Uterine fibroids and their treatment options

Uterine Fibroids, or uterine myomas (short for leiomyoma) are benign clonal tumours that arise from the smooth muscle cells of the uterus. The terms fibroid and myoma are used interchangeably. They affect more than 30% of women . Most fibroids do not cause symptoms, and do not require treatment. Fibroids may require treatment in the following circumstances:

1. Fibroids are growing large enough to cause pressure on other organs, such as the bladder.
2. Fibroids are growing rapidly
3. Fibroids are causing abnormal bleeding
4. Fibroids are causing problems with fertility.

Types of Fibroids

Fibroids are classified by their location, which affects the symptoms they may cause and how they can be treated.

Submucous fibroids are deep within the uterus, just under the lining of the uterine cavity. They are the least common fibroids, but they often cause symptoms.

Intramural fibroids are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. These are the most common fibroids.

Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroids.)

Diagnosis of Fibroids

Fibroids may be felt during a pelvic exam . The presence of fibroids will be confirmed by abdominal ultrasound which will provide a visual image of the size , shape and structure of the uterus. To obtain the clearest possible images of the fibroids a magnetic resonance imaging will be ordered.

One of the most common conditions confused with fibroids is adenomyosis. In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. On ultrasound examination this will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. Adenomyosis is usually a diffuse process, and rarely can be removed without taking out the uterus. Since fibroids can be removed, it is important to differentiate between the two conditions before planning treatment. It is also common to have some adenomyosis in addition to fibroids.

Treatment of Fibroids

The majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Only fibroids that are causing significant symptoms need treatment. The location of the fibroids plays a strong influence on how to treat them.

Medical Treatment

Most of the time medical treatment is the first proposed treatment. This might include birth- control pills or other hormonal therapy , the use of non-steroidal anti-inflammatory drugs or GnRH antagonists.

In many patients symptoms are controlled with these treatments , but some hormone therapies have side effects and have only a transitory effect . Fibroids grow back after therapy is discontinued.

Surgical treatment of fibroids

Surgery has long been the mode of therapy of myomas.

Hysterectomy eliminates the symptoms and the chance of recurrence .Depending on the size of the fibroid , hysterectomy can be performed through vagina or abdomen .Use of GnRH antagonists can reduce the size of the fibroid to allow less invasive surgery through the vagina. For many women who have completed childbearing, the freedom from future problems makes hysterectomy an attractive option. However for women who desire future pregnancies or wish to keep their uterus for other reasons , other treatments could be an option .

Myomectomy can be a treatment option for women who wish to retain their uterus for some reason. Myomectomy is the surgical removal of the fibroids only. This can be accomplished through hysterectomy , laparoscopy , or by open procedure. The surgical treatment depends on the size and location of the fibroid.

Uterine fibroid embolization

Uterine fibroid embolization is the least invasive treatment that may be used to treat uterine fibroids. This is the newest treatment for fibroids. The first embolization was performed in 1995.

A small incision is made in the groin and a catheter is inserted into the femoral artery. Local anaesthesia is used to make the needle puncture not painful. Contrast medium is injected to show up the vessels and to guide the catheter to the fibroid’s blood vessels. Once the catheter in position small embolization materials are injected through the catheter. By selecting the exact diameter of embolization material , the blood flow to the fibroid tissue is blocked . As a result the fibroid tissue started to shrink . Treatment results vary , but on average ,fibroid size is reduced in between 20% to 70% percent over the six months following the procedure.