Uterine Fibroids

Uterine fibroids at a glance

  • Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), sometimes causing abnormal bleeding, pain, and infertility; the location and size of the fibroid can also lead to miscarriages.
  • Uterine fibroids can be diagnosed through a routine pelvic exam or through imaging tests such as an ultrasound or MRI.
  • Treatment is not always necessary, but may include hormonal and vitamin supplements or surgical removal.

About uterine fibroids

Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female reproductive organ. They can cause abnormal bleeding and pain and depending upon their position in the uterus, they may impair infertility. Fibroids sometimes protrude directly into the uterine cavity – and sometimes are within the uterus itself. The location and size can sometimes lead to miscarriages.

Uterine fibroids are common – as many as one in five women may have fibroids during their childbearing years, and half of women have fibroids by age 50. Fibroids are rare in women under age 20, and they are more common in African Americans.

Causes of uterine fibroids

The cause of uterine fibroids is unknown. However, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. Fibroids can be so tiny that you need a microscope to see them. However, they can also grow very large. They may fill the entire uterus and may weigh several pounds.

Symptoms of uterine fibroids

Often, there are no symptoms, but more common symptoms of uterine fibroids are:

  • Heavy menstrual bleeding, sometimes with the passage of blood clots
  • Bleeding between periods
  • Menstrual periods that may last longer than normal
  • Pelvic cramping or pain with periods
  • Sensation of fullness or pressure in lower abdomen
  • Pain during intercourse
  • Need to urinate more often

Uterine fibroids may be difficult to detect during a physical exam, especially if the woman is overweight. Commonly, physicians discover fibroids via ultrasound or occasionally by magnetic resonance imaging.

Fibroids may be located several places in the uterus, but those that affect fertility tend to be the ones that change the shape of the uterine cavity or are within the cavity itself. Removal of these fibroids may increase fertility.

Diagnosing uterine fibroids

If a woman has symptoms of uterine fibroids, a doctor may perform a pelvic exam to feel for irregularities in the shape of the uterus. Uterine fibroids can cause such irregularities. Imaging tests such as vaginal ultrasounds or MRIs may also be used to identify the size and placement of the fibroids.

In addition to MRIs or ultrasounds, a doctor may perform the following imaging tests to better map out the location of fibroids.

Hysterosonography

Hysterosonography, also called sonohysterography or a saline infusion sonogram, is when a doctor uses a catheter to push saline into the uterus during an ultrasound. The saline expands the uterus, which helps the doctor identify abnormalities in the uterine lining (the endometrium) and the inside of the uterus.

A hysterosonography is a noninvasive procedure, since the catheter is inserted through the vagina. Side effects are rare, although women may experience cramping during the procedure and light spotting afterwards.

Hysterosalpingography

A hysterosalpingography (HSG) is an infertility diagnostic test used to evaluate the uterus and the fallopian tubes. In this procedure, a doctor uses a tube or cannula to place dye into the uterus and fallopian tubes. The dye acts as a contrast medium, which means it illuminates the shape of the organs when viewed through an X-ray. The doctor can then use the X-ray to identify any growths, blockages or other abnormalities present in the uterus or fallopian tubes.

A doctor may inject local anesthesia before an HSG or recommend a woman take over-the-counter pain medication. Women often experience vaginal discharge after the procedure as the fluid from the HSG leaves the uterus. Other side effects include vaginal bleeding, cramping and nausea or feeling dizzy after the procedure.

Hysteroscopy

During a hysteroscopy, a doctor inserts a very small, lighted camera (called a hysteroscope) through the vagina and into the uterus. The camera on the end of the hysteroscope allows the doctor to view the inside of the uterus. Carbon dioxide or saline is often used in conjunction with the hysteroscope, which allows the doctor to expand and better see inside the uterus.

In addition to diagnosis, a hysteroscopy may also be used to treat fibroids via hysteroscopic myomectomy. In this variation, a doctor uses a resectoscope, which is a hysteroscope that can cut tissue, to remove the fibroids.

Treatment of fibroids

Some women do not need treatment, instead requiring only pelvic exams or periodic ultrasounds to monitor the fibroid’s growth. Treatment for the symptoms of fibroids may include:

  • Intrauterine devices (IUDs) that release the hormone progestin to help reduce heavy bleeding and pain
  • Short-term hormonal therapy injections to help shrink the fibroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or Naprosyn for cramps or pain
  • Iron supplements to prevent or treat anemia due to heavy periods
  • Birth control pills (oral contraceptives) to help control heavy periods

If removal of fibroids is called for by a physician, these four surgical procedures remove fibroids:

  • Women who have fibroids growing inside the uterine cavity may need an outpatient procedure using a hysteroscope to remove the fibroids.
  • Embolization: This procedure cuts the blood supply to the fibroid, causing it to die and shrink. This procedure must be carefully considered if a woman wants to become pregnant later on. It can cause premature ovarian failure by plugging the ovarian vessels.
  • Surgery called myomectomy completely removes the fibroids. It preserves fertility, so it is a good choice for women who want to have children. Risk: More fibroids can develop after this surgery.
  • Hysterectomy could be called “the death penalty for fibroids.” However, it is invasive and completely removes a woman’s entire reproductive system and should only be considered if nothing else has or will work.

Medical studies have shown that myomectomy may preserve or restore fertility after removal of fibroids. This procedure is done by a specialist, so consult your OB/GYN or reproductive specialist on the best alternatives.

Myomectomy treatment and cost at Servy Massey Fertility Institute

When the best treatment for uterine fibroids is surgical removal, or a myomectomy, we perform the surgery through the smallest possible incision (mini-laparotomy). This allows for a prompt recovery and helps restore fertility. When surgery is performed for infertility, there is often a sharp increase in conception, usually 50 percent of them occurring within six months after surgery.

Depending on the size and the location, myomectomy can be performed in hospital or in an outpatient facility under general anesthesia.

Costs of an outpatient myomectomy at the Servy Massey Fertility Institute are very competitive. The total cost is less than $6500, which is half the normal cost at a hospital. For more information on this service, contact us today or request an appointment.

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