Fibroids

Uterine fibroids, also called myomas, are the most common tumors of the female reproductive organs. Although the exact cause of these tumors is unknown, current medical opinion is that they arise from a single microscopic smooth muscle cell. Smooth muscle cells are the type of cell that forms the uterus. Although these tumors start out as a microscopic abnormality, they can grow to be very large. Occasionally the size of these tumors will be as large as the uterus of a woman who is 5 to 6 months pregnant.

It is estimated that at least one out of every four women has fibroids. Most of these women remain asymptomatic, and will never need treatment. However, up to 40% will experience some combination of pain, bleeding, anemia, miscarriage, or infertility. For these individuals, various treatment options are available.

If a woman has significant problems from her fibroids, and does not desire any more children, hysterectomy is a valid option. Approximately 175,000 hysterectomies per year, which is 30% of all hysterectomies, are performed for fibroids. This makes fibroid tumors the most common indication for hysterectomy in the United States.

However, a hysterectomy is not always necessary. For women who wish to preserve their uterus, a myomectomy can be performed. This is a surgery where the fibroids themselves are removed, but the uterus is left in place. This procedure can be performed as an outpatient through the use of either hysteroscopy or laparoscopy. In hysteroscopy, a telescope-like instrument is inserted into the uterus through the natural opening in the cervix, and no incisions are required. With laparoscopy, the same telescope is used, but a small incision is needed through the belly-button. Sometimes major abdominal surgery is required, however, the patient will usually be out of the hospital within 2-3 days.

The growth of fibroids is dependent upon the female hormone estrogen. Therefore, if a woman is close to menopause, she may be able to avoid surgery since these tumors usually shrink or even disappear after menopause. For younger women who require surgery, medications called gonadotropin-releasing hormone (GnRH) agonists can be used to help shrink the tumors before the operation. The effect of these medications are temporary, so surgery is usually scheduled three months after they are started.

The important points here are that uterine fibroids are common, and most of the time do not need any treatment other than regular check-ups. When treatment is required, a hysterectomy can sometimes be avoided. Your physician will help you to decide which treatment options are best for your situation.

References:

Bibliography

1. Te Linde’s Operative Gynecology, Eighth Edition, Rock, J.R., and Thompson, J.D., Lippincott-Raven, Philadelphia, 1997.

2. Uterine Leiomyomata, ACOG Technical Bulletin #192, May 1994.

3. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, MD, Williams &Wilkins, Baltimore, 1996.

4. Getting the Facts on Fibroids, Woman’s Health, Seltzer, V., September 22, 1997.

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