Fibroids
Fibroids of the uterus (leiomyomas or myomas) are benign (non-cancerous) tumors made of smooth muscle that usually grow within the uterine walls. Fibroids may cause heavy menstrual flow, severe cramping, pelvic pressure and bladder or bowel problems. Depending on their location, size and growth rate, fibroids can also interfere with conception and pregnancy.
Diagnosing Fibroids
A variety of means are available for diagnosing fibroids, depending on their size and location.
Pelvic Examination If the fibroid tumor or tumors are very large, they may be felt on pelvic examination.
Routine Pelvic Ultrasound - This is a transvaginal ultrasound, used to view the lining of the uterus. It is usually the best way to see a fibroid. In order to evaluate the potential effect on the uterine cavity, the ultrasound should be performed shortly before ovulation, when the endometrial lining is at its thickest. A 3 D pelvic scan is especially helpful.
Hysterosonogram - Ultrasound (Saline sonogram or water sonogram). This is a vaginal ultrasound in which the physician injects sterile saline (salt water) into the uterine cavity. The saline serves to enlarge the uterus, and also makes it easier to view and measure any fibroids within the area. It is best used to visualize submucous fibroids, those within the uterine cavity.
Hysteroscopy - Hysteroscopy is a minor surgical procedure that involves placing a lighted telescopic instrument (hysteroscope) through the uterine cervix and visualizing any abnormalities within the wall of the uterine cavity. If a fibroid is seen, it can be removed during the same procedure.
Magnetic resonance imaging MRI - This procedure uses a powerful magnetic field, radio frequency pulses and a computer to produce highly detailed pictures of the soft tissue (as well as virtually all other body structures). In the case of fibroids, MRI can help to delineate multiple growths of various sizes in order to insure that all may be removed. Because of its specificity, the MRI can help to distinguish fibroids from the one other uterine abnormality that it can sometimes be confused with, adenomyosis. Adenomyosis cannot be removed surgically, however fibroids can – thus the importance of distinguishing between the two.
Treating Fibroids
In a surgical procedure called myomectomy, the fibroid can be removed, preserving the uterus and ovaries so that conception can occur. There are various methods to perform myomectomy, depending on the location, size and number of fibroid(s).
Myomectomy with laparotomy - If the fibroids are mostly within the wall of the uterus, the surgery is usually done by laparotomy, involving a large incision through the abdominal wall. This "abdominal myomectomy" is the best approach for large and/or multiple fibroids within the muscle wall of the uterus. This surgical procedure can be performed by most all gynecologists. Of course, as this is a major abdominal surgery, a hospital stay of 2-3 days is usually required and recovery can take 4-6 weeks. Most women who have an abdominal myomectomy will need to have a Cesarean section with any subsequent pregnancy.
Myomectomy with a hysteroscope (hysteroscopic resection) - If the fibroid is mostly situated within the uterine cavity, the best approach is usually through a hysteroscope, a thin lighted telescope inserted through the vagina and into the uterus. The hysteroscope is fitted with specific surgical instruments, enabling the physician to view and remove the fibroids. This surgery must be done by gynecologists with adequate training in hysteroscopy. As no incisions are involved it is usually performed as a day surgery with no overnight hospital stays and recovery is rapid – less than a week - and there are no incisions.
Myomectomy with a Laparoscope (Laparoscopic myomectomy) - This procedure uses a laparoscope and one or more small incisions in the abdomen. Though laparoscopic myomectomy is minimally invasive, it requires special training by a gynecologic surgeon. In recent years, laparoscopic surgeons are also starting to use robotic assisted surgery and this has been especially helpful for myomectomies. There are only a handful of gynecologists adequately trained in robotic laparoscopic myomectomy. With laparoscopic myomectomy, scar tissue formation after surgery is usually less than with open surgery; and recovery time is relatively quick, due to minimal abdominal incisions.
Uterine Artery Embolization - This relatively new procedure holds promise, but because long term effects are still being studied, it is not yet recommended for women who want to preserve their fertility. The embolization procedure blocks fibroid blood supply by injecting small particles (beads) into the arteries that supply the fibroids. For the embolization, the physician guides a catheter through the leg arteries and into the uterine artery.