Got fibroids?

I have fibroids. Fibroids come many shapes and sizes and range in symptomatology from no symptoms to unbearable, pain and heavy bleeding. Not all fibroids are associated with infertility, but those that distort the cavity or cause symptoms in women who desire fertility should be evaluated by a gynecologist or reproductive endocrinologist/infertility specialist. The picture below shows all of the difference locations on the uterus that fibroids can appear.

Fibroids are a benign tumor of the uterus. This means that a small part of the uterus grows and enlarges abnormally, but usually does not threaten any part of the body except for the uterus. The uterus is made up of “smooth” muscle that functions during pregnancy to aid in pushing out a newborn. As some women get older, some muscle cells in the uterus may start to grow and divide more rapidly, causing a fibroid that can become uncomfortable and bleed. Fibroids can sometimes make getting pregnant more difficult if they distort the uterine cavity.

Common symptoms of fibroids include pressure or pain, heavy periods that last more than seven days, frequent urination, constipation, or backache. This is because a uterus enlarged by fibroids can press on nearby structures in your pelvis, such as your bladder, bowels, and nerves. You should see your doctor if you notice an enlarged uterus or abdomen. Also see your doctor if pain continues or worsens, or if your periods become heavy or painful to the point that they interfere with everyday activities. Pain with sex and any difficulty urinating are also reasons to see your doctor. A vaginal ultrasound is the first step in the evaluation of fibroids. 

There are some medicines for fibroids. If the only symptom you have from fibroids is heavy bleeding, these medicines may work well for you. Oral contraceptives help reduce the increased menstrual flow associated with fibroids, and injectable drugs that work on the brain to reduce hormones that are responsible for growth of the fibroids. These drugs thus help the uterus shrink and bleed less. Some women may benefit from an levonorgestrel IUD (intrauterine device) that can decrease bleeding.

 

         For symptoms caused by bulkier fibroids that change the shape of the uterus or press on nearby structures, a surgery to remove the fibroids and “debulk” the uterus (myomectomy) is usually the most effective treatment and can be done either through a small incision in the “bikini” line, laparoscopy (“key hole” surgery) or hysteroscopy. Myomectomy is the preferred option for women who desire future fertility. Removing the uterus (hysterectomy) is a definite cure for fibroids for women who are sure they never want children or are done having children. Uterine artery embolization and other directed techniques using ultrasound are newer forms of treatment. There are advantages and risks to each of these procedures that you should discuss with your doctor based on your symptoms and your goals.

Dr Kenan Omurtag, MD is fellowship trained Reproductive Endocrinologist and Infertility specialist at the Washington University Infertility and Reproductive Medicine Center. He sees patient's at both the Central West End and Missouri Baptist locations.
Christopher Chung, MS3 Washington University St Louis School of Medicine contributed to this post.