Can Major Fibroid Surgery Be Avoided?

One of my favorite professors in medical school was fond of saying “There is nothing so constant in medicine as variation.” From my perspective, more than 25 years in clinical medicine, there is nothing so constant in medicine as change. At times the rate at which this change goes on is quite amazing. This can especially be said for the treatment of uterine fibroids over the last 100 years.

The most dramatic change in fibroid treatment occurred as a consequence of the evolution of surgical techniques. Historically surgery was a very dangerous undertaking from which many did not survive. Now surgery is commonplace and easy at least for the surgeon. In fact, it has become so easy that it has leant itself to excess use. The term ‘elective surgery’ which did not exist prior to the 20th century is now used to describe the majority of gynecologic surgery. In essence, this term refers to the fact that a procedure is not being performed to save a person’s life. Certainly this is justifiable when the quality of life is being improved or future foreseeable threats can be made avoidable. But when major surgery is performed in the absence of either symptoms or foreseeable future threat to well-being justification is wanting.

Hysterectomy for fibroids has become so common that it has become synonymous with fibroids in the minds of some. No matter how easy and safe major surgery has become, to be cut open has never been a life’s goal any sane individual. Thus, at the same time that surgery was becoming more commonplace, methods to minimalize or avoid it have evolved. Thus we have seen laparoscopy used increasingly to eliminate the need for large incisions in major surgery to reduce complications and shorten recuperation time.

Hysteroscopic procedures have been introduced to replace major surgery in some instances. This is especially true where bleeding associated with fibroid tumors requires treatment. Resection of submucous fibroids from the inside of the uterine cavity and destruction of the lining of the uterus, endometrial ablation, are examples of such hysteroscopic treatments.

Blockage of the uterine arteries has been noted to cause fibroid tumors to die and the heavy bleeding associated with them to cease. This approach has become popularized as uterine artery embolization (UAE) aka uterine fibroid embolization (UFE). It has also become apparent that any method by which these arteries are blocked temporarily or permanently will have the same result. As a consequence, a new method that will be done by gynecologists on an outpatient basis is under investigation.

Thus, the answer is yes that major surgery can be avoided in the treatment of uterine fibroids. Even more exciting is the fact that there are other options available and becoming available in the near future . This will be the subject of the future installments of this discussion where we will pursue the fascinating world of medical/drug therapies.

Click for more information about Dr. Hutchins and the Hope For Fibroids website.

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Fibroids!

extracted uterine fibroids

What are
uterine fibroids?

 

Uterine fibroids are tumors or lumps made of
muscle cells and other tissue that grow within the wall of the uterus. Fibroids
may grow as a single tumor or in clusters.

A single fibroid can be less
than one inch in size or can grow to eight inches across or more. A bunch or
cluster of fibroids can also vary in size.

Where do
uterine fibroids grow?

Location of uterine fibroidsMost fibroids grow within the
wall of the uterus. Health care providers put fibroids into three groups based
on where they grow:

 

  • Submucosal (pronounced sub-myou-co-sul)
    fibroids grow just underneath the uterine lining.
  • Intramural (pronounced in-tra-myur-ul)
    fibroids grow in between the muscles of the uterus.
  • Subserosal (pronounced sub-sir-oh-sul)
    fibroids grow on the outside of the uterus.

 

 

Some fibroids grow on stalks (also called
peduncles, pronounced ped-uncles) that grow out from the surface of the
uterus, or into the cavity of the uterus.

What are the
symptoms of uterine fibroids?

Many women don’t feel any symptoms with uterine
fibroids. But fibroids can cause the following symptoms:

 

  • Heavy bleeding or painful periods
  • Bleeding between periods
  • Feeling “full” in the lower abdomen—sometimes
    called “pelvic pressure”
  • Urinating often (results from a fibroid pressing
    on the bladder)
  • Pain during sex
  • Lower back pain
  • Reproductive problems, such as infertility,
    multiple miscarriages, and early onset of labor during pregnancy

 

 

 

What causes
uterine fibroids?

Currently, we know little about what causes
uterine fibroids. Scientists have a number of theories, but none of these ideas
explains fibroids completely. Most likely, fibroids are the end result of many
factors interacting with each other. These factors could be genetic, hormonal,
environmental, or a combination of all three. Once we know the cause or causes
of fibroids, our efforts to find a cure or even prevent fibroids will move ahead
more quickly.

Does having
uterine fibroids mean that a woman will be infertile or unable to have
children?

In some cases, fibroids can prevent a woman from
getting pregnant through natural methods. However, advances in treatments for
fibroids and infertility have greatly improved the chances for a woman to get
pregnant, even if she has uterine fibroids.

Researchers are still looking
into what role, if any, uterine fibroids play in infertility. Currently, though,
there are few answers. One study’s results suggest that only submucosal fibroids
have a negative impact on fertility (Pritts
2001
), but these results are not yet confirmed. The relationship between
fibroids and infertility remains a very active research area.

Does having
uterine fibroids mean a woman will need a hysterectomy (removing the uterus)?

Hysterectomy is not the best option for every
woman with uterine fibroids. If a woman wants to have children, then she would
want to avoid this treatment. Likewise, if a woman isn’t showing symptoms of
uterine fibroids, or her fibroids are small, she may have better results from
pain medications or hormone treatments. Doctors are also exploring less-invasive
surgical treatments for fibroids that save the uterus. See the What are the
treatments for uterine fibroids?
section of this fact sheet for more
information about less-invasive treatments.

In some cases, though, a
hysterectomy is the best method of treatment. If you have uterine fibroids and
are thinking about having a hysterectomy, make sure you talk over all
features
of the surgery with your doctor and your family. Having a
hysterectomy means that you will no longer be able to have children. This
process cannot be reversed, so be certain about your choice before having the
surgery.

Keep in mind that the physical scars of the procedure may heal
quickly, but some of the effects of hysterectomy are long-lasting. You may want
to talk to women who have had the procedure before you decide to have your
surgery. Many health care centers, women’s clinics, and hospitals offer support
groups for women who have had, or are in the process of having a hysterectomy.

Who gets
uterine fibroids?

Most of the time, fibroids grow in women of
childbearing age. Research studies estimate that doctors diagnose up to 30
percent of women of childbearing age with uterine fibroids; but, because some
women show no symptoms of fibroids, as many as 77 percent of women of
childbearing age could have the condition, without knowing it. We don’t know
exactly how many new cases of fibroids occur in a year, nor do we know how many
women have fibroids at any one time.

There have also been reports of rare
cases in which young girls who have not yet started their periods (pre-pubertal)
had small fibroids.

Researchers now recognize several risk factors for
uterine fibroids.

 

  • Current statistics place African-American women
    at three-to-five times greater risk than white women for fibroids.
  • Women who are overweight or obese for their
    height (based on body mass index or BMI*) are also at slightly higher risk for
    fibroids than women who are average weight for their height.
  • Women who have given birth appear to be at lower
    risk for uterine fibroids.

 

 

But, because we don’t know what causes fibroids,
we also don’t know what increases or reduces their growth.

How do I know
that I have uterine fibroids?

Unless you start to have symptoms, you probably
won’t know that you have uterine fibroids.

Sometimes, health care
providers find fibroids during a routine gynecological exam.