Every woman may feel frightened when diagnosed to have a uterine fibroid. Uterine fibroids occur in childbearing age, because uterine fibroid causes are linked to hormonal imbalance. Uterine fibroids treatment options include both, conservative and surgical methods. Below you may find more detailed information about types of fibroids, as well as uterine fibroids treatment and diagnosis methods.
Uterine fibroids are benign growths that develop in the muscular wall of the uterus. These fibroids can range in size from very tiny (quarter of an inch) to larger than a cantaloupe. Fibroids are known to grow to a size similar to that of a 5 month pregnancy; in most cases there could be more than one fibroid in the uterus. Although there are no fibroid causing symptoms they can lead to problems like heavy bleeding and pain.
During pregnancy, fibroids can increases dramatically; this is thought occur as a result of an increase in estrogen levels during pregnancy but shrink back to the original size pre-pregnancy. The fibroid condition improves after menopause due to the decrease of estrogen circulation the blood. However, women who have reached the menopausal stage and are taking supplemental estrogen do not experience a relief of symptoms. Uterine fibroids are the most common tumours of the female genital tract. They are very common in women and they cause minor or no symptoms. They can also be known as leiomyomata, myoma or fibromyoma.
UTERINE FIBROIDS SYMPTOMS
Though fibroid does not cause symptoms they can cause problems depending on size, location and number of fibroids present. They include:
- Pelvic pain and pressure.
- Back and leg pains.
- Pain during sexual intercourse.
- Bladder pressure leading to frequent urge to urinate.
- Pressure on the bowel leading to constipation and bloating.
- Abnormally enlarged abdomen.
- Prolonged heavy menstrual periods and unusual monthly bleeding leading to anaemia.
UTERINE FIBROIDS TREATMENT OPTIONS
- Watchful Waiting: Many women exhibit little or no signs or symptoms of fibroids, in this case, watchful waiting could be the best option. Fibroids are not cancerous, rarely interfere with pregnancies and they tend to shrink after menopause.
Medications for fibroids do not eliminate them but shrink them by targeting hormones that regulate menstrual cycles and treating symptoms like heavy bleeding. These medications include:
- Gonadotropin-releasing hormone (Gn-RH) agonists: These include drugs like Lupron, Synarel that treat are used for the treatment of fibroids by blocking the production of estrogen and progesterone thereby putting one in a temporary postmenopausal state. This medication may be prescribed by the doctor to shrink the size of the fibroid before a planned surgery. This medication is not taken for more than six months as it may lead to bone loss.
- Progestin-releasing intrauterine device (IUD): This does not eliminate or shrink the fibroids but provides symptom relief, for example, relieving heavy bleeding caused by fibroids.
- Other medications: Other medications such as oral contraceptives or progestin which help to control menstrual bleeding, NSAIDs which may be effective in relieving pain related to fibroids can be recommended by the doctor. Vitamins and iron supplements may also be suggested to in cases of heavy bleeding and anaemia.
MRI-guided focused ultrasound surgery (FUS): This is a non-invasive treatment option for uterine fibroids where the uterus is preserved, no incision is required and is performed on an outpatient basis. This procedure is carried out in an MRI scanner equipped with a high energy ultrasound transducer which focuses sound waves into the fibroid (once it is located) to heat and destroy small areas of fibroid tissue. This is a safe and effective method for treating uterine fibroids.
MINIMALLY INVASIVE PROCEDURES
These are procedures which can destroy uterine fibroids without actually removing them through surgery. This includes:
- Uterine artery embolization: The objective of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply. Complications may occur if the blood supply to the ovaries and other parts of the body’s organ is compromised.
- Myolysis: This is a laparoscopic procedure where electric current or laser is used to destroy fibroids and shrink the blood vessels supplying them. Cryomyolsis is a similar method where the fibroids are frozen.
- Laparoscopic or robotic myomectomy: During myomectomy, the surgeon removes the fibroids and leaves the uterus in place. In cases where the fibroids are small, the doctor uses the laparoscopic or robotic procedure where slender instruments are inserted through small incisions made in the abdomen. The doctor views the abdominal area through a camera attached to one of the instruments. Robotic myomectomy offers a 3-D view of the abdomen offering more precision, flexibility and dexterity compared to other methods.
- Hysteroscopic myomectomy: This procedure is considered if the fibroids are contained in the uterus (submucosal). The fibroids are removed using instruments that are inserted through the vagina and cervix to the uterus.
- Endometrial ablation and resection of submucosal fibroids: This form of treatment destroys the lining of the uterus through the insertion of a specialized instrument into the instrument which makes use of heat, microwave energy, hot water or electric current.
TRADITIONAL SURGICAL PROCEDURES
Options for traditional surgical procedures include:
- Abdominal myomectomy: An open abdominal surgery may be performed if the doctor finds multiple fibroids, very large fibroids or very deep fibroids. This procedure can be performed in place of hysterectomy.
- Hysterectomy: This is the surgical removal of the uterus which is a proven permanent solution to uterine fibroids. This procedure ends the ability of a woman get pregnant and may bring on menopause if the ovaries are elected to be removed.
SECOND OPINION PRIOR TO HYSTERECTOMY
Patients should be aware of all the treatment options available. Those considering the surgical option should also get a second opinion from a seasoned radiologist who is most qualified in interpreting MRI and determining if they are candidates for the interventional procedure.
DIAGNOSING UTERINE FIBROIDS
- Physical examination: Uterine fibroids are usually found during routine pelvic exams. The doctor may feel irregularities in the shape of the uterus which may suggest the presence of fibroids. Tests ordered by the doctor following symptoms of uterine fibroids.
- Ultrasound: The doctor may recommend this if confirmation is needed. This test makes use of high frequency sound waves to create images of the internal body. To create the images of the reproductive organs, a device known as the transducer is either pressed against the abdominal skin or inserted into the vagina to get images of the uterus.
- Lab tests: In experiencing abnormal vaginal bleeding, tests may be ordered to investigate potential causes. These tests include complete blood count (CBC) that determines if one has anaemia due to chronic blood loss. Other blood tests rule out bleeding disorders or thyroid problems.
- Magnetic Resonance Imaging (MRI): This is an imaging test which gives the precise location and size of the fibroids and helps in determining the appropriate treatment for it.
- Hysterosonography: This Is also known as saline infusion sonogram where sterile saline is used in expanding the uterine cavity making it easier to capture images of the uterine cavity and endometrium.
- Hysterosalpingography: This procedure makes use of a dye to highlight the uterine cavity and fallopian tubes on x-ray images. This is recommended by the doctor in concerns of infertility. Apart from detecting fibroids, it also lets the doctor if the fallopian tubes are open.
- Hysteroscopy: This involves the insertion of a small instrument known as a hysteroscope into the uterus. A saline solution is injected following the insertion of the instrument which expands the uterine cavity allowing the doctor examine the walls and the fallopian tubes.