Some women who have fibroids are symptom-free while others have serious side effects. Treatment for fibroids needs to take into account a variety of factors including whether or not the patient wants to be able to have children in the future.
Fibroids are non-cancerous tumors that grow in or on a woman’s uterus, or womb. Many women who have fibroids do not have any symptoms and are unaware of the tumors unless their doctor discovers them during a regular check-up. Possible symptoms include:
• Heavy bleeding or painful periods – Excessive bleeding from fibroids can cause anemia. Periods may last longer than normal and may include large clots. There can also be bleeding between normal periods.
• Feeling of fullness – The pelvic area or abdomen may feel full. Constipation and gas may also be present.
• Large abdomen – Large fibroids may cause the uterus to stretch, giving the appearance of pregnancy.
• Frequent need to urinate – Fibroids pressing on the bladder may cause the need to urinate more often, or may block urine from flowing freely, preventing the bladder from emptying completely.
• Pain during sex
• Lower back pain
During an annual pelvic exam, the doctor may note that the uterus is enlarged or lumpy, which may mean fibroids are present. The doctor may schedule an ultrasound or MRI to confirm the diagnosis. It is very rare for fibroids to become cancerous, but a biopsy can be done to make sure cancer is not present.
The need for treatment depends on a variety of factors including age, what symptoms are present, and whether the woman wants to get pregnant or not. Treatment for fibroid symptoms may include:
• Birth control pills – Oral contraceptives can help control the symptoms of heavy periods, as can IUDs (intrauterine devices) that release hormones directly into the uterus.
• Iron supplements – If bleeding is very heavy, these supplements will help treat anemia.
Treatments to remove fibroids can include the following:
• Myomectomy – This surgery is often the treatment of choice for women who still want to be able to have children. The surgeon makes an incision across the lower abdomen to remove tumors from inside or outside the uterus. This procedure cannot be used to remove tumors growing inside the wall of the uterus. It is usually possible for a woman to get pregnant after a myomectomy.
• Hytsteroscopic myomectomy – In this variation on the abdominal surgery, the surgeon inserts a small camera into the uterus through the cervix (birth canal) to remove tumors growing inside the cavity of the uterus. It is usually possible for a woman to get pregnant after this procedure.
• Uterine artery embolization – In this procedure, the surgeon cuts off the blood supply to the fibroid by inserting a thin tube into the blood vessel and depositing tiny plastic or gel particles there to stop the blood flow. This causes the tumor to die. Not all fibroids can be treated with this method, and it should not be used by women who want to have children after the procedure.
• Endometrial ablation – During this surgery, the surgeon removes or destroys the lining of the uterus to control very heavy bleeding. About half of women who have this procedure stop having menstrual bleeding. About three women in 10 have lighter bleeding. It is not possible to get pregnant or have a baby after this procedure.
Women who are sexually active or who are over the age of 21 should begin having pap tests to check for cancer and pelvic exams to check for other problems including fibroids at least once every three years.