Medical Information (Gynecology)

Uterine Fibroids

What are uterine fibroids?

Fibroids are firm, compact tumors made of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is estimated that between 20% to 50% of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 30% to 77% of women will develop fibroids sometime during their childbearing years. Although Only about one-third of these fibroids are large enough to be detected by a healthcare provider during a physical exam.

In more than 99% of fibroid cases, the tumors are not cancer. These tumors are not linked to cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.

What causes uterine fibroid tumors?

The cause of uterine fibroids is not known. But, it’s thought that each tumor develops from an abnormal muscle cell in the uterus. This cell multiplies rapidly because of the effect of estrogen.

Who is at risk for uterine fibroids?

Women who are nearing menopause are at the greatest risk for fibroids. This is because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk. The reasons for this are not clearly understood.

Other risk factors:

Diet high in red meat
Family history of fibroids
High blood pressure

What are the symptoms of uterine fibroids?

Some women who have fibroids have no symptoms, or have only mild symptoms. Other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids. Symptoms of uterine fibroids may include:

Heavy or prolonged periods
Abnormal bleeding between periods
Pelvic pain, caused as the tumor presses on pelvic organs
Frequent urination
Low back pain
Pain during intercourse
A firm mass, often located near the middle of the pelvis, which can be felt by your healthcare provider

How are uterine fibroids diagnosed?

Fibroids are most often found during a routine pelvic exam. Your healthcare provider may feel a firm, irregular pelvic mass during an abdominal exam. Other tests may include:

X-ray. Electromagnetic energy used to produce images of bones and internal organs onto film.
Transvaginal ultrasound. An ultrasound test using a small instrument, called a transducer, that is placed in the vagina.
MRI. A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.
Hysterosalpingography. X-ray exam of the uterus and fallopian tubes that uses dye. It is often done to rule out tubal obstruction.
Hysteroscopy. Visual exam of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Endometrial biopsy. A procedure in which a sample of tissue is taken through a tube inserted into the uterus.
Blood test. This is to check for iron-deficiency anemia if heavy bleeding is caused by the tumor.

How are uterine fibroids treated?

Since most fibroids stop growing or may even shrink as you approach menopause, your healthcare provider may simply suggest "watchful waiting." With this approach, your healthcare provider monitors your symptoms carefully to make sure that there are no significant changes and that the fibroids are not growing.

If your fibroids are large or cause significant symptoms, treatment may be necessary. Treatment will be discussed with you by your healthcare provider based on:

How old you are
Your overall health and past health
How sick you are
How well you can handle specific medicines, procedures, or therapies
How long your condition is expected to last
Your opinion or preference
Your desire for pregnancy

In general, treatment for fibroids may include:

Hysterectomy. This is the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the U.S.
Conservative surgical therapy. Conservative surgical therapy uses a procedure called a myomectomy. With this approach, fibroids are removed, but the uterus stays intact. This may allow a future pregnancy.
Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers your estrogen level. This triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgery easier.
Anti-hormonal medicines. Certain medicines oppose estrogen (such as progestin and Danazol), and seem to work to treat fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
Uterine artery embolization. Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Healthcare providers continue to look at the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
Anti-inflammatory painkillers. This type of medicine is often effective for women who have occasional pelvic pain or discomfort.

In some cases, the heavy or prolonged periods, or the abnormal bleeding between periods, can lead to iron-deficiency anemia. This also requires treatment.

What are the complications of uterine fibroids?

Uterine fibroids may have effects on the reproductive system, causing infertility, increased risk of miscarriage, or adverse pregnancy outcomes.

Laparoscope-assisted vaginal hysterectomy

The skin over the surgical site will be cleaned with an antiseptic solution.
Your healthcare provider will make a small incision in the belly near the navel. He or she will inflate the belly with carbon dioxide gas. This lets the surgeon easily see the uterus and surrounding organs. Your provider may make more incisions in the belly for other surgical tools.
The operating table will be tilted so that your head is lower than your feet. This helps to move the other abdominal organs and structures out of the surgical field and make room for the laparoscopic surgical instruments.
Your provider will insert the laparoscope through the incision and examine the abdominal cavity. He or she will remove the tissues surrounding the uterus.
Your provider will then remove the uterus through the vagina or through the laparoscope. He or she may also remove other organs or structures, such as the ovaries or fallopian tubes, as needed.
When the procedure is done, your provider will remove the laparoscope.

After the procedure, all methods

Your provider will send the uterus and any other organs or tissues removed to the lab for study.
Your provider will use stitches or surgical staples to close any skin incision(s).
Your provider will put on a sterile bandage, dressing, or adhesive strips to skin incisions. He or she will apply a sanitary pad to the perineal area to absorb any drainage from the vagina.

What happens after a hysterectomy?

In the hospital

After the procedure, you will be taken to the recovery room. Your recovery will vary based on the type of procedure done and the type of anesthesia used. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room.

You may have abdominal cramping after the surgery. You may get pain medicine as needed, either by a nurse or by giving it to yourself through a device connected to your IV.

If you had an abdominal hysterectomy, you may have a thin, plastic tube put through your nose into your stomach to remove air that you swallow. The tube will be removed when your bowels go back to normal. You will not be able to eat or drink until the tube is removed.

You may have small to moderate amounts of vaginal drainage for several days. The nurse will check the sanitary pads to keep an eye on the amount of drainage.

You will be urged to get out of bed within a few hours after a vaginal procedure or by the next day after an abdominal procedure. You will also be taught to do coughing and deep breathing exercises.

Based on your situation, you may be given liquids to drink a few hours after surgery. Your will gradually be able to eat more solid foods as you can handle them.

Arrange for a follow-up visit with your healthcare provider, usually a few weeks after the procedure.

At home

Once you are home, it is important to keep the incision clean and dry. Your healthcare provider will give you specific bathing instructions. If you went home with stitches or surgical staples, your provider will remove them during a follow-up office visit. If your provider used adhesive strips, keep them dry. They should fall off within a few days.

The incision and the abdominal muscles may ache, especially after long periods of standing. If a laparoscope was used, you may have shoulder pain from the carbon dioxide in your belly. Take a pain reliever as recommended by your healthcare provider.

Aspirin or certain other pain medicines may increase the chance of bleeding. So, be sure to take only recommended medicines.

You will be able to walk and have limited movement, but avoid strenuous activity. Your healthcare provider will tell you when you can go back to work and other normal activities.

Include fiber and plenty of liquids to avoid constipation. Your healthcare provider may recommend a mild laxative. If you had a laparoscopic procedure, avoid drinking carbonated drinks for 1 to 2 days after the procedure. This will help lessen the discomfort from the carbon dioxide gas. These drinks may also cause nausea.

Do not use a douche, tampons, have sex, or return to work until your healthcare provider says it’s OK.

Tell your healthcare provider if you have any of the following:

Fever or chills
Redness, swelling, or bleeding or other drainage from the incision site(s)
Increased pain around the incision site(s)
Abdominal pain, cramping, or swelling
Increased vaginal bleeding or other drainage
Leg pain

After a hysterectomy, your healthcare provider may give you other instructions, based on your situation.

Dr. Amin Jurdi