Other facts about fibroids
Other key points about uterine fibroids:
- Uterine fibroids are the most common tumor of the reproductive tract.
- Women who are nearing menopause are at the greatest risk for fibroids.
- Fibroids are most often found during a routine pelvic exam.
- Symptoms may include heavy and prolonged periods, bleeding between periods and pelvic pain.
- There are a variety of treatment options available.
Where do fibroids grow?
- There are several places both inside and outside of your uterus where fibroids can grow. The location and size of your fibroids is important for your treatment. Where your fibroids are growing, how big they are and how many of them you have will determine which type of treatment will work best for you or if treatment is even necessary.
- There are different names given for the places your fibroids are located in and on the uterus. These names describe not only where the fibroid is, but how it’s attached. Specific locations where you can have uterine fibroids include:
- Submucosal fibroids: In this case, the fibroids are growing inside the uterine space (cavity) where a baby grows during pregnancy. Think of the growths extending down into the empty space in the middle of the uterus.
- Intramural fibroids: These fibroids are embedded into the wall of the uterus itself. Picture the sides of the uterus like walls of a house. The fibroids are growing inside this muscular wall.
- Subserosal fibroids: Located on the outside of the uterus this time, these fibroids are connected closely to the outside wall of the uterus.
- Pedunculated fibroids: The least common type, these fibroids are also located on the outside of the uterus. However, pedunculated fibroids are connected to the uterus with a thin stem. They’re often described as mushroom-like because they have a stalk and then a much wider top.
How are uterine fibroids treated?
Treatment for uterine fibroids can vary depending on the size, number and location of the fibroids, as well as what symptoms they’re causing. Your treatment plan will depend on a few factors, including:
- How many fibroids you have.
- The size of your fibroids.
- Where your fibroids are located.
- What symptoms you are experiencing related to the fibroids.
- Your desire for pregnancy.
- Your desire for uterine preservation. Treatment options for uterine fibroids can include:
Medications
- Over-the-counter (OTC) pain medications: These medications can be used to manage discomforts and pain caused by the fibroids. OTC medications include acetaminophen and ibuprofen.
- Iron supplements: If you have anemia from the excess bleeding, your provider may also suggest you take an iron supplement.
- Birth control: Birth control can also be used to help with symptoms of fibroids — specifically heavy bleeding during and between periods and menstrual cramps. Birth control can be used to help control heavy menstrual bleeding. There are a variety of birth control options you can use, including oral contraceptive pills, intravaginal contraception, injections and intrauterine devices (IUDs).
- Gonadotropin-releasing hormone (GnRH) agonists: These medications can be taken via a nasal spray or injection and they work by shrinking your fibroids. They’re sometimes used to shrink a fibroid before surgery, making it easier to remove the fibroid. However, these medications are temporary and if you stop taking them, the fibroids can grow back.
- Oral therapies: Elagolix is a new oral therapy indicated for the management of heavy uterine bleeding in premenopausal women with symptomatic uterine fibroids. It can be used up to 24 months. Talk to your doctor for pros and cons of this therapy. Another oral therapy, Tranexamic acid, is an antifibrinolytic oral drug that’s indicated for the treatment of cyclic heavy menstrual bleeding in women with uterine fibroids. Your doctor will monitor you during this therapy.
It’s important to talk to your healthcare provider about any medication you take. Always consult your provider before starting a new medication to discuss any possible complications.
Fibroid surgery
There are several factors to consider when talking about the different types of surgery for fibroid removal. Not only can the size, location and number of fibroids influence the type of surgery, but your wishes for future pregnancies can also be an important factor when developing a treatment plan. Some surgical options preserve the uterus and allow you to become pregnant in the future, while other options can either damage or remove the uterus.
Myomectomy is a procedure that allows your provider to remove the fibroids without damaging the uterus. There are several types of myomectomy. The type of procedure that may work best for you will depend on where your fibroids are located, how big they are and the number of fibroids. The types of myomectomy procedure to remove fibroids can include:
- Hysteroscopy: This procedure is done by inserting a scope (a thin, flexible tube-like tool) through the vagina and cervix and into the uterus. No incisions are made during this procedure. During the procedure, you provider will use the scope to cut away the fibroids. Your provider will then remove the fibroids.
- Laparoscopy: In this procedure, your provider will use a scope to remove the fibroids. Unlike the hysteroscopy, this procedure involves placing a few small incisions in your abdomen. This is how the scope will enter and exist your body. This procedure can also be accomplished with the assistance of a robot.
- Laparotomy: During this procedure, an incision is made in your abdomen and the fibroids are removed through this one larger cut.
If you aren’t planning future pregnancies, there are additional surgical options your healthcare provider may recommend. These options are not recommended if pregnancy is desired and there are surgical approaches that remove the uterus. These surgeries can be very effective, but they typically prevent future pregnancies. Surgeries to remove fibroids can include:
- Hysterectomy: During this surgery, your uterus is removed. A hysterectomy is the only way to cure fibroids. By removing your uterus completely, the fibroids can’t come back and your symptoms should go away. If your uterus alone is removed — the ovaries are left in place — you will not go into menopause after a hysterectomy. This procedure might be recommended if you’re experiencing very heavy bleeding from your fibroids or if you have large fibroids. When recommended, the most minimally invasive procedure to perform hysteroscopy is advisable. Minimally invasive procedures include vaginal, laparoscopic or robotic approaches.
- Uterine fibroid embolization: This procedure is performed by an interventional radiologist who works with your gynecologist. A small catheter is placed in the uterine artery or radial artery and small particles are used to block the flow of blood from the uterine artery to the fibroids. Loss of blood flow shrinks the fibroids — improving your symptoms.
- Radiofrequency ablation (RFA): This is a safe and effective treatment for women with symptomatic uterine fibroids and can be delivered by laparoscopic, transvaginal or transcervical approaches.
There’s also a newer procedure called magnetic resonance imaging (MRI)-guided focused ultrasound that can be used to treat fibroids. This technique is actually done while you’re inside a MRI machine. You are placed inside the machine — which allows your provider to have a clear view of the fibroids — and then an ultrasound is used to send targeted sound waves at the fibroids. This damages the fibroids.
What are the complications of uterine fibroids?
It is uncommon for fibroids to cause severe health consequences. However, women can have heavy bleeding that can lead to dangerous anemia, or lack of red blood cells.
Rarely, large fibroids can press on the bladder and the channel (ureter) that sends urine there from the kidney. This pressure can lead to kidney damage. Other complications include infertility and repeated pregnancy loss.
Uterine Fibroid Prevention
Fibroids can’t be prevented, but there is some research that suggests certain lifestyle habits can reduce your chances.
One study found that high-sugar diets may be linked to a higher risk in some women. Another study found that eating fresh fruits and cruciferous vegetables like arugula, broccoli, cabbage, cauliflower, collard greens, and turnip greens could lower your odds. Cruciferous vegetables are rich in beta-carotene, folate, vitamins C, E, and K, and other minerals. They’re also full of fiber.
Regular exercise also can lower your chances of uterine fibroids.
Sources: https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids, https://www.uclahealth.org/fibroids/what-are-fibroids, https://www.webmd.com/women/uterine-fibroids/uterine-fibroids