Myomectomy
 

What are fibroids?

Fibroids (also called leiomyomas or myomas) are benign tumors of the uterine muscle. Fibroids are common tumors and are found more frequently in women as they get older. It is estimated that 25-30% of women in their mid-30’s have fibroids. However, not all women will have symptoms from the fibroids. Fibroids tend to grow slowly and are rarely malignant (cancerous). The size and location of the fibroids are important factors that determine whether or not a woman will have symptoms. Common symptoms attributable to fibroids include pelvic pain/pressure, urinary and bowel symptoms and heavy menstrual periods. Fibroids can sometimes be associated with infertility and recurrent miscarriages. Fibroids are usually multiple, although occasionally a solitary fibroid will be found.

What causes fibroids?

It is not clear why some women develop fibroids and others do not. Fibroids are estrogen dependent tumors and tend to grow when estrogen levels are high, such as during pregnancy, and get smaller when estrogen levels are low, such as after menopause. Other hormones and growth factors may also be involved in the development of fibroids. There may be a genetic predisposition to the development of fibroids in some women. Each fibroid is composed of cells that are clones of an original cell that escaped the usual regulatory mechanisms that control and limit cell growth in the uterus. So all of the cells in an individual fibroid will be identical and will be different from the cells in an adjacent fibroid. Birth control pills do not cause fibroids. Women who have taken, or are currently taking, birth control pills are not at an increased risk for the development of fibroids. Likewise, if a woman has fibroids, she can usually take birth control pills for contraception.

How are fibroids diagnosed?

An enlarged uterus on pelvic exam can suggest the diagnosis of fibroids. Transvaginal ultrasound examination is the best way to confirm the diagnosis. Ultrasound can also determine the number, size and location of the fibroids. Although MRI and CT scans can also be used to diagnose fibroids, they are usually not required to make the diagnosis and are considerably more expensive than ultrasound.

How are fibroids treated?

There is no good medical treatment for fibroids. Medications such as lupron are helpful in shrinking fibroids, but do not make them go away. When lupron is stopped, the fibroids will re-grow to their original size. Treatment for uterine fibroids generally involves surgery. For those women with symptomatic fibroids who no longer wish to preserve their fertility, hysterectomy is usually the best option. However, for those women who wish to preserve their fertility or who do not want to have a hysterectomy, the fibroids can be removed without removing the uterus. This surgical procedure is called a myomectomy.

The traditional way to remove fibroids is through a large incision in the lower abdomen. This requires several days in the hospital and several weeks to recover. Laparoscopic removal of fibroids can be performed in selected patients. With laparoscopic removal, the patient is usually discharged home the same day of the surgery and the recovery time is much quicker. Instead of a large incision in the abdomen, 3-4 small incisions are made in the abdomen. Each laparoscopic incision measures one-quarter to one-half inch in diameter. Not all gynecologists are skilled in the performance of laparoscopic myomectomy. The surgeons at Arkansas Fertility & Gynecology Associates pioneered the technique of laparoscopic myomectomy in Arkansas and have been performing this procedure for many years. Not all fibroids are suitable for laparoscopic removal and your doctor will need to determine whether or not this approach is for you.

Fibroids located exclusively within the uterine cavity can be removed through the cervix with an instrument called a hysteroscope. No abdominal incisions are required for hysteroscopic myomectomy and patients are discharged home the same day of the surgery.

Will fibroids come back after they are treated?

Some fibroids will recur after surgical treatment. The risk of recurrence depends on several factors including the age of the woman and the number of fibroids that were removed. The chance of recurrence is less if a solitary fibroid is removed than if multiple fibroids are removed. Women who are younger at the time of myomectomy tend to have a slightly greater chance of recurrence than older women. However, just because fibroids may have recurred, does not necessarily mean more surgery will be required.

Newer, nonsurgical, approaches to fibroid treatment

Several nonsurgical approaches to the treatment of symptomatic fibroids are under development. Uterine artery embolization (UAE) is a procedure that involves injecting tiny spheres into the blood vessels supplying the fibroids. The blood supply to the fibroids is reduced which results in shrinkage of the fibroids. This procedure is performed by an interventional radiologist and usually requires an overnight hospital stay. This procedure appears to be effective in improving pain and bleeding in symptomatic women. Uterine artery embolization is currently not recommended in women who may want to have another child. Ideal candidates for UAE are women who have completed their childbearing and who may be poor candidates for surgery due to coexisting medical conditions. This is still a relatively new procedure and long term results remain to be established.

MRI directed high intensity ultrasound treatment of symptomatic fibroids is currently under investigation. Using MRI of the pelvis as a guide, ultrasound waves are focused transvaginally on the fibroids to destroy them. This procedure is not recommended in women who may wish to have more children and it is still experimental.

New drugs are being developed that may inhibit fibroid growth. Drugs that block the action of estrogen, progesterone and various growth factors that stimulate fibroid growth are actively being pursued by the pharmaceutical industry. At present, no such drugs are available for use in the general public.