Understanding Uterine Fibroids -- Diagnosis and Treatment
How Do I Know If I Have Uterine Fibroids?
Fibroids are often first found during a routine pelvic exam. To double check, an ultrasound may be performed, either transvaginally or abdominally. A three-dimensional (3D) ultrasound or an MRI (magnetic resonance imaging) can also be used to find the fibroids, a process called fibroid mapping.
What Are the Treatments for Uterine Fibroids?
If your fibroids aren't causing you any problems, it is reasonable to consider doing nothing. Not all fibroids grow. Even large fibroids may not cause any symptoms, and most fibroids shrink after menopause. But you should monitor their growth, especially if you develop symptoms such as bleeding or pain, by having exams every six months.
To help prevent more growth of the fibroid, your doctor may recommend that you stop taking birth control pills or hormone replacement therapy. But in some cases, oral contraceptives are prescribed to help control the bleeding and anemia from fibroids, even though certain forms of the pill may cause fibroids to grow.
Gonadotropin-releasing hormone (GnRH) agonists may be prescribed to shrink fibroids and reduce anemia. These drugs are expensive and shouldn't be taken for more than six months due to the risk of developing osteoporosis. A low-dose of progestin may be given with GnRH agonists to avoid osteoporosis and menopausal symptoms. Once women stop taking the drug, the fibroids regrow. Therefore, this treatment is usually given primarily to shrink the size of the fibroids or to improve anemia in preparation for surgery.
SERMs, or selective estrogen receptor modulators, may be able to shrink fibroids without causing menopause symptoms.
Progestin-releasing Intrauterine Device
While this treatment does not shrink the fibroids, it can control the associated bleeding and cramping.
To shrink a fibroid, your doctor may recommend uterine fibroid embolization. In this procedure, polyvinyl alcohol (PVA) is injected into the arteries that feed the fibroid. The PVA blocks the blood supply to the fibroid, causing it to shrink. Uterine fibroid embolization is a nonsurgical procedure, but you may need to spend several nights in the hospital since nausea, vomiting, and pain may occur in the first few days afterward.
There are several methods in which the lining of uterus is destroyed to decrease the bleeding associated with small fibroids.
Fibroids can be removed by a surgery known as a myomectomy. If you plan to become pregnant, a myomectomy may be recommended over other options. Even with myomectomy, though, surgery can cause scarring that may cause infertility.
Discuss any plans you have to conceive with your doctor before deciding on surgery. Women should wait four to six months after surgery before trying to conceive. In most women, symptoms go away following a myomectomy, although fibroids return in a quarter to a third of women who have this procedure. Successful surgery partially depends on the number of fibroids and whether they were all removed.
A less invasive type of myomectomy uses a hysteroscope -- a long, thin lighted tube -- to enter the uterus through the vagina and cervix. Fibroids can then be removed by a tool inserted through the hysteroscope.
There is an experimental method that uses MRI-guided intense ultrasound energy to pinpoint the fibroids and shrink or destroy the fibroid.
Hysterectomy (surgical removal of the uterus), is the only treatment that guarantees a cure from fibroids. For many women, though, hysterectomy may not be necessary.