Uterine fibroids

In many cases, uterine fibroids are found during a routine pelvic exam. When your doctor does an internal exam to feel the organs of the lower pelvis, they can feel irregularities in the uterus that alert them to the presence of fibroids.

If fibroids have not been detected during a physical exam but you have symptoms, the primary tests your doctor will order may include:

• Ultrasound – This will provide an image of your uterus and any fibroids that are present.
• Blood test – This will test your complete blood count (CBC) to check for anemia, and it will check for blood disorders or thyroid issues.

In addition, your doctor might order one or more of the following tests:

• Magnetic resonance imaging (MRI) – This is an imaging test that provides more detail than an ultrasound.
• Hysterosonography – This test involves the insertion of a saline solution into the uterus to expand it, so that it is easier to get good images of the uterine lining and any fibroids that are present.
• Hysterosalpingography – This test uses a dye to make the uterine cavity and fallopian tubes easier to see on an x-ray. This is a test that is often recommended if there is a concern of infertility.
• Hysteroscopy – This test involves the insertion of a small telescope with a light into the uterus via the vagina and cervix. A saline solution is used to expand the uterine cavity, so the walls of the uterus and fallopian tubes can be viewed.

Treatment

In many cases, there is no need for treatment. However, if fibroids are causing pain or discomfort, heavy menstrual bleeding, or other disruptions to your quality of life, you have a number of options.

Your treatment options depend on the size, location, and number of fibroids you have. Your doctor will consider the severity of your symptoms, your age, and your medical history, as well as your reproductive goals, when deciding on a treatment. Treatment for uterine fibroids may include medication, particularly if your symptoms are mild. Your doctor may recommend over-the-counter pain relief medication to relieve discomfort during your menstrual period.

If your symptoms are interfering with your life, your doctor may prescribe birth control pills or recommend a hormone-releasing intrauterine device (IUD) to regulate your hormone levels and decrease symptoms. Medications called gonadotropin-releasing hormone agonists can also be used to shrink uterine fibroids.

If you need treatment beyond medication, there are a number of minimally invasive procedures that can be done, including:

• Uterine artery embolization – Doctors can shrink uterine fibroids by cutting off their blood supply. During a uterine artery embolization, doctors place tiny plastic or gel particles into the blood vessels feeding the fibroids.
• Radiofrequency ablation – This treatment uses radiofrequency energy to destroy fibroids and shrink the blood vessels that are feeding them. The procedure consists of making two incisions in the abdomen through which a camera is inserted to located fibroids. Once a fibroid is found, a device inserts tiny needles into the fibroid to heat the fibroid tissue and destroy it.
• Hysteroscopic myomectomy – During the hysteroscopy described above, your doctor may be able to remove fibroids that are attached to the uterine lining.
• Endometrial ablation – This specialized procedure uses heat, electricity, microwave energy, or hot water to destroy the lining of the uterus in order to eliminate most fibroids.
• Laparoscopic myomectomy – Also known as a robotic myomectomy, this procedure requires small incisions to be made in the abdomen, through which thin instruments will be inserted to remove the fibroids.

In some instances, when fibroids are severe, more traditional surgery is required. There are two options here. An abdominal myomectomy is surgery to remove uterine fibroids. Surgeons take out the fibroids in the uterus but leave the uterus intact. If a woman is done having children, her surgeon may suggest a hysterectomy (surgical removal of the entire uterus) instead.

Preparation

When preparing for your initial diagnostic appointment with your doctor, be prepared to discuss your symptoms and medical history and to ask any questions you have. You should also be ready to undergo a pelvic exam.

When preparing for the treatment of your fibroids, you will meet with your doctor and care team, who will ensure you know what to expect and what to do to ahead of your procedure. Some general tips include:

• Do not shave the general area of the surgery.
• Stop eating or drinking the night before the surgery (usually eight hours).
• Stop taking any medications that your doctor indicates (such as blood thinners) at the appointed time prior to surgery.
• Ensure you have someone to drive you home after the procedure.
• Prepare your home to make it more comfortable during your recovery.
• Pack for a hospital stay if you will be admitted after the procedure.

Your doctor will discuss your treatment options with you and help you select the most appropriate treatment for your personal situation.

Recovery

Your recovery from fibroid treatment will depend on a number of factors, including your age, level of health, severity of your fibroids, and the method of removal. The less invasive the treatment is, the quicker the recovery.

Minimally invasive treatments are done on an outpatient basis. This means you will be discharged the same day of the surgery and will have a shorter recovery time than you would with a more invasive procedure. Often, you can return to work and other regular activities within three to five days.

With a laparoscopic myomectomy, you will need to fast and will be put under general anesthesia. You will also be in the hospital overnight, and full recovery will take two to four weeks, although you will be able to return to work as soon as you feel up to it.

With an abdominal myomectomy, you will also need to fast and be under general anesthesia. Because this is an invasive procedure, you will stay in the hospital for up to four days after the surgery. Full recovery takes four to six weeks.

Results

In most cases, once fibroids have been removed, there is relief from the symptoms associated with them. In addition, many women experience increased fertility.

Complications

It is extraordinarily rare that uterine fibroids are cause for concern. However, they can lead to heavy periods, which can cause anemia to develop. There is also a rare chance that uterine fibroids could cause infertility or preterm delivery during pregnancy.

In addition, uterine fibroids are sometimes removed using morcellation, which involves breaking down the fibroid tissue into smaller pieces for easier removal. If there is any cancerous mass present that is also broken into pieces, there could be a risk of spreading the cancer.

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare