Fibroids

No one knows exactly what causes fibroids, but by age 40, somewhere between 40 and 70 percent of women will probably have them, notes Steven R. Goldstein, M.D., professor of obstetrics and gynecology at New York University in New York City.

These noncancerous tumors can grow on the inside, out side or within the wall of the uterus, or can be attached to it by a stemlike structure. Many women who have fibroids are not aware of them because the growths can remain small and not cause any symptoms. However, in some women, fibroids that are large or numerous can cause problems. When symptoms do occur, they often include irregular bleeding, pelvic and lower back pain and pres sure, difficulty urinating and an enlarged abdomen. In some women, fibroids cause infertility and miscarriage, although many women with fibroids can conceive and carry a pregnancy to term.

Fortunately, women have several options for dealing with fibroids. "Treatment depends on where the fibroids are located, the symptoms they cause and their size," says Howard T. Sharp, M.D., associate professor and chief of the general division of obstetrics and gynecology at the University of Utah School of Medicine. Treatment options include the following:

Wait and see

In the absence of any symptoms, the best treatment may be no treatment at all, especially near menopause, a time when fibroids naturally shrink. Your doctor may simply monitor the fibroids regularly to make sure they aren't growing.

Q&A.

How are fibroids diagnosed? Your doctor may detect fibroids during a routine pelvic exam. Further tests can provide more information: Ultrasonography uses sound waves to create a picture of the uterus. Hysteroscopy uses a thin telescope inserted into the vagina and cervix that permits the doctor to see some fibroids inside the uterine cavity, HSG (hysterosalpingography) is a special X-ray test to detect abnormal changes in the size and shape of the uterus and fallopian tubes. Laparoscopy uses a slender device inserted through a small cut just below the navel that enables the doctor to see fibroids on the outside of the uterus.

Can I still get pregnant after having a myomectomy or uterine artery embolization to remove fibroids? A woman can usually become pregnant after both procedures. But the safety of pregnancy after embolization needs more research. Although 100 women in one study conceived after an embolization, some had problems. In a number of cases, the baby did not grow properly, or the fetus was abnormally positioned.

A myomectomy preserves a woman's ability to become pregnant, but delivery may involve a C-section since the uterine wall is often weakened. Sometimes a myomectomy can cause scarring, which may lead to infertility.

Drug treatments

Oral contraceptives and progestin-only pills can suppress excessive bleeding, and pain relievers such as ibuprofen may ease discomfort If the fibroid is large, your doctor may prescribe a hormone medication to shrink it and reduce bleeding. The problem with these medications is that the fibroid grows back once the drug is discon tinued. The drug can also lower bone density and, with extended use, can cause fnenopausal symp toms such as hot flashes and vaginal drynegs.

 

Surgical or outpatient options

MYOMECTOMY

In this procedure, the doctor removes the fibroids but leaves the uterus intact. Women who eventually plan to become pregnant may opt for a myomectomy. The proce dure may also be useful for women with multiple or large fibroids. How the treatment will be done depends on the size and number of the fibroids.

ENDOMETRIAL ABLATION

This procedure destroys the lining of the uterus to halt or reduce heavy blood loss, a common symptom of fibroids. A doctor can use a range of methods, including radio waves, low-voltage electricity, laser energy, freezing or a heated loop. This outpatient surgery requires general anesthesia, but most women recover within a day. After treatment, pregnancy is usually not possible.

UTERINE ARTERY EMBOLIZATION

Performed by interventional radiologists, this nonsurgical procedure preserves a woman's uterus and usually main tains her hormonal cycles. A catheter is inserted into each of the two uterine arteries and small partides are injected

to cut off the blood flow to the fibroids, which causes them to shrink. Early results suggest that embolization provides effective short-term relief, but long-term results are undear. Because the safety for future pregnancies with emboliza tion isn't known, it is currently recommended only for women who have completed their families.

EXABLATE 2000

This device, approved by the PDA in October 2004, uses an ultrasound beam guided by a magnetic resonance imaging (MRI) machine to target and destroy fibroids. The technique may require as many. as 50 'pulses, with each one lasting about 15 seconds, and the procedure can take up to three hours to complete. ExAblate is currently not available nationwide, and many doctors still consider it an experimental treatment.

HYSTERECTOMY

If other treatments fail and the pain and abnormal bleed ing associated with fibroids persist, a doctor may recom mend a hysterectomy, the surgical removal of the uterus. If the ovaries are also removed to reduce the risk of ovarian cancer when a hysterectomy is done, many women enter early menopause after the procedure, which can cause bone loss, hot flashes and vaginal dryness.

Culled from: www.womansday.com

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