There probably isn't a woman alive who doesn't feel a wave of terror when her doctor mentions the word tumor. But when it's a fibroid tumor, experts say there is little to fear.
"There is virtually no threat of malignancy -- and there are a number of excellent treatment options, as well as the option to do nothing at all -- so there really is no reason to worry," says Steve Goldstein, MD, professor of obstetrics and gynecology at NYU Medical Center.
Fibroid tumors are composed of renegade muscle cells that come together to form a fibrous "knot" or "mass" within the uterus. Although all uterine fibroids are the same, they are categorized based on their location:
- Submucosal fibroids are located just under the uterine lining.
- Intramural fibroids lie between the muscles of the uterine wall.
- Subserol fibroids extend from the uterine wall into the pelvic cavity.
Fibroids most commonly occur between ages 30 and 40, with black women at greatest risk. To date, at least one genetic link has been identified, indicating that fibroids may also run in families.
For some women fibroids cause no symptoms, but when they do, doctors say problems often involve heavy menstrual periods and prolonged bleeding.
"They can also cause pelvic or abdominal pain or swelling and increased urination," says Aydin Arici, MD, professor of obstetrics and gynecology and director of reproductive endocrinology and infertility at the Yale University School of Medicine.
Arici says that ultimately, it is a combination of your symptoms, the location of the fibroid, and the numbers and size, as well as your age and your childbearing potential, that help determine what your course of treatment should be.
Treatment Options: What You Should Know
In the not-too-distant past, doctors routinely performed a hysterectomy for fibroid tumors. And while newer, less-invasive treatments are available, studies show this dramatic operation is still being performed today -- far more frequently than necessary.
"A panel convened by our own governing body -- the American College of Obstetricians and Gynecologists -- found that 76% of all hysterectomies performed today do not meet the criteria for this surgery. They are being done unnecessarily," says Ernst Bartsich, MD, associate professor of obstetrics and gynecology at the New York Hospital-Cornell Medical Center in New York.
"I believe many women are conceding to a hysterectomy for fibroid tumors because they are led to believe it's the only solution -- and that is wrong," says Bartsich.
At the same time, Goldstein says it's also important to recognize that not all hysterectomies are alike. In particular, he says the newest form of this operation (called a supra cervical hysterectomy) could still hold the answer for some women. Why?
"In a supra cervical hysterectomy you remove only the uterine cavity holding the fibroids and you do not touch the tubes, ovaries, cervix, or vagina, or any of the support muscles in the bladder or pelvis," says Goldstein. This, he says, means you don't suffer any of the consequences linked to a traditional hysterectomy, including bladder and sexual dysfunction, or instant menopause.
Recovery is also fast. Most women are out of the hospital in two days and back to normal living within two weeks. It's also a permanent treatment for fibroids that can bring much-needed relief.
Says Goldstein: "My personal choice is to always do as little treatment as possible; but at the same time, women should not routinely close their ears when the doctor mentions hysterectomy, because this one particular type can be extremely helpful and cause no more problems than some of the newer alternatives."
That said, it's also important that you know all your options. To this end, WebMD asked our panel of experts to help us prepare the following guide -- a look at some of the alternative treatments for fibroid tumors. Though not every option will be right for every woman, the experts we consulted unanimously agreed that for each woman, there is frequently one or more alternatives to a hysterectomy.
Option 1: Myomectomy Fibroid Surgery
What it does: Removes only the fibroid tumors, leaving the uterus and all other organs completely intact.
How It's Done: The three major approaches include traditional surgery with a large incision on the abdomen, minimally invasive laparoscopic surgery done through pin hole-sized incisions, and, depending on the site of the fibroid, some can be done through hysteroscopy, a surgery done through the vagina.
What It Accomplishes: Removes the fibroid tumor and offers relief for up to several years, after which time fibroids can sometimes grow back.
Best Suited for: Women who have fibroid tumors but wish to preserve their fertility.
What You Should Know: "Of the three approaches, hysteroscopy is the most effective if you have bleeding or fertility-related problems or recurrent pregnancy loss due to fibroid tumors," says Arici.
That said, Arici cautions that myomectomy can cause adhesions or scar tissue to develop, which later may interfere with fertility. "A woman may need to use IVF in order to conceive after this surgery," he says. The uterus, however, remains strong enough to support a healthy pregnancy, he says.
Option 2: Uterine Artery Embolization
What It Is: A radiological procedure that blocks blood flow to the fibroid, causing it to shrink and eventually die.
How It's Done: A minimally invasive procedure, it involves placing a catheter into the uterine arteries through which tiny particles are injected that seal off the blood supply to the tumor.
What It Accomplishes: Without a blood supply, the fibroid withers and dies.
Best Suited for: Women who have completed childbearing.
What You Should Know: While doctors agree this is a safe, smart treatment, that opinion changes dramatically if a woman has not completed her childbearing. The reason? "Studies show that obstetric complications are higher following this treatment, including a higher rate of preterm labor," says Arici.
The reason behind all these problems, says Bartsich, is compromised blood flow to the uterus. "If you are going to do a good job of blocking blood flow to the fibroid, then you are also blocking blood flow to the uterus, and that causes difficulties during pregnancy," Bartsich tells WebMD. While he says some women have gone on to have a healthy pregnancy after embolization, he believes it's "risky."
Option 3: MRI-Guided Ultrasound
What It Is: For this procedure doctors use high focused ultrasound waves that are converted to heat and destroy the tumor. The MRI is used to guide the radio waves to the tumor site.
How It's Done: Patients are sedated and placed inside an MRI machine that is specially equipped with the ultrasound. The procedure can take up to three hours.
What It Accomplishes: Using heat it destroys the fibroids, though frequently two or more sessions may be needed. In the past, similar methods have used lasers or some form of electric current to accomplish the same thing.
Best Suited For: Women who have completed childbearing.
What You Should Know: Although recently approved by the FDA, doctors say there is insufficient data concerning impact on future pregnancy. Bartsich says risks include potential damage to other organs and the presence of "dead" fibroid tissue, which may compromise fertility -- problems akin to what was found in similar procedures that eventually fell out of favor.
Option 4: Medical Management
What It Is: Medications that shrink fibroids by reducing hormonal stimulation, primarily a GnRH angonist known as Lupron.
What It Accomplishes: Turns off the production of steroid hormones without which fibroids shrink. However, they generally return when treatment is stopped.
Best Suited for: Women with very small fibroids or those who wish to shrink tumors prior to surgery. Also frequently used to halt severe bleeding, allowing a woman to build her blood supply for transfusion prior to a myomectomy.
What You Should Know: Though this treatment does shrink tumors, Goldstein says it is unsafe to use for longer than nine months, after which time the fibroids generally return. However, he says it can be the treatment of choice for women who are very close to menopause. "If you can stop the bleeding for a year a woman will have made it to menopause, after which time the fibroids shrink on their own," Goldstein tells WebMD.
Option 5: Medical Monitoring What It Is: A watchful waiting, checking the size and number of fibroids -- and any resulting symptoms -- at regular intervals. How It's Done: Via vaginal ultrasound exam and a blood test for anemia.What It Accomplishes: It may help carry a woman through to her menopause without treatment, after which time hormone levels drop and fibroids disappear on their own. Best Suited for: Women with minimal symptoms who are nearing menopause and who have completed their childbearing.
What You Should Know: If symptoms are not severe, Goldstein says women should be wary of being talked into treatment they might not need.
Adds Goldstein: "As long as the fibroids are not causing severe pain or heavy bleeding, it is safe to leave them alone -- even if they are fast growing."