Living Well: How to choose the best treatment for fibroid tumors
Consider the options
BY BECKY FIX, WHNP
Ministry Medical Group
Also known as leimyomas or myomas, fibroid tumors are abnormal growths that occur either on or in the uterus. They’re made up of smooth muscle and connective tissue, are dense and usually round. They can vary in size from being as small as a pea to as large as a cantaloupe. But they are almost never associated with cancer.
There are four types of fibroid tumors, classified according to their location. Intramural fibroids occur within the lining of the uterus. They’re the most common type and can grow very large. Subserosal fibroids are found on the outside of the uterus (the serosa).
Submucosal fibroids are less common. They’re found in the inner lining of the uterus (the myometrium).They can cause heavy bleeding and can also affect fertility. Pedunculated fibroids grow out on a stalk or stem from the uterine wall. They can shift or become twisted, causing pain and pressure.
Fibroids occur in women of child-bearing age but are most likely to be seen as they approach menopause.
Fueled by female hormones, they can get worse during pregnancy. Women who are obese have a higher risk. They tend to run in families so if your mother had fibroids, you face a higher risk.
Common symptoms include heavy menstrual periods and sometimes heavy bleeding between periods, increased menstrual cramping, anemia, caused by the excessive blood loss, lower pelvic pain, back pain, needing to urinate more frequently, painful intercourse; feeling pressure in the abdomen, having an enlarged abdomen.
Treatment for fibroids depends on a number of factors including the location or type of fibroid, the size of the tumor, the severity of symptoms and the patient’s preference.
The patient’s age can also have a bearing on treatment decisions as fibroids usually shrink as a woman gets close to menopause. For some women watchful waiting may be the best answer.
Medications used to treat fibroids usually focus on combating the effects of estrogen. Estrogen-opposing drugs such as progestin and Danazol or progesterone-blocking drugs are sometimes prescribed.
Gonadotropin-releasing hormone agonists (GnRH agonists) lower estrogen levels and, in some cases, are prescribed in order to induce a medical menopause. They may also be used to shrink fibroids prior to surgery.
Uterine artery embolization is a minimally-invasive technique that identifies the arteries that supply blood to the fibroid then blocks off the blood supply. The effect is to shrink the fibroid.
Myomectomy is a surgical technique in which the fibroid is removed and the uterus left intact, making it possible for the patient to become pregnant in the future.
At five years of follow up after myomectomy, 15 to 30 percent of patients will have a recurrence. The number and size of the fibroid tumors also affects the likelihood of a successful outcome.
Hysterectomy, the surgical removal of the uterus, is an option when more conservative treatment methods have failed and a woman does not want to become pregnant in the future.
Forced Ultrasound Surgery (FUS) is a relatively new procedure that uses an MRI machine to visualize the inside of the uterus, then directs high-frequency ultrasound waves to the fibroids and destroys them. It’s a non-invasive procedure that can be performed on an out-patient basis.
With so many treatment options it’s wise to talk to your gynecologist and make sure you understand all the options that might be appropriate for the type and size of fibroids you have, taking into account your age and wishes concerning fertility. Fibroids may cause discomfort and inconvenience but are not
Life-threatening, so don’t feel rushed or pressured about making a decision.
Becky Fix, WHNP is an OB/GYN Nurse Practitioner with Ministry Medical Group, part of Ascension.