7/9/2013 2:11:00 PM Dr. K for July 9, 2013 Painful fibroids can be surgically removed
DEAR DOCTOR K: I saw my doctor for intense pain and heavy bleeding during my periods. It turns out I have fibroids. What are my treatment options?
DEAR READER: A fibroid is a lump or growth in the uterus. The uterus is made of a special kind of muscle. The muscle doesn't do much most of the time, but once a month, it ejects the bloody discharge that collects inside it. During pregnancy, it expands to accommodate the growing baby. And, of course, the uterus squeezes out the baby at the time of birth.
Fibroids are balls of uterine muscle. They are almost never cancerous, but they can cause severe pain and discomfort, most often during menstrual periods. In some cases, fibroids can cause infertility or repeated miscarriages. Fortunately, many treatment options exist.
Fibroids can be as small as a pea or as large as a basketball (really). They are usually round and pinkish, and they can grow anywhere inside or on the uterus. (I've put an illustration on my website, AskDoctorK.com.)
Some women with fibroids do not have symptoms and may not realize they have them until a gynecologist feels them during a pelvic exam. Small fibroids that are not causing symptoms and don't interfere with fertility do not need to be treated.
In other cases, women experience pain and heavy bleeding. A doctor may prescribe medications that stop the ovaries from making the female hormone estrogen, which fibroids need in order to grow. This controls excessive bleeding and temporarily shrinks the fibroids. When the medication is stopped, periods return and fibroids start growing again.
Fibroids that cause severe symptoms or interfere with fertility may be surgically removed. There are several techniques:
-- In a myomectomy, the fibroid is cut from the uterine wall. Myomectomy allows a woman to keep her entire uterus in case she wants to have children. In some cases, a traditional surgical approach is needed. The doctor makes a large incision in the lower abdomen, sees the uterus directly and cuts out the fibroids.
Often a less invasive procedure, laparoscopic surgery, can be done. A flexible tube or scope is placed through those incisions. At the end of the scope is a light, a camera and surgical instruments that the doctor can manipulate. Instead of seeing the uterus and fibroids directly, the doctor sees them on a video monitor and watches the surgery she is doing on the monitor. Because laparoscopic procedures are less invasive, people recuperate faster.
-- In a hysteroscopic resection, a viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope remove fibroids growing inside the uterus.
-- In the X-ray-guided procedure called uterine artery embolization, material is injected into the arteries that provide blood to the fibroids. Starving the fibroid of blood shrinks it.
-- Hysterectomy involves the removal of the uterus. Once the uterus is removed, a woman can no longer bear children.
Fibroids often shrink on their own after menopause, because they no longer have enough female hormones to grow.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)