Fibroids are noncancerous growths that develop in the uterus. Fibroids grow to be as small as a pea or expand to the size of a grapefruit, and in rare cases even larger. Fibroids can grow on the uterine walls or inside the uterine wall tissue. Some patients may have no symptoms while others can have a variety of uncomfortable symptoms.
• Menstrual changes
◦ Longer, more frequent, or heavy menstrual periods
◦ Menstrual cramps
◦ Vaginal bleeding between menses
◦ In the abdomen or lower back
◦ During sex
◦ Difficulty urinating or frequent urination
◦ Constipation, rectal pain, or difficult bowel movements
• Enlarged uterus and/or abdomen
When meeting for a consultation, a simple pelvic exam may indicate a fibroid uterus. We can obtain a pelvic ultrasound which allows us to visualize the uterus and ovaries.
• Birth control pills and other types of hormonal birth control methods—used to control heavy bleeding and cramps.
• Gonadotropin-releasing hormone (GnRH) agonists—stop the menstrual cycle and can shrink fibroids. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
• Progestin–releasing intrauterine device—This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
• Hysteroscopy—This technique is used to remove fibroids that protrude into the cavity of the uterus. A resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. Hysteroscopy often can be performed as an outpatient procedure (you do not have to stay overnight in the hospital).
• Endometrial ablation—This procedure destroys the lining of the uterus. It is used to treat women with small fibroids (less than 3 centimeters).
• Uterine artery embolization (UAE)—In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.
• Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.
• Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.
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