Fibroids are non-cancerous growths that occur from the muscle of the womb. The womb is also called the uterus. Fibroids are “fibrous” tough masses that require estrogen and progesterone – the female hormones – for growth.
Fibroids can occur anywhere in the uterus, and are named for their location. Cervical fibroids are rare, whereas most fibroids develop from the muscle or myometrium.
Fibroids are the most common growth in women. Eighty percent of ALL women have fibroids in their womb, with 12 to 25% having problems from fibroids such as heavy bleeding and pain.
African American women have fibroids two to three times more than Caucasian or Hispanic women. Also, African American women have a much higher chance of fibroids growing larger and causing problems than in Caucasian women. African American women develop problems with fibroids at an earlier age, with the fibroids growing faster, becoming larger, and causing more bleeding and anemia than with women of other races.
Medications: Birth control pills do not cause fibroids to grow, but may control some of the symptoms associated with fibroids. Injections of depo-provera, or progesterone (the anti-estrogen) has been shown to protect against fibroid growth. Medicines used for fertility have no effect on fibroid growth.
Diet: Caffeine will not cause an increase in new fibroids or growth of fibroids. Foods that have been shown to have an association with increased fibroid growth include beef and red meat, ham, and alcohol. Green vegetables, dairy products and fruit will decrease the risk. Soy will not affect fibroid growth.
Smoking: Smoking has a possible decreased effect on fibroid development and growth. Smoking, of course, is not a reasonable option for preventing fibroids, as it is associated with higher risks of lung, bladder, and cervical cancer.
The following is a list of common symptoms from most to least frequent:
Fibroids in the cavity of the uterus, also known as submucosal fibroids, can prevent implantation. Implantation occurs when the embryo (the egg and the sperm combined) attach to the endometrial lining, with the placenta developing and obtaining blood supply from the uterine muscle. Submucosal fibroids can prevent implantation, and can cause problems with conception (the ability to become pregnant) or can result in miscarriage (loss of the pregnancy). Intramural fibroids (fibroids in the muscle) can also prevent conception. Fibroids can also obstruct the fallopian tubes, resulting in difficulty in becoming pregnant. Fibroid blockage of the tube will not allow the embryo to pass into the uterine cavity, and implant on the endometrial lining. Fibroids can also cause problems during pregnancy. These include:
Yes. Fibroid location is important in understanding how fibroids cause problems.
Bleeding and pain
Pain and Pressure
Pain with Intercourse
Ultrasound is a simple, inexpensive, and very effective method for diagnosing the size, number, and location of fibroids, and is very well tolerated by the patient. MRI, or Magnetic Resonance Imaging, is usually not needed, but can provide more information about the specific location of fibroids and rule out adenomyosis. CT scans, or Computed Tomography, are not helpful, and should not be performed. Pelvic exams may be helpful, but are very limited in their ability to identify the size, number, and location of fibroids. Pelvic exams can also confuse pelvic masses with fibroids, and have significant limitations in patients with prior surgery, other GYN conditions such as endometriosis, and in heavier patients. Pelvic exams can also be painful both during and after exams.
Treatment of fibroids is either medical, radiological, or surgical.
For any surgery to be performed, there needs to be an “indication”, or a reason for the procedure. Indications for surgery may include any of the following:There are two surgical treatment options for fibroids: To help you choose the right procedure, please answer the following: If your answer is YES to either of the questions, please click here to learn more about the myomectomy procedure. If your answer is NO to both questions, the hysterectomy may be a better option for you. Please click here to learn more about the hysterectomy procedure.
Medical therapy means treating fibroids without surgery or radiological procedures. Medical therapy is not helpful for most patients with bleeding, pain, and growth of the fibroids continuing over the long term, but may help to decrease the bleeding associated with fibroids over the short term. Estrogen and progesterone make fibroids grow, and are produced from the ovaries of all women. Types of medical therapy include hormones that block the effect of estrogen or progesterone, or reduce or eliminate the production of these hormones from the ovaries.
