids Diagnosed?
The first step to diagnosing fibroids is a thorough history and physical exam, including a pelvic exam. Based on your symptoms, your provider will usually request a Pelvic or Transvaginal Ultrasound to evaluate the uterus and visualize any fibroids. Ultrasounds are machines that use soundwaves to evaluate pelvic organs. They are performed the same-day as your visit, at your bedside with trained sonographers at Parkmed without need for a referral to an outside radiology center. This ultrasound is a quick and thorough assessment of your uterine cavity, ovaries and fallopian tubes, and can also detect Fibroids, Polyps and any other gynecologic pathology. Based on the initial findings, your physician may recommend additional imaging which may include:
Saline Infusion Sonography (SIS): a test in which fluid is put into the uterus through the cervix and ultrasonography is then used to show the inside of the uterus. This is useful for diagnosis of Polyps and Submucosal Fibroids.
Hysteroscopy: a camera device (Hysteroscope) is inserted through the vagina & cervix and used to directly visualize fibroids the inside of the uterus. It can also detect polyps, abnormal uterine shape and abnormal tissue.
Hysterosalpingography is a special X-ray test done at a radiology center that detects abnormal changes in the size and shape of the uterus and fallopian tubes.
Laparoscopy uses a camera device (the laparoscope) that is inserted through a small cut just below or through the navel (belly-button) to allow the doctor to see the inside of the abdomen & fibroids on the outside of the uterus.
CT Scan / MRI: these are imaging techniques done at a radiology center to visualize the details of your uterus and fibroids. They are used as a part of your surgical planning for complicated procedures, or to evaluate for cancer.
At Parkmed we perform our own ultrasonography, SIS and hysteroscopy at the office. If we feel that you may need additional detailed imaging, we will take care of your referrals and insurance approvals to any of our associated local radiology centers.
When should I seek Treatment?
Certain signs and symptoms may signal the need for treatment:
- Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
- Heavy periods and irregular bleeding between periods
- Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
- Rapid increase in growth of the fibroid
- Pelvic pain
Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment, but should be monitored with ultrasonography as recommended by your physician.
How are Fibroids Treated?
Medical drugs and surgical options both exist for fibroids. Different patients will require different approaches to the treatment of their fibroids. It is important that each patient is individually assessed and a treatment regimen is tailored specifically for them and the alleviation of their particular symptoms. Treatment is often dependent on the location of your fibroid, and the symptoms that you are experiencing. Certain medications may reduce the heavy bleeding and painful periods that fibroids cause but they may not prevent the growth of fibroids. Surgery often is needed as well. Drug treatment for fibroids includes the following options:
- NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) - helps with pain
- Birth control pills - helps with bleeding and pain
- IUD (Intrauterine Device) (Mirena)- helps with bleeding and pain
- Gonadotropin-releasing hormone agonists (GnRH) - used for only a short time and help to shrink the fibroid before surgery
- Antifibrinolytic agents - used in specific patients for heavy bleeding
- Other drugs can be used but only in very specific situations based on your provider’s evaluation
How are Fibroids removed?
Various surgeries can be performed to alleviate symptoms, shrink fibroids, or to remove fibroids, depending on the goal that you and your provider have agreed on.
Hysteroscopy - used to remove Submucosal fibroids that are inside the cavity of the uterus. Often, an instrument called a Resectoscope is used.
Endometrial Ablation - used to destroy the lining of the uterus to alleviate heavy bleeding. This can also be done selectively to reduce vasculature and shrink fibroids.
Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.
Hysterectomy is the removal of the uterus. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large and a woman is no longer planning to have children.
Uterine Artery Embolization (UAE) is a technique that cuts off blood flow to the uterus to shrink the fibroid - this is usually reserved for patients who are too high risk or not candidates for other surgeries.
Myomectomies and Hysterectomies can be performed using a variety of techniques. Most fibroids can be addressed using a Minimally-Invasive approach, with few or no incisions on the abdomen. For larger fibroids, your physician may recommend an open technique that may sometimes require a short stay in a hospital.
Fibroid Treatment at Parkmed
Parkmed specializes in fibroid management and outpatient treatment. Our board-certified physicians are experts at evaluating and treating patients with fibroids using all of the available techniques and combinations with the most up-to-date therapies and medications. We understand that each patient’s concerns are different and their treatment has to be individually designed. Because fibroids come in all sizes and exist in different parts of the pelvis, symptoms can vary greatly from one patient to the next. During your visits, we will do your full evaluation, sonogram and laboratory work and review all the appropriate treatments with you as we generate a plan together. We maintain two operative suites and we perform a multitude of procedures for fibroid treatment without the need for referral to a hospital including:
- Hysteroscopy with Fibroid Resection
- Endometrial Ablation
- Medical management of fibroids
- Infertility affected by fibroids
- D&C, Miscarriages & pregnancies affected by fibroids
If necessary, our Physicians also perform Laparoscopy, Minimally-Invasive Surgery, and Robotic-Assisted Surgery at NYU Langone Medical Center or Mount Sinai Hospital. Our office will take care of your insurance approvals, preoperative evaluation and schedule your surgery with one of our physicians at the hospital.
Whether you’ve been told that you have fibroids, are concerned about your symptoms, need a second opinion for surgery, or just want to plan a safe pregnancy, give us a call and make an appointment for your consultation today!