Uterine Fibroids |Treatment | MedStar Health

What are fibroids?

Fibroids are benign tumors of the uterus. They are also called leiomyomas or myomas. Uterine fibroids are the most common tumors of the female genital tract and the leading reason for hysterectomy in the U.S. Fibroids occur in over 50% of women by the age of 50, although most do not cause symptoms or require treatment.

Fibroids are named according to their location within the uterus. They may occur under the inner lining of the uterus (submucosal), within the muscular wall of the uterus (intramural), or on the outer part of the uterus (serosal or subserosal).

Fibroids grow over time. How quickly growth occurs varies greatly from patient to patient. However, hormonal changes cause fibroids to stop growing once a woman has reached menopause.

What are the symptoms of fibroids?

While fibroids may appear in patients in their twenties, most patients do not experience any symptoms until their late thirties or forties. Many patients will never experience symptoms. For those that do, symptoms will vary based on fibroid type and severity.

  • Heavy menstrual bleeding: The most common symptom associated with fibroids is heavy menstrual bleeding, often with clots. The result can be longer periods and an increase in the number of heavy days of bleeding. Anemia (low blood cell count) is a common side effect.  This symptom is associated with submucosal or intramural fibroid types.
  • Cramping: Menstrual cramps are a common symptom of fibroids, particularly in women who have heavy menstrual bleeding. This can be due to the passage of blood clots or from the disruption of normal uterine contractions that might occur at the time of menstrual bleeding.
  • Discomfort and pressure: Fibroids can cause discomfort, a feeling of heaviness, bloating, a dull ache, or mild tenderness of the pelvis. Discomfort may also be felt in the lower back or in the thighs. Symptoms can be worse just before and during the menstrual cycle, and during or after exercise or sexual intercourse. This fibroid symptom is associated with intramural and subserosal fibroid types.
  • Urinary and rectal symptoms: Fibroids can cause or contribute to increased urinary frequency (including the need to get up at night to urinate), incontinence (urine leakage), rectal pain, or difficulty with bowel movements. In rare cases, fibroids can make it difficult to urinate. These symptoms may get worse in the days leading up to the start of the menstrual period and during the period.
  • Pain: On rare occasions, a fibroid may suddenly die due to a loss of its blood supply. This is a painful process that may last several days.

What causes fibroids?

A combination of genetic factors and the interaction of various hormones and growth factors appear to lead to a fibroid’s development. However, the exact cause of fibroids is still not fully understood.

African-American women are over three times as likely to develop fibroids as Caucasian women, an increased risk that may be due to genetic differences. There is some variation among other racial groups.

While the link is not definitive, some research suggests that high blood pressure and obesity may contribute to fibroid growth.

Types of fibroids

  • Pedunculated fibroids are connected to the outside of the uterus by a stalk. A woman may feel the fibroid moving around, or may have pain if the stalk becomes twisted and blood supply to the fibroid is decreased.
  • Subserosal fibroids lie on the outside of the uterus and usually cause few symptoms unless they become very large.
  • Intramural fibroids are buried in the muscular wall of the uterus. They can cause pain and abnormal bleeding.
  • Submucosal fibroids project into the uterine cavity and often cause heavy menstrual bleeding and bleeding between periods.

Fibroid treatment

MedStar Health offers diagnosis and treatment of uterine fibroids. Fibroids, which are non-cancerous growths in the uterus, are made of muscle and can develop within the uterine wall or attach to it. Fibroids usually start out about the size of a pea and often grow when women are in their 30s and 40s.

How are fibroids treated?

If fibroids are not causing symptoms, surveillance may be the only care required. If fibroids are creating health issues, there are several non-surgical and surgical treatment options.

For many years, the most common form of treatment for fibroids was a hysterectomy (surgical removal of the uterus); however, recent advances in medical technology and surgical techniques have led to the development of less invasive treatments that allow a woman to keep her uterus.

Treatment options for uterine fibroids include:

  • Myomectomy:  The surgical removal of fibroids from uterus
  • Endometrial ablation: The laser removal of fibroids
  • Hysterectomy: The removal of the uterus
  • Uterine fibroid embolization (UFE): A minimally invasive treatment involving the injection of microscopic particles into particular targeted arteries to selectively block blood flow to the fibroids, causing the fibroids themselves to gradually and consistently shrink over time

Other options include:

  • Observation
  • Pain relievers
  • Hormones
  • Change in diet and exercise
  • Complementary and alternative medicine

Hysterectomy

A hysterectomy is an operation to remove the uterus. This procedure may be necessary for a variety of reasons, including painful uterine fibroids, a prolapsed uterus, cancer of the pelvic region, or endometriosis. A hysterectomy is often a last-resort option, after other treatment options have not been successful. Depending on the reason for the hysterectomy, either a portion of the uterus will be removed, or it will be removed entirely.

At MedStar Health, our gynecologists are trained in performing minimally invasive hysterectomies, so you are back on your feet faster, pain-free.

Pelvic reconstruction

Some patients need pelvic reconstruction surgery after a previous surgery to correct a urogynecologic condition. Perhaps you had surgery for cancer in the pelvic region or needed major surgery for another reason. In any case, if you are experiencing symptoms such as urinary incontinence or pelvic pain, you may be a candidate for pelvic reconstructive surgery. Our urogynecologists have vast experience performing these procedures using minimally invasive approaches.

Common pelvic procedures include:

  • Cystocele repair tightens the tissue that separates the bladder and vagina
  • Rectocele repair tightens the tissue that separates the rectum and vagina

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