Fibroids, also called leiomyomas or myomas are growths from the uterus. They are generally described as an overgrowth of the cells of the uterus which are primarily muscle cells. Remember the uterus stretching and contracting is the function of these muscle cells.
Fibroids can bulge from the inside of the uterus or the outside and are not thought to be cancerous. The fact that 80% of women will have fibroids during their lifetime is an eye-opening statistic and 25% of these women will in fact have fibroid-related problems or symptoms related to this.
Fibroids do respond to estrogen and progesterone and with fast growing fibroids, I sometimes use the analogy of estrogen acting on fibroids like gasoline on a fire. Many times, if fibroids are very symptomatic and a woman is close to menopause, we are able to bridge the gap to menopause to take advantage of this estrogen- fibroid relationship and bring a less favorable hormone environment to fibroid growth.
Fibroid size can range from very small like a few cells, to the size of a grapefruit and sometimes even bigger than that. The larger the fibroid, the more likely to cause heavy bleeding or pressure symptoms. Fibroids can influence the amount of bleeding flow or the duration and regularity of a period. Sometimes the bleeding results in severe anemia. They can also cause pain or bulk symptoms. Pressure on the bladder, constant bloating and painful periods are all part of this bulk symptom constellation.
Most women with fibroids are able to get pregnant without any difficulty. Some fibroids can be problematic and bulge into the lining of the uterus and some can destabilize the lining of the uterus adding challenges to implantation. Size again can become an issue in that if a fibroid is bigger than the size of a baseball, it can cause other pregnancy risks.
The treatment of fibroids is very personalized and to be effective, it needs to be focused on the symptoms and fertility desires of the patient. Most medical treatments that I prescribe are oriented towards decreasing the amount of bleeding but some also can shrink the size of the fibroid and help with pain and anemia.
Surgical intervention is generally warranted if medical therapies fail. Additionally, there are times when fibroids are so big and pain or bulk symptoms just dictate that the fibroid be removed. Fertility patients with fibroids that impinge on the uterine cavity generally require a D&C or dilation and curettage with a hysteroscopic myomectomy. (Myoma is the name for a fibroid and ectomy is from the Lating ectomia or excision of a part) This is a surgery that generally takes less than 10 minutes and involves passing a small camera and rotating blade through the cervix and shaving the fibroid down so the lining of the uterus is smooth.
We often do laparoscopic or robotic myomectomies when fibroids involve the outer portion of the uterus or they are very large. These surgeries involve small incisions on the abdomen and removal of singular or multiple fibroids. A robotic myomectomy allows you to use very small instruments that make it seem like the physician is shrinking down his hands. Surgeries that used to require large abdominal incisions can many times be done through incisions that are the diameter of your ring finger.
Our gynecologists at Oakland Macomb OB/GYN are well versed in the treatment of all different types of fibroids. Please call to schedule an appointment for a personalized strategy to approach and treat any of your GYN concerns.