Fibroids are usually first diagnosed during a pelvic exam performed by your doctor. The presence of fibroid tumors is then confirmed by either a pelvic Ultrasound or an MRI. These are painless diagnostic tests which help to determine how large the fibroids are and where they are in the uterus.

What symptoms should you look for?  

While fibroids may not cause any symptoms, there size and location can lead to significant problems for many women.

Typical symptoms include:

• Heavy prolonged bleeding during the menstrual period or in between periods. In severe cases; bleeding may be so severe as to cause anemia or a drop in blood counts.
  
• Pelvic pain or pressure
  
• Pressure on the bladder leading to a constant urge to urinate
  
• Pressure on the bowel leading to constipation or bloating
  
• Abnormally enlarged abdomen

How are fibroids treated?  

Appropriate treatment depends on the size and location of the fibroids, as well as the severity of symptoms. If a woman is not experiencing symptoms, her doctor will most likely suggest "watchful waiting" — checking the fibroid at annual gynecologic examinations and monitoring for symptoms.

If symptoms develop, there are a number of treatment options:

Drug therapy, including non-steroidal anti-inflammatory drugs (NSAIDs), birth-control pills and hormone therapy;

Uterine fibroid embolization, a non-surgical treatment that causes the fibroid to shrink.

Surgical treatments, including myomectomy (surgical removal of the fibroids) and hysterectomy (surgical removal of the uterus)

Treatment Option: Drug Therapy

Drug therapy is usually tried first. This might include:

• the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen sodium (Naprosyn),
• birth-control pills, or
• hormone therapy.
  

In some patients, symptoms are controlled with these treatments and no other therapy is required. However, some hormone therapies can have risks and side effects (menopausal symptoms, erratic or no menstruation, bloating, moodiness) when used long-term, and generally are used temporarily.

A newer group of drugs being used for fibroids are hormones known as GnRH analogues, which are administered by injection. Some physicians recommend these hormones prior to surgery to reduce the size of the fibroids and make them easier to remove. The effectiveness of the hormones is considered temporary as studies show that when the therapy is stopped, fibroids regrow to their original size in four to six months. The GnRH hormones also may cause side effects that mimic menopause, including hot flashes, vaginal dryness, mood swings and a decrease in bone density (osteoporosis).

Surgery (Hysterectomy and Myomectomy):

Surgical Treatments: Hysterectomy

Approximately one-third of the more than half-million hysterectomies performed in the United States each year are due to fibroids.

In a hysterectomy, the uterus is removed in an open surgical procedure. This operation is considered major surgery and is performed while the patient is under general anesthesia. It requires 3 to 4 days of hospitalization and the average recovery period is about six weeks. Some women are candidates for a newer, laparoscopic procedure. The recovery time for this procedure is considerably shorter.

Hysterectomy is the most common current therapy for women who have fibroids. It is typically performed in women who have completed their childbearing years or who understand that after the procedure, they cannot become pregnant.

Surgical Treatments: Myomectomy

Myomectomy is a surgical procedure that removes visible fibroids from the uterine wall. Myomectomy, like UFE, leaves the uterus in place and may, therefore, preserve the woman's ability to have children. There are several ways to perform myomectomy, including hysteroscopic myomectomy, laparoscopic myomectomy and abdominal myomectomy.

While myomectomy is successful in controlling symptoms about 80 percent of the time, the more fibroids there are in a patient's uterus, the less successful the surgery generally is. In addition, fibroids grow back several years after myomectomy in 10 percent to 30 percent of cases.

Hysteroscopic Myomectomy: Hysteroscopic myomectomy is used only for fibroids that are just under the lining of the uterus and that protrude into the uterine cavity. There is no need for a surgical incision. The doctor inserts a flexible scope (hysteroscope) into the uterus through the vagina and cervix and removes the fibroids using special surgical tools fitted to the scope. Usually this is an outpatient procedure performed while the patient is under anesthesia and not conscious.

Laparoscopic Myomectomy: Laparoscopic myomectomy may be used if the fibroid is on the outside of the uterus. Small incisions are made so the doctor can insert a probe with a tiny camera attached and another probe fitted with surgical instruments inside the abdominal cavity and remove the tumors. It is performed while the patient is under general anesthesia and not conscious. The average recovery time is about two weeks.

Abdominal Myomectomy: This is a surgical procedure, in which an incision is made in the abdomen to access the uterus, and another incision is made in the uterus to remove the tumor. Once the fibroids are removed, the uterus is stitched closed. The patient is given general anesthesia and is not conscious for this procedure, which requires a several-day hospital stay. Typical recovery is four to six weeks.

What non-surgical, less invasive options are available to treat fibroids? 

Uterine fibroid embolization:

Uterine fibroid embolization is a minimally invasive procedure that is rapidly growing in popularity as a non-surgical alternative to the treatment of fibroids. Uterine fibroid embolization is performed by an Interventional Radiologist, a physician who is trained to perform many types of minimally invasive procedures. It is performed on an outpatient basis under a mild sedative.

The interventional radiologist makes a tiny less than ¼ of an inch incision in the top of the leg and inserts a very small tube into the artery. Using x-ray guidance, the tube is guided through the artery to the uterus. Tiny plastic beads, the size of grains of sand, are then injected into the blood vessels that supply blood to the fibroid. This blocks the blood flow to the fibroid and causes it to shrink. The procedure takes approximately 90 minutes to perform and requires only a band-aid at the incision site.

Women typically experience cramping and pain the first few hours after the procedure which is controlled by medication. Most women resume light activities in a few days and are able to return to normal activity in less than one week.

According to Dr John Sunderland at Caritas Medical Center, “in the hands of experienced interventional radiologists, up to 90% of women experience significant or total relief of heavy bleeding, pelvic pain and other symptoms related to their fibroids.”

Myolysis:

This procedure is still investigational. Surgical instruments are inserted into the abdomen through small incisions and an electric current applied to the fibroid. This cuts off the blood supply to the fibroid and allows it to shrink over time.

What questions should I ask if treatment of my fibroids is recommended?

• What alternatives are there for me besides hysterectomy or surgery?
  
• What are the advantages, disadvantages and risks of treatment ?
  
• Will I experience early menopause from the recommended treatment?
  
• How soon can I resume normal activities and return to work?

For more in depth information on fibroids and their treatments, visit the Society for Interventional Radiology (SIR) web site at www.sirweb.org.

Drs Daren Repishti, John Sunderland and C. Blair Cornell are Interventional Radiologists and Endovascular Specialists at Caritas Medical Center in Louisville, Kentucky.  They are the regions leading experts in the diagnosis of and non-surgical treatment of uterine fibroids.  They can be contacted directly at 1-866-856-5959, 502-361-6764 or by email at fibroidinfo@dxpimaging.com.