By August Bruno, Jr. MD
Uterine fibroids are the most common non-cancerous tumors in women of childbearing age.
Made of smooth muscle cells and other material found in or on the wall of the uterus, fibroids can cause pain, abnormal uterine bleeding, and make it difficult for a woman to get pregnant or maintain a pregnancy. Up to 80 percent of women have fibroids by age 50.
There are three types of fibroids. Intramural fibroids, the most common, appear within the muscular wall of the uterus, and can grow larger, causing the womb to stretch. Subserosal fibroids, which form on the outer edge of the uterus, can grow into large masses that cause pressure, pain, abdominal protrusion, and significant bleeding problems due to their position along the uterine lining where menstrual bleeding occurs. Medical experts don’t know what causes fibroids, but believe hormone imbalance, obesity, a family history of fibroids, alcohol use, and being African American are contributing factors.
Fibroid symptoms depend on the number of tumors present, their location, and size; however, some women have no symptoms. Fibroids can cause heavy bleeding with blood clots between or during periods, pelvic and lower back pain, increased menstrual cramping, lengthier periods, increased urination, painful intercourse, and lower abdominal and pelvic pressure. Such symptoms require the expertise of a gynecologist for a proper diagnosis, which often includes a pelvic ultrasound or MRI.
Fibroid treatment options depend on many factors — a woman’s desire to have children; whether they are nearing menopause; the number, size, and location of their fibroids; the presence of abnormal uterine bleeding, pelvic pressure, or pain; and whether they have symptoms associated with bulk, such as constipation or increased urination due to fibroid size. Conservative therapies include hormone regulating medications, such as birth control pills; a progesterone-releasing IUD; gonadotropin releasing hormone (GnRH) analogs, which are medications that reduce the ovaries’ hormone production; and tranexamic acid, a medication that reduces blood flow. While all of these options can help reduce bleeding and pain, they do not shrink or eliminate fibroids.
Other minimally invasive therapies include focused ultrasound ablation (targeted high frequency sound waves to shrink and remove fibroids); radiofrequency ablation (thermal energy probes that shrink and dissolve tumors); and uterine artery embolization (non-surgical treatment that cuts off blood supply to the uterus and fibroids). Submucous fibroids can be managed with an outpatient surgery that removes the fibroids called a hysteroscopy. Other fibroids can be removed with a minimally invasive laparoscopic or robotic surgery (myomectomy). A hysterectomy, which removes the uterus and fibroids, treats all symptoms, and can usually be performed with a minimally invasive vaginal, laparoscopic, or robotic procedure.
Your gynecologist will work with you to develop an appropriate treatment plan based on your unique situation.
August Bruno, Jr., MD, FACOG specializes in urogynecology, obstetrics and gynecology treating all aspects of women’s reproductive health at General Physician, PC. To make an appointment to see Dr. Bruno call 716-656-4077. Learn more at www.gppconline.com/august-bruno-jr-m-d.
