What Are Fibroids and How to Treat Them
Fibroids are non-cancerous tumors of the uterus composed of muscle and fibrous tissues. When the normal uterine cells grow abnormally, it will develop into a benign tumor. Fibroids are also called fibromas, myomas, or leiomyomas. These are not associated with uterine cancer and in fact, they usually do not develop into a cancer.
Uterine fibroids are very common, due to the fact that many women have fibroids at some point in their lives. As their growth is dependent on estrogen and progesterone, they occur during the middle and late stages of the woman’s reproductive years. They do not grow until puberty ensues and usually appeas at 30 to 50 years of age. After menopause when the estrogen levels drop, they just shrink or disappear.
The composition of all fibroids is the same. They are all made up of uterine muscle cells growing into a tight mass. They can be classified based on the location of their growth. Myometrial or intramural fibroids are found in the uterine muscular wall, and are the most common type of fibroids. Submucosal fibroids develop beneath the interior surface of the uterine wall but may project in the uterus. Subserosal fibroids can grow very large on the outer wall of the uterus into the pelvis. Pedunculated fibroids grow and attach to the outer wall of the uterus by a narrow stalk. Cervical fibroids develop in the cervical wall.
In some cases, uterine fibroids are asymptomatic and treatment is not needed. However, in other cases, they can be symptomatic. The symptoms are produced in relation to size and location. These include heavy or prolonged menstrual bleeding, pelvic pain or pressure, back or leg pain, urinary frequency, difficulty emptying the bladder, constipation or painful defecation, abdominal discomfort or sensation of fullness, or pain during intercourse. Iron deficiency anemia may also be present due to the heavy vaginal bleeding. Fibroids may also occur along with endometriosis which causes infertility. The urinary and gastrointestinal problems are due to the compression effect of the fibroids. In rare cases, they can develop into malignant cancers called leiomyosarcomas.
When these symptoms are present, women should immediately see their doctors. Large fibroids can be palpated during pelvic examination. However, imaging studies such as ultrasound, hysteroscopy or hysterosonography may be performed to confirm the presence of the fibroids.
Asymptomatic fibroids are usually discovered incidentally during pelvic examination. Since they do not produce symptoms, the best action is to just observe and monitor. However, for symptomatic fibroids, non-operative and operative treatment options are available depending on the severity.
Non-operative treatment options include: Oral contraceptives (birth control pills) help control the heavy bleeding, but they do not reduce the size of the fibroids; Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve the pain; Progestin-releasing intrauterine device (IUD) can be used for non-distorting fibroids. They can relieve the symptoms, but they do not make the fibroids disappear.
Finally, gonadotropin-realesing hormone (Gn-RH) agonists reduce the estrogen and progesterone levels making the fibroids shrink and eventually disappear. These are only used for a short period of time, either before surgical removal of fibroid or when a woman is nearly menopausal.
Operative treatment options include:
Myomectomy can be opted for women who still want to have babies. The fibroids are removed sparing the uterus. For multiple and large fibroids, the surgeon may perform an open abdominal myomectomy. However, for small and only few fibroids, a laparoscopic myomectomy can be done wherein the surgeon creates a small incision to allow the instrument to enter the uterus with a small camera attached and uses a surgical robot to remove the fibroids. For submucosal fibroids, a hysteroscopic myomectomy can be done. A scope is passed through the vagina and into the uterus where the surgeon can view and remove the fibroids.
Hysterectomy is a major surgery, where the uterus is removed and is one sure way to permanently remove the fibroids.
Endometrial ablation is effective in stopping the bleeding but does not affect the fibroids outside the inner uterine wall. This treatment uses heat, hot water, microwave energy, or electric current to destroy the inner surface of the uterus by utilizing an instrument inserted into the uterus.
Uterine artery embolization is efficient in shrinking the fibroids and relieving the symptoms. This can be done by injecting embolic agents into the arteries supplying blood to the uterus to cut off the flow to the fibroids.
Myolysis is a laparoscopic procedure in which a laser or electric current is utilized to shrink the blood vessels supplying the fibroids and eventually destroying them. In the case of cryomyolysis, a liquid nitrogen is used instead to freeze the fibroids.
Some women may experience no symptoms with fibroids, and some do not even know they have one. During pregnancy, the fibroids may increase in size due to the increased estrogen level and blood flow. However, they shrink back to their normal size after childbirth. For women who are experiencing symptoms, they should seek medical attention. It is also important that they discuss their treatment options well with their families and doctors before deciding. They have to weigh the pros and cons of each treatment and choose the option that best suits their situation.