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Fibroids (myomas)

Uterine fibroids are non-cancerous growths of the wall of the uterus. They are sometimes referred to as tumors, but they are benign, nonmalignant, areas of tissue overgrowth. They can develop on the inside surface of, within the musculature of, or on the outside surface of the uterus (womb). These masses stem from normal uterus muscle cells that start growing abnormally.

Fibroids are a prevalent condition, affecting a significant percentage of women. These masses may be single or multiple, and very small or big enough to occupy a large space within the pelvis. Sometimes a physician may discover them in a patient during a routine physical examination.

large space within the pelvis. Sometimes a physician may discover them in a patient during a routine physical examination.

Providing a full range of options in fibroid care, Virtua gynecologic specialists seek to minimize the invasiveness of treatment while resolving symptoms of these most common of benign tumors in females.

History and Age Are Factors

Types of uterine fibroids by location.
© 2011 Intuitive Surgical, Inc.

Family history of fibroids appears to be a risk for this condition, and fibroids are more common in African-American women. Other risk factors include being overweight or obese, never having had a child and having experienced early onset of menstruation.

Fibroids most frequently appear in the period of a woman’s life between midthirties and menopause. Estrogens within the body stimulate their growth chronically, as well as cyclically with menstruation.

Brings a Variety of Symptoms

These growths often cause no symptoms, and in such cases usually do not require treatment. However, for other individuals, uterine fibroids place pressure against the uterus, bladder, intestine, fallopian tubes or other areas in the pelvis, and thus can cause:

  • pelvic pain, cramping or pressure;
  • abdominal enlargement or feeling of fullness;
  • heavy or prolonged bleeding, or spotting or bleeding between menstrual cycles;
  • infertility;
  • pain during intercourse;
  • pressure on the bowel or bladder that disrupts elimination, including with constipation and increased urinary frequency and discomfort;
  • and pain in the lower back.

Ultrasound, MR imaging or other radiologic studies can help confirm the presence, size and location of uterine fibroids.

Uterine fibroidsduring pregnancyIn the less-common case that a pregnant woman has existing fibroids of any size, these fibroids will  normally not pose a problem  for the pregnancy. In these women, the growths are usually discovered during routine pregnancy ultrasound. Typically the fibroids cause no symptoms during the course of pregnancy.Depending on their location, though, and whether they increase in size due to the swelling and expansion of the uterus, fibroids of the uterus can sometimes cause symptoms during pregnancy. These include bleeding as well as discomfort due to pressure.Less commonly, these fibroids can increase  risk for a pregnancy  for miscarriage, preterm labor or breech birth. Rarely, their position may necessitate a cesarean delivery, or the fibroids may be large enough to compromise the fetal space in the womb, requiring removal of the fibroid during pregnancy.

Noninvasive, Medical Care

Fibroids usually grow slowly and are rarely dangerous. If they produce symptoms, these are often mild. Thus many women take a watch-and-wait approach and use simple means of dealing with the manifestations of uterine fibroids. When women go through menopause and estrogen levels decrease, fibroids tend to shrink; thus, one option, especially for manageable cases and depending on age, is to use conservative symptom management during the child-bearing years.

Hormonal treatments can also provide symptom relief, temporarily shrinking fibroids; but, with their side affects, this medical approach is not looked upon as a permanent or complete solution. These options can include a progestin-releasing intrauterine device and low-dose birth control pills that reduce the number of menstrual cycles per year.

Invasive Care without Surgical Incisions

Invasive interventions include hysteroscopic removal of the fibroids. Experienced gynecologic specialists at Virtua use an endoscope, introduced vaginally into the uterus, to resect the lesions. Women who need fibroid treatment but want to retain the option of becoming pregnant often opt for this procedure.

In this hysteroscopic myomectomy, the specialist passes slender instruments past the cervix into the womb to reach fibroids that are accessible by this route. One option in hysteroscopic treatment of fibroid tumors is to employ instruments that use various methods to heat or freeze the fibroids to destroy them. The surgeon removes the fibroid growths and leaves the uterus intact or performs any needed repairs on the uterus to restore its integrity. This operation preserves fertility for women who wish to have children.

A newer and popular option is uterine fibroid embolization (UFE), an outpatient procedure in which the interventional team inserts a catheter into a blood vessel through a puncture in the groin and, under x-ray guidance, advances the catheter to the artery that supplies blood to the uterus. The interventional team injects a gel foam that plugs the vessel to block the blood supply to the fibroid so it shrinks over time.

UFE, usually performed by an interventional radiologist, has been a major development in the field of fibroid treatment and has been well received by patients. But UFE is not recommended for women who seek future pregnancies because of the effect of the treatment on the womb.

Fibroid tumors are the number one reason that women chose to have a hysterectomy.

Invasive Care Requiring Surgical Incisions

If other care has failed or is not appropriate for a patient, the Virtua surgical team will discuss operative options with the patient. These include myomectomy through laparoscopy or open surgery to remove the portion of the uterine wall containing the fibroid tumor. These operations are proven approaches for uterine fibroids.

Removal of the uterus (hysterectomy) is also an option-and remains the only choice that guarantees that fibroids will not return. This operation is normally reserved for women who have severe fibroid development, have already reached menopause or are not planning to conceive. Fibroid removal is the most common reason in the U.S. for performing a hysterectomy.

At Virtua, myomectomy or hysterectomy using robotic technology provides a number of advantages to patients. It offers improved visualization and operative precision for surgeons and avoids the large abdominal incision of open surgery. In addition, it sometimes makes a laparoscopic surgical approach available to women who in the past would have needed open surgery due to multiple previous abdominal or pelvic surgeries or due to obesity or large fibroids. It has also facilitated the laparoscopic approach to myomectomy. The same operations when performed by traditional open surgery are marked by substantial blood loss and pain, and require three or four days in the hospital and four-to-eight weeks of recovery. Patients undergoing myomectomy or hysterectomy with robot-assisted laparoscopic technology can often return home the same day and return to activities much more quickly.

Regular re-examination for additional fibroids growths is important for women receiving any treatment short of hysterectomy.

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