Treatment of fibroids through radiology refers to locating the fibroids to be treated in the uterus by some type of radiological test, and then treating the fibroid either through:
Also known as UFE (uterine fibroid embolization), this type of treatment relies on blocking the blood supply, using plastic particles or some other method to eliminate blood flow to the fibroid. Using fluoroscopy – a radiological test that uses dye to locate the uterine artery – a needle is inserted into the large artery of the groin. A small plastic tube is then inserted through the needle, and the blood supply to the uterus and fibroids is located. Small plastic particles or “beads” are then inserted into the blood supply of the fibroid, blocking the supply. This causes “necrosis” or death of the fibroid. Since there are two uterine arteries – one on each side of the uterus – both arteries need to undergo UAE to achieve the best results. The procedure is done twice, once to the left groin, and then once to the right groin.
Results on UAE are reported for the short term, which is three years and less, and for the long term, which is more than five years.
Short-term data is much better than long-term data. The most reliable information comes from the Society of Interventional Radiology on over 1,200 patients. Three years after UAE the following results were reported:
Results more than five years after UAE show 20 percent of patients requiring a surgical procedure to control fibroid symptoms, including hysterectomy, myomectomy (removal of fibroids) or repeated UAE. This means that UAE was unsuccessful in one-fifth of the patients, and recurrence of bleeding, pain, or other symptoms due to enlargement or growth of new fibroids required surgical removal due to failure of the UAE procedure.
In this non-surgical procedure, MRI – Magnetic Resonance Imaging – is used to identify fibroids in the uterus, and then ultrasound waves are focused on the fibroid to destroy it. This procedure cannot be used for patients who want to become pregnant, or for adenomyosis. It is not effective for larger fibroids, for more than five fibroids in the uterus, or for fibroids that have decreased blood supply. Although some reports are encouraging for this procedure, it takes multiple treatment visits, is expensive, and cannot be used if other organs such as the bowel are in front of the fibroids, since damage can result.
Also called myolysis, this is destruction of fibroid tissue using heat or freezing. A new procedure using radiowaves has been introduced, but also has limited use and effectiveness for multiple or larger fibroids.
Finding out that you have fibroids can cause a mixture of relief and worry. It is helpful to finally understand why you are having uncomfortable symptoms, but choosing where to obtain your treatment is a big decision.
Many of our patients require a hysterectomy as their fibroid removal surgery. Did you know that our surgeons perform an average of 400 hysterectomies per year, as opposed to the 27 performed by the average OB/GYN?
Why shouldn’t I get treatment from my OB/GYN? There is no doubt that your OB/GYN is a skilled practitioner in Obstetrics. However, studies have shown that GYN surgery is merely a secondary component of what an OB/GYN does. Nearly every OB/GYN website states that the doctors are qualified to perform laparoscopic surgery, but very few of these doctors actually perform the procedures often enough to gain tenured experience and expertise.
At CIGC, our careers are dedicated to the techniques and procedures that optimize the surgical care and recovery of women. CIGC surgeons are true GYN surgical specialists – not simply doctors who are taking advantage of the “marketing of medicine.” While your OB/GYN’s main focus is Obstetrics, our main focus is advanced laparoscopic surgery. We are board-certified, fellowship-trained in Minimally Invasive Surgery or Gynecologic Oncology, and completely focused on GYN surgery. Since we get a high volume of patients needing gynecological surgery, we have the experience to have mastered the procedures and skill.
We do not perform Obstetrics – we leave that to the experts in that field, and we are experts in our own.
When you need fibroid removal surgery, we can offer you options. We take into consideration your future plans, such as whether you intend to have children or if you are willing to undergo future surgeries, should the fibroids return. We get to know each and every patient on a personal level to ensure that they are getting the treatment that is right for them.
Your recovery in mind. CIGC will always choose the least invasive fibroid surgery possible in order to decrease your pain and increase your recovery time. Knowing which procedure to perform requires comprehensive knowledge about each available option and the technology and practices that make them work.
As a patient, we urge you to find peace of mind in the form of the expertise and care of our surgical experts. Our physicians will help you to fully understand your condition as well as your options. We promise to employ only the most effective and least invasive surgical techniques to facilitate a swift recovery. We have offices in Bethesda and Annapolis, Maryland, as well as in Reston, Virginia for your convenience. Please give us a call at (888) 787-4379.