Your Options for Uterine Fibroid Tumors

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Approximately 30% of women will have uterine fibroids at some time during their lives, but thankfully, most have no symptoms and do not need treatment. However, for some women they can cause heavy menstrual bleeding, prolonged periods, pelvic pressure or pain, and difficulty with urination or constipation. Anemia can develop from the loss of blood.

Uterine fibroids are non cancerous growths that can occur either inside or outside of the uterus. Submucosal fibroids grow in the inner cavity of the uterus and can interfere with the ability to become pregnant. Subserosal fibroids project on the outside of the uterus, and can press on the bladder, rectum, or spinal nerves.
Fibroids often appear during childbearing years, possibly due to the higher levels of estrogen. Other factors that can cause fibroids include genetic alterations (fibroids tend to run in families) and natural body chemicals such as insulin-like growth factor (IGF). Black women are more likely to have fibroids than women of other racial groups.

For women who are not experiencing adverse effects from their uterine fibroids, doctors often just monitor their growth over time. After menopause, fibroids are not often a problem because of the drop in reproductive hormones.

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Fibroids are probably responsible for more unnecessary gynecological surgery than any other female condition. About 600,000 hysterectomies are performed each year in the United States, with about 30% of those involving fibroid tumors. There are other options for the treatment of uterine fibroids.

Medications can be used to shrink the fibroid tumor. These drugs target hormones that regulate the menstrual cycle and therefore relieve such symptoms as heavy menstrual bleeding and pelvic pressure. Gonadotropin-releasing hormone (Gn-RH) agonists such as Lupron or Synarel can be used to decrease estrogen and progesterone levels, stopping menstruation and shrinking fibroids. Other medications that can be used include a progestin-releasing intrauterine device (IUD), androgens, oral contraceptives, and NSAIDs to relieve symptoms, although these do not shrink the tumors.

Medications, however, cannot completely get rid of the fibroid tumor, so if it is still causing complications, physicians may choose to first try a less-invasive procedure such as a myomectomy which remove just the tumor itself. The surgery can either be performed abdominally through a small bikini-line incision, laparoscopically through the navel, or intravaginally – called resectoscope myomectomy. With this surgery, there is a risk of fibroid recurrence.

Newer procedures for fibroid treatment include myolysis, a laparoscopic procedure that uses a current or laser to destroy the fibroid and shrink the blood vessels that feed them. Endometrial ablation uses heat, microwave energy, hot water, or electric current to destroy the lining of the uterus to stop abnormal bleeding, however this procedure will not be effective for reducing the recurrence of tumors that grow on the outside of the uterus. Uterine artery embolization uses small particles that are injected into the arteries of the uterus to cut off blood supply, causing the fibroid to shrink.

Another noninvasive treatment option includes MRI-guided focused ultrasound surgery (FUS) in which focused high-frequency sound waves are used to target and destroy the tumor. Initial results appear promising, but long-term studies have not been completed to fully understand its overall effectiveness.

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