Thursday, April 28, 2011 at 8:46 pm by Jon Nielsen, MD
My patients are a great bellwether about what’s of interest in consumer and medical media. Questions about diverse topics that include hormone replacement therapy, Vitamin D and uterine fibroids have been popular of late and lead me to write about an increasingly common condition affecting many of my patients: uterine fibroids.
What are uterine fibroids? Called myomas or leiomyomas, uterine fibroids are muscular tumors that grow in the wall of the uterus. They are the most common type of gynecologic tumor and are rarely cancerous. They can be as small as an apple seed or as large as a cantaloupe.
What causes uterine fibroids? Not much is known about the cause(s) of uterine fibroids, but we know they are more likely to occur in Asian and African American women. There seems to be a relationship to estrogen as well, impacting women who are pregnant or moving toward menopause and taking estrogen, or taking estrogen after menopause. There also is a genetic component to fibroids: it certainly seems to run in families.
Three out of four women will have a uterine fibroid sometime in her life. In my practice, I see fibroids more often in women who are in their 40s and 50s, but that doesn’t exclude younger women.
Some of my patients have no symptoms while others come to my clinic experiencing symptoms that include abnormal bleeding or discomfort. Some of my patients experience infertility or pregnancy complications as a result of a uterine fibroid, which is discovered during a clinical exam. Fibroids larger than a lemon can press on soft tissue and urinary and bowel organs. It can be uncomfortable, often causing a sense of fullness or distention in the lower abdominal area. Some fibroids are found inside the uterine lining, in the endometrium. The result is very heavy or irregular bleeding, even if the fibroid is tiny. Patients who experience this are often tired from blood loss and now have anemia, or low iron.
A common patient question is “How is it treated?” Most fibroids will continue to grow unless they are treated. The size and location of a uterine fibroid determines how I approach treatment. It’s important to work with patients to find an option that considers lifestyle and long-term goals, such as having a baby.
Treatment options may be medical, procedural or surgical. The medical approach tries to reduce the fibroid’s access to estrogen, thereby shutting down its food supply. Anti-estrogen therapies can be effective. Recent novel research in anti-progesterone therapy looks promising too.
A procedural approach to shrink the fibroid is called uterine artery embolization, a procedure performed by an interventional radiologist. It is based on the concept of reducing the blood supply to the fibroid. Without “food” the cells die, leading to shrinking fibroids.
For years, a hysterectomy was the surgical therapy of choice but today, surgical advances allow us to remove tumors, often without even making an incision. In one such outpatient procedure, a hysteroscope is inserted into the uterus and pieces of the fibroid are removed until it’s gone. Minimally-invasive laparoscopic surgery is a true advance, allowing for removal of the fibroid through tiny incisions in the abdomen. My patients are in surgery for about an hour, are in less pain and have a shorter recovery time.
Laparoscopic surgery however, can be complex. That’s why the advent of the daVinci robot has been welcomed by gynecologic surgeons. This assistive surgical device allows doctors a view into tiny spaces with a special camera and helps them to operate with precision in very small areas – all good news for patients who want to get back to their families and life as quickly as possible.
To conclude, uterine fibroids are common and treatable, and rarely cancerous. There are many options from which to choose, dependent on size, location and patient goals. As a gynecologic surgeon, I am lucky to be able to offer so many options to my patients.
Jon S Nielsen MD
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