Uterine Fibroids can effect quality of life, can at times cause dangerous problems such as severe hemorrhage, but most often cause no problems at all. The first question to ask is should fibroids be treated rather than how.
Fibroids should be treated if they cause heavy bleeding resulting in anemia that can’t be controlled with iron and medicines. Fibroids that prolapse (protrude) through the cervix often cause heavy bleeding, pain, and can become infected. Certain types of fibroids can cause infertility or difficulty in pregnancy. These fibroids should be treated.
I like to draw analogies. Imagine you have a car and the brakes don’t work. If you don’t fix them immediately bad things will happen!
Many fibroids are so small that a woman is unaware that she has them, or cause only minimal symptoms. These can be watched by a gynecologist and many never require any treatment.
The decision of when and how to treat fibroids that interfere with the quality of life without actually presenting a major health hazard can be difficult. Let me present two examples of such problems that can be caused by fibroids:
- Joan notices that it is difficult to fit in her clothes because her fibroids make her look like she is 5 months pregnant. She has to urinate frequently, and is bothered by the pressure.
- Kristine is a teacher, and has periods so heavy that she is afraid she’ll soak through her clothes several days a month. She frequently bleeds between periods, and finds it difficult to plan vacations because of her bleeding. She takes iron, so her blood count is normal.
Let’s get back to the car analogy. Let’s say the heater and air conditioner don’t work and the windows are stuck down in a town where it’s zero degrees in the winter and 105 in the summer. When does the car need to be fixed? When you are tired of freezing or roasting. But it’s not like driving without brakes, as it’s a matter of comfort rather than safety. The decision is not that different than deciding when to treat fibroids. When they interfere with your ability to do what you want to do you should consider treatment.
It’s important to remember that fibroids often grow until menopause, and then usually decrease in size. A woman who is 30 has many year until menopause, and it is likely that if she is bothered by fibroids it will only get worse over the years. On the other hand a woman who is 49 would be expected to reach menopause soon, and if there are ways to control her symptoms from the fibroids there is a reasonable chance that they may improve after menopause.
Once the decision is made that fibroids should be treated, the next question is how. There are many different procedures, each claiming to be the greatest and the best. While I will be writing about many methods of fibroid treatments in detail, it is far less confusing if you realize that all of the methods fall into four basic categories:
- Medical treatment of fibroids. While there are no medicines that cure fibroids, there are medicines that may control symptoms and result in a temporary decrease in size.
- Destroy the fibroids. These methods leave the fibroids in place, but attempt to kill them by cutting off their blood supply, or using electrical, thermal, or ultrasound energy to “cook” them. The body then absorbs the dead tissue.
- Take out the fibroids. Depending on size and location, fibroids may be removed through an incision, a laparoscope or robot, or through the cervix (hysteroscopically). Once the fibroids are gone they do not grow back, but new fibroids can grow.
- Take out the uterus. This guarantees that the fibroids are gone forever. There are some situations where this is the best option and many in which it is unacceptable. More about this in the oncoming months.
Another factor in planning treatment is the desire for future pregnancy. I’ll talk about fibroids and pregnancy in the future, but obviously a hysterectomy is out of the question for someone who wants to have a baby. I have serious reservations about any of the destructive procedures, such as embolization (UFE) if future pregnancy is desired. If we are going to remove the fibroids then we need to consider which procedure is most likely to leave a normal uterus.
Lastly, preference is definitely important. Back to the car analogy…. If you tell me you want a red car because red cars are faster than blue cars we can do an experiment and race them. But if you tell me you want a red car because you hate blue, it is a matter of personal preference. I see many women for myomectomy that could be appropriately treated by other methods such as embolization or hysterectomy, but they don’t like the idea of losing their uterus and don’t want foreign particles in their body. My job is to inform them of the advantages and disadvantages of each of these choices, and help them decide which treatment best suits their lifestyle and personal beliefs.
The most important thing to realize is that you can not make a decision about which treatment is most appropriate just by reading!!! A 3 cm. (1+ inch) fibroid that is inside the cavity of the uterus and causing heavy periods is almost always best treated by hysteroscopic resection, a quick outpatient procedure. If the same size fibroid is mostly in the wall the treatment may be different, or it may not need to be treated at all. While it is good to learn as much as you can by reading an appropriate treatment plan can only be reached after an accurate diagnosis. Unfortunately there are varying abilities to make an accurate diagnosis. I find reading an ultrasound report much like reading a movie review in the newspaper. Sometimes it’s right on and sometimes you can’t believe it’s the same movie. I see women who have been told they have fibroids turn out to have adenomyosis or at times ovarian cysts, or even nothing at all. While it is good to learn about different treatment methods, you need the help of a gynecologist knowledgable about all options to help you decide what is best for your individual situation.
