Fibroids

Symptoms

Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a doctor

See your doctor if you have:

• Pelvic pain that doesn't go away
• Overly heavy, prolonged or painful periods
• Spotting or bleeding between periods
• Difficulty emptying your bladder
• Unexplained low red blood cell count (anemia)

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

How are uterine fibroids diagnosed?

In many cases, fibroids are first discovered during a regular exam. They can be felt during a pelvic exam and can be found during a gynecologic exam or during prenatal care. Quite often your description of heavy bleeding and other related symptoms may alert your doctor to consider fibroids as a part of the diagnosis. There are several tests that can be done to confirm fibroids and determine their size and location. These tests can include:

An anesthesiologist will give you either:

• Ultrasonography: This non-invasive imaging test creates a picture of your internal organs with sound waves. Depending on the size of the uterus, the ultrasound may be performed by the transvaginal or transabdominal route.
• Magnetic resonance imaging (MRI): This test creates detailed images of your internal organs by using magnets and radio waves.
• Computed tomography (CT): A CT scan uses X-ray images to make a detailed image of your internal organs from several angles.
• Hysteroscopy: During a hysteroscopy, your provider will use a device called a scope (a thin, flexible tube with a camera on the end) to look at fibroids inside your uterus. The scope is passed through your vagina and cervix and then moved into your uterus.
• Hysterosalpingography (HSG): This a detailed X-ray where a contrast material is injected first and then X-rays of the uterus are taken. This is more often used in women who are also undergoing infertility evaluation.
• Sonohysterography: In this imaging test, a small catheter is placed transvaginally and saline is injected via the catheter into the uterine cavity. This extra fluid helps to create a clearer image of your uterus than you would see during a standard ultrasound.
• Laparoscopy: During this test, your provider will make a small cut (incision) in your lower abdomen. A thin and flexible tube with a camera on the end will be inserted to look closely at your internal organs.

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. If you aren’t experiencing any symptoms from your fibroids, you may not need treatment. Small fibroids can often be left alone. Some women never experience any symptoms or have any problems associated with fibroids. Your fibroids will be monitored closely over time, but there’s no need to take immediate action. Periodic pelvic exams and ultrasound may be recommend by your healthcare provider depending on the size or symptoms of your fibroid.If you are experiencing symptoms from your fibroids — including anemia from the excess bleeding, moderate to severe pain, infertility issues or urinary tract and bowel problems — treatment is usually needed to help. 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.

The best treatment option for you will also depend on your future fertility goals. If you want to have children in the future, some treatment options may not be an option for you. Talk to your healthcare provider about your thoughts on fertility and your goals for the future when discussing treatment options. 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.

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, your doctor will use the scope to cut away the fibroids. Your doctor 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. 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.