Fibroids are tumors that each grow from a single cell, but are usually non-cancerous. We don’t know exactly what causes them but there may be genetic and environmental factors – race and maybe diet play a part. Up to 50% of African-American women have them, up to 25% of other ethnicities. Not all fibroids need treatment – only if they are causing symptoms like heavy or painful periods or pelvic pressure symptoms including pushing on the bladder causing frequent urination, or if they are affecting fertility.
Treatment should be individualized, not ‘one-size-fits-all’. Other than hysterectomy these are the options:
- 1. Myomectomy – surgical removal of fibroids. This can be done through the hysteroscope (a small telescope that goes through the cervix) for fibroids that are totally or partly inside the cavity of the uterus. Open myomectomy goes through a bikini-line or vertical incision in the abdomen and can remove large fibroids or fibroids deep inside the muscle of the uterus. Laparoscopic myomectomy uses a telescope through the belly button, and small incisions, to remove fibroids on the outside of the uterus. These procedures are most appropriate for women who want to have children in the future, but can be done if a woman just wants to keep her uterus. With the open myomectomy, we can do an ultrasound scan during the surgery to find smaller fibroids that could be missed and cause problems in the future. It is safe to get pegnant after a myomectomy but you may need a C/Section for delivery, depending on where the fibroid or fibroids were located.
- 2. Uterine artery embolization / uterine fibroid embolization (UAE / UFE) – an interventional radiologist can insert material into the blood vessels ‘feeding’ a fibroid to reduce its blood supply. This can shrink a fibroid but may not make it disappear altogether. This procedure is non-surgical but has complications, including post-procedure pain, infection or blood clots. It is not appropriate for women who want to have kids in the future – it may not be safe to get pregnant, and the procedure can reduce the blood supply to the ovaries, which get part of their blood flow from the uterus, causing diminished ovarian reserve (low egg supply).
- 3. MRI-guided focused ultrasound (MRgFUS) – this non-surgical procedure uses Magnetic Resonance Imaging (MRI) to direct a powerful ultrasound beam to damage fibroids and cause them to shrink. This can be performed by a specially trained Ob/Gyn or an interventional radiologist. Again, it may shrink a fibroid but may not make it disappear altogether. It is also not an appropriate choice for a woman who wants to have children in the future.
We don’t have good medications to shrink fibroids other than Depo-Lupron shots (a monthly or 3-monthly injection given in a Dr’s office) which may be used short-term – their best use is to shrink and soften fibroids before hysteroscopic surgery. They are not a long-term treatment for fibroids due to side-effects. This may change in the future as a new class of medicines comes out (oral GnRH antagonists).
If you are interested in future fertility I recommend seeing a Reproductive Endocrinologist, and even if you are not interested in childbearing or done with having kids we can see you as a Gynecology patient for the heavy periods and offer you a more detailed evaluation. There are interventional radiologists who offer the UAE / UFE procedure.There may be one physician offering MRgFUS in the Seattle area in the near future.
