Fibroids and Hormonal Imbalance
Fibroids are found in 20 – 30 percent of all women by the age of 40 and more than 40 percent of women have them by the time they reach menopause.They are much more common than most people expect. Fibroids can also be associated with infertility or problems in pregnancy, including preterm labor, abnormal attachment of the placenta, increased need for C-section, or postpartum hemorrhage.
What are Fibroids?
Fibroids are growths, which may appear alone or in groups. They range in mass from the size of a pea to the size of a small melon. These growths tend to shrink after menopause. The growths can be bound to the wall of the uterus or grow into the cavity of the womb. They can also grow outward from the uterus on stalks. Less than 0.5 percent of the time they can become cancerous.
What are the causes of fibroids?
The causes of fibroids are unknown; there is a genetic link, and estrogen promotes their growth.
Fibroids are commonly asymptomatic.
What are the symptoms associated with Fibroids?
- Emergency symptoms: sharp, sudden pain in the abdomen (when a fibroid on a stalk becomes twisted or if it has outgrown its blood supply)
- Heavy periods, resulting in anemia
- Abdominal discomfort, abdominal fullness
- Lower back pain
- Bladder or rectal pressure
How do I know if I have fibroids?
Women should have annual pelvic exams once they reach the age of 21 or when they plan to become sexually active; to aid in early detection and treatment of abnormalities. A pelvic examination, during which the doctor presses on the uterus, may reveal the presence of uterine fibroids.
Diagnosing Uterine fibroids
To diagnose uterine fibroids, your Primary Care Facility may order one of the following tests:
- Abdominal and/or transvaginal ultrasound (also known as a sonogram). An ultrasound probe projects sound waves onto the internal organs, which reflect the sound back in the form of a picture. The doctor can see the size, shape and texture of the uterus and evaluate any growths. It is a painless test and usually lasts 30 minutes.
- Magnetic resonance imaging (MRI). This is a form of advanced imaging technology that provides highly refined, optimal images of internal body parts, useful in determining the exact location and characteristics of fibroids, and in planning minimally invasive treatments.
Treatment Options for Fibroids
For asymptomatic fibroids, your doctor may recommend watchful waiting, with regular follow-up visits and ultrasounds.
If treatment is needed, options may include:
- Non-hormonal treatment: non-steroidal anti-inflammatory agents (like ibuprofen or naproxen) may reduce menstrual bleeding associated with fibroids
- Hormonal treatment:
- Oral contraceptive pills may help control bleeding, but do not affect the size of fibroids
- Progesterone-containing agents (pills or injection) may also control bleeding but do not affect the size of fibroids. The progesterone-releasing IUS (Mirena™) also works in this way
- Gonadotropin-releasing hormone (GnRH) agonists (leoprolide acetate) work to shrink fibroids by inducing a temporary menopausal state and reducing the amount of estrogen in the body. The side- effects with this are similar to natural menopause, which limits its long-term use.
- Procedural options:
- Traditional Abdominal Myomectomy: Using an abdominal incision, fibroids are removed from the uterus leaving the uterus intact. This is the best option for women interested in preserving fertility. The main risks are bleeding, scar tissue formation, and a 1 percent chance of uterine rupture in a future pregnancy. There is also a 50 percent chance that new fibroids will be seen on ultrasound in five years, but only 10 percent of women will require another treatment.
- Laparoscopic or robotic myomectomy. This procedure uses “keyhole” incisions to perform the same myomectomy as described above. This is associated with less blood loss, scarring, and pain than traditional myomectomy, and leads to a faster recovery. Hospital stay is usually one day. Not all patients are appropriate candidates for minimally invasive myomectomy. Your doctor will determine this by your examination and imaging studies, as well as your past medical and surgical history.
- Hysteroscopic myomectomy. This is an outpatient procedure for fibroids bulging into the uterine cavity. A camera in inserted through the cervix into the uterus, and instruments are used to shave off the visible portions of the tumors.
- Hysterectomy or removal of the uterus. This can be accomplished abdominally via an incision, laparoscopically or robotically, depending on the size of the uterus and location of the fibroids, prior medical and surgical history. Again, the minimally invasive approach is associated with less blood loss, pain, scarring, and shorter hospital stay and recovery period. Also, discuss with your doctor options for preserving or removing the ovaries and cervix.
- Uterine artery embolization or fibroid embolization (UAE). This procedure involves cutting off the blood flow to the fibroids, which causes them to shrink. An interventional radiologist performs this procedure, using x-rays for guidance. S/he sedates the patient, makes a small nick in the groin, and passes a small tube or catheter into the artery. The catheter is guided to the uterus, and plastic or gelatin sponge particles the size of grains of sand are injected into the vessels to the fibroids, blocking the blood supply to them. Patients typically stay in the hospital one night and recover in a week. It is successful in 80 percent of patients; however, as with myomectomy, since the uterus is left in place, additional treatments may be needed in the future for new fibroids.
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