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| Uterine leiomyomas, also known as myomas or fibroids, are benign growths within the uterus. They are the most common tumors in the female pelvis and are responsible for 35-50% of the hysterectomies performed in the U.S. each year. It is thought that fibroids exist in 20% of women over the age of 35, however, fewer than half of these cause symptoms. The most common symptom in women with uterine fibroid tumors is abnormal bleeding occurring in 30 percent of the patients. Other symptoms include pelvic pain and infertility. |
DIAGNOSIS
Fibroids can be diagnosed by pelvic examination, ultrasound, saline infusion sonography (SIS), MRI scanning, and hysterosalpingogram (HSG-Tubal X rays) or visualized directly utilizing surgical procedures such as Laparoscopy and Hysteroscopy. Not all fibroids are symptomatic and not all fibroids need to be treated. Because most women have no symptoms, the majority are appropriately managed with observation alone. The subsequent worsening of symptoms or the development of other complications would warrant further consideration. The goals of care are the minimization of complications such as anemia, pain, and infertility while maintaining fertility in women who so desire. |
TYPES OF FIBROIDS
 Fibroids that distort the uterine cavity (Intracavitary or submucous) are thought to significantly affect fertility whereas fibroids, especially the small ones, located elsewhere (Intramural, pedunculated)l in the uterus may not be as significant. Since most women presenting with uterine fibroids are in their late 30s or early '40s and are still considering having children, surgical removal of the fibroids is often undertaken. For such women desiring future fertility, other treatments including observation alone, medical suppression of the fibroids or uterine artery embolization (UAE) may not be acceptable since the quality of their eggs rapidly deteriorates. Women with advanced reproductive age may therefore benefit from surgery (if indicated)to remove their fibroids and consider In Vitro Fertilization(IVF) in the shortest interval possible. |
WHAT ARE THE FIBROID TREATMENTS OPTIONS ?
NO TREATMENT
Women that have no symptoms and have no fertility considerations can be evaluated periodically by pelvic examination and ultrasound to monitor the size of the fibroid.
SURGERY
 There are several surgical approaches to removal of the fibroids (myomectomy): for fibroid tumors which are located within the uterine cavity (submucous), outpatient Operative Hysteroscopy may be undertaken(click to view hysteroscopic myomectomy video). When the fibroid is unusually large Hysteroscopy may need to be repeated if the tumor cannot be resected in one sitting. For fibroid tumors located within the wall of the uterus (intramural), outpatient laparoscopic surgery may be performed but requires the surgeon to have a high level of expertise. Laparoscopic myomectomy is most suitable for fibroids which measure less than 6 centimeters (2 1/2 inches) in diameter. For fibroid tumors which are larger  than 6 centimeters or if several tumors are present, a major abdominal surgery (laparotomy) may be necessary. Sometimes your surgeon may elect to treat you with medications such as Lupron or Synarel to shrink the fibroid so that it can be removed laparoscopically and to minimize bleeding during surgery. Complications from myomectomy include bleeding, scar tissue formation, infection and the likelihood that once pregnant, cesarean delivery may be necessary to avoid their risk of uterine rupture during labor. |
MEDICAL THERAPY
 Women who are symptomatic but do not desire having any more children can be treated medically to "shrink" the tumor resulting in decreased bleeding or pain. Medical therapy may consist of treatment with anti estrogen medications (such as Lupron or Synarel) or anti progesterone medications (such as Mifepristone).
Unfortunately, the benefit from Lupron therapy is temporary since the fibroid tumors grow back to their pretreatment size shortly after the therapy is completed. Other
side effects associated with Lupron include hot flushes and bone loss. This medication
is mostly utilized before surgery to shrink the size of the fibroids; This may allow
your surgeon to remove the fibroids by laparoscopy in an outpatient setting.
Another promising medication for treatment of uterine fibroid is
Asoprisnil. This medicine is currently being evaluated for treatment
of fibroids in patients who do not desire children. The main advantage of this drug
over other medical therapies is its ability to bring about cessation of menses with
decrease in fibroid size, eliminating the annoying hot flushes and bone loss associated
with other anti fibroid medications. |
 UTERINE
ARTERY EMBOLIZATION (UAE) is a nonsurgical and nonmedical alternative treatment for fibroids utilized first in 1997. The procedure involves injection of particles into the uterine artery to block the blood supply of the fibroid resulting in significant
reduction in the size of the fibroid and improvement of symtoms such as pain and
bleeding. This treatment may not be appropriate for patients who desire future fertility because of concerns regarding the risk of premature delivery, miscarriage and increased risk of cesarean section. The treatment is also not optimal for patients with fibroids
located entirely within the uterine cavity.
FOCUSED ULTRASOUND
WITH MRI GUIDANCE is a completely noninvasive
treatment for uterine fibroids. This treatment is still being evaluated
and selection criteria for this therapy remains unclear. The procedure in many cases
can take more than 3 hours to complete and is associated with mild to moderate pain in 66%
of patients and severe pain in another 16%. The procedure is not ideal for patients
with fibroids over 10cm in size, fibroids located under the bladder or in patients
with abdominal scar tissue.
The procedure is also expensive(over $17,000) and is not covered by medical insurance. |
| Fibroids rarely become cancerous. In fact, it is thought to occur in no more than .1% of all fibroids. Uterine leiomyomas are not to be confused with leiomyosarcomas, which are malignant uterine tumors that usually affect post-menopausal women.
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