Mitzi Perdue

Fibroids: Medical and Surgical Management

FIBROIDS ARE VERY, VERY COMMON

In the U.S., 80% of women who come from the African diaspora, including women from the Caribbean and South America, have or will have fibroid tumors. Even in the case of the ethnicity with the lowest prevalence, women of Asian descent, 40% will have fibroids. We know these statistics from MRIs, ultrasound, and autopsies of, for example, women who die in car accidents.

NOT ALL FIBROIDS REQUIRE TREATMENT

The odds of a uterine mass being malignant are approximately 1 in 350. Assuming that you know you are not dealing with a malignancy, it is important not to over-treat fibroids. Treatment itself can create problems such as scar tissue, bleeding, or wound infection. Often, a woman may have fibroids, even large ones, and still be asymptomatic. Or if she has symptoms, they may not be personally distressing. Further, we do not know how fast or even if her fibroids are going to grow. An additional consideration is that during menopause, as her estrogen and progesterone decrease, her fibroids will shrink and her symptoms are likely to disappear on their own.

SOME FIBROIDS WILL REQUIRE TREATMENT

When a woman is having symptoms that interfere significantly with her quality of life, it is a different story and she will need treatment. A woman with fibroids may experience any or all of the following: heavy, irregular, or prolonged bleeding; cramps; urinary frequency; constipation; painful intercourse; difficulty conceiving; and premature labor. In addition, while a normal uterus is about the size of a lemon, fibroids can cause it to enlarge to the size of a watermelon.

MANY SURGICAL CHOICES ARE AVAILABLE

For a woman who would still like to have children, there are uterus-preserving surgeries for removing fibroids. If a woman has four or fewer fibroids, she may be able to have them removed with robotic or laparoscopic surgery, using small incisions. There is also hysteroscopic surgery, which is performed through the vagina. However, depending on the number and position of the fibroids, she may instead need an open myomectomy with a larger incision.

Another treatment used to destroy fibroids without surgery is using ultrasound waves to break down the fibroids. Fibroids can also be treated by killing the fibroid tissue, using extreme cold (cryomyolysis) or myolysis, which uses a high-frequency electrical current to shrink the fibroid by blocking its blood supply. Myolysis was FDA-approved a little over a year and a half ago, but as of now, there are only a small number of physicians trained to perform it.

For women who do not want future pregnancies, and who have long-lasting and severe symptoms, surgical removal of the entire uterus may be an option.

PHARMACOLOGICAL HELP FOR SPECIFIC FIBROID SYMPTOMS

For severe cramps, high-dose ibuprofen can help. For severe bleeding, tranexamic acid can be useful. However, because of its side effects, it shouldn’t be taken for more than 5 days. Low-dose oral contraceptive pills can help, and a longer-lasting approach is a levonorgestrel-releasing IUD, which is good for 5 years.

FOR MORE INFORMATION:

* The American College of Gynecologic Laparoscopists’ website, www.aagl.org, is a good source for information on minimally invasive procedures to offer patients.

* The American College of Obstetricians and Gynecologists website also has useful information: www.acog.org also has useful information.