Written By: Mary Powell, MD/OB/GYN Uterine fibroids are a common gynecologic condition that many women will experience during their lifetime. In brief, fibroids are a benign (noncancerous) growth of the uterine smooth muscle type cells that develops within the uterus. They can range in size from very small (< 1 cm), to very large (> 15cm). They may develop in the center of the uterine cavity, in the wall, or on the outside of the uterus. Women may have multiple fibroids or just one.
Treatment of uterine fibroids is not always necessary. Many women have them present without symptoms. The two category of symptoms that often result in treatment are bleeding abnormalities or pain/pressure symptoms. The location of the uterine fibroid tends to have the biggest impact on bleeding. Those fibroids that are located in the central part of the uterus (the endometrial cavity) are often associated with the most bleeding, even if on the smaller size. The fibroid in that location can often be removed with a minimally invasive procedure, called a hysteroscopy. This involves placing a small camera through the cervix after some dilation to visualize the fibroid. Then tools can be used to remove the tissue from the cavity. No incisions are needed for this procedure, which leads to rapid recovery.
The women that have pain and or pressure symptoms that are bothersome tend to have larger fibroids or multiple ones that cause an overall global enlargement to the uterus. The increase in uterine size can put pressure on nearby organs, such as the bladder and bowels. If these symptoms are due to an isolated fibroid sometimes treatment can be directed to that fibroid alone. If multiple fibroids are the cause and maintaining childbearing is not desired, then removal of the uterus (hysterectomy) along with its attached fibroids is often the most effective treatment. For women that desire future pregnancies a myomectomy (which involves removal of the fibroid alone) can sometimes be offered. It is still a significant surgery associated with risk of bleeding, infection, and the typical surgical risks. Plus, it can weaken the uterine wall and may require future pregnancies to be delivered 3-4 weeks prior to the due date and by cesarean section.
There are some additional treatments for fibroids that can be offered by specialists that do not always require a hysterectomy. This can include uterine artery embolization, a procedure offered typically by interventional radiologists. If you have been diagnosed with fibroids, please come see us. We can review your unique situation and help you determine what (if any) additional evaluation or treatment is warranted.