Fibroids

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Uterine fibroids, also called leiomyomas, are noncancerous tumors of the uterus (less than 1% are cancerous). Fibroids are the most common solid pelvic tumor in women. They are usually detected in women in their 30's and 40's. After menopause, fibroids may shrink due to lack of estrogen.

Fibroids are classified by their location. Fibroids located just underneath the outer surface of the uterus are called subserosal. Intramural fibroids are located within the thick muscle of the uterus, the myometrium. Fibroids located just under the lining of the inside of the uterus (endometrium) are considered submucosal. The majority of fibroids are subserosal and intramural. A small percentage of fibroids are submucosal. Rarely, fibroids may be located in the cervix and in the ligaments supporting the uterus.

The most common symptoms of fibroids include:

• Heavy or irregular uterine bleeding
  
• Pelvic pain Pelvic pressure (especially bladder or rectal pressure)
  

The location and sizes of fibroids are evaluated by pelvic examination and ultrasound.

Treatment options for fibroids include the use of gonadotropin-releasing hormone (GnRH) agonists, uterine artery embolization, and surgery.

Surgery for uterine fibroids may involve removal of the fibroids (myomectomy) or removal of the uterus (hysterectomy). If myomectomy is chosen, the surgery may be performed by laparoscopy, hysteroscopy, or through an open abdominal incision. Removal of a submucosal fibroid is performed using advanced hysteroscopy. Usually, a small wire acts as a scalpel to shave pieces of the fibroid until it is completely removed. Intramural fibroids may be removed using the laparoscope or hysteroscope. Advanced laparoscopy allows removal of subserosal fibroids while minimizing the size of abdominal incisions. If the surgery is performed laparoscopically or hysteroscopically the patient will usually go home the day of surgery. If a larger abdominal incision is made, patients will often stay overnight. There is a recurrence risk with myomectomy unlike hysterectomy.

GnRH agonists create a state of "menopause" to stop the growth-promoting effects of estrogen and decrease the size of fibroids. Unfortunately, the effects are short-lived. GnRH agonists are only a short-term solution due to their negative effects on bone and their associated symptoms. Without hormone replacement therapy, women may experience symptoms of menopause (hot flashes, vaginal dryness, and irritability). After GnRH therapy is discontinued, the fibroids often return to their pretreatment size.

Uterine artery embolization is a radiologic alternative to surgery. The uterine arteries are blocked, thus decreasing the blood supply to the fibroids. Uterine artery embolization may have serious consequences including massive uterine bleeding, infection, and uterine necrosis. Patients can experience significant uterine pain.

Other innovative techniques that are not as widely available include myolysis which involves delivering an electric current to the fibroid using needles during laparoscopy and crymyolysis which involves using a freezing probe.