Fibroids
What are they?
Fibroids, or leiomyomas, are tumors of the muscle of the uterus. Fibroids are rarely cancerous, with only one in 4,000 being a malignant fibroid, or sarcoma. They can vary greatly in size and in quantity. Some women might only have one solitary fibroid while some may have over fifty. They can be as tiny as a pea or as large as a watermelon.
All fibroids start in the muscle of the uterus. Fibroids that stay within the wall of the uterus are called intramural fibroids. Sometimes they grow into the inside of the cavity of the uterus (submucosal fibroids), and sometimes they grow out onto the outside surface of the uterus (subserosal fibroids). They can even grow on the outside of the uterus on a stalk (pedunculated fibroids). Rarely, fibroids can grow into the cervix (cervical fibroids).
Who gets them?
Fibroids are very common. According to the NIH, by the time a women is 50 years old, she has a 70-80% chance of developing fibroids. Fibroids are much more common among women of African descent and often occur at an earlier age.
Why do they occur?
It is not clear what causes fibroids. What we do know is that the hormone estrogen plays a role in its growth. After a woman enters menopause, estrogen levels are low, and fibroids stop growing.
How are they diagnosed?
Depending on their size and location, fibroids can sometimes be felt on a pelvic exam by your physician. Pelvic exams are not very accurate or effective, and imaging studies are best for diagnosing fibroids. A pelvic ultrasound is an excellent way to determine the size, location, and quantity of fibroids. Sometimes an MRI is needed if more information is desired.
What symptoms do they cause?
Fibroids can by completely asymptomatic, or can cause many symptoms, including:
- Very heavy periods
- Bleeding between periods
- Anemia
- Pelvic pain or pressure
- Rectal pressure
- Bladder pressure, or urinary frequency and urgency
- Pain during intercourse
- Increased abdominal size
- Infertility
- Miscarriage
How are they treated?
Because fibroids can vary so much in their size, quantity, and symptoms, treatment should be individualized for each patient. At CGS, time is spent with each patient to learn the symptoms fibroids are causing and how they may be affecting you. Since treatments vary depending on what goals are trying to reached, CGS physicians will review the best medical, non surgical, and surgical options available to achieve those goals. Together, we can find the treatment that will work best for you. The surgeons at CGS are fibroid surgical specialists, and have treated more patients with fibroids than almost any other practice in the country.
Medical Treatment
Unfortunately there is no simple pill to cure fibroids. There is one medication that some doctors use as a temporary therapy until surgery can be performed. Luprolide (Depot Lurpron) is a medication that will stop the menstrual cycle and decrease the body’s production of estrogen. Because of the significant side-effects of this medication (bone loss, hot flashes, night sweats, vaginal dryness) it can only be used for six months at a time. Fibroids will start growing again once the medication is stopped and it is not curative. At CGS, Lurpron is not routinely recommended for fibroid therapy. In many cases the fibroids do not significantly decrease in size and appropriate surgical therapy is delayed. In addition, the side effects of Lurpron do not justify the small decrease in size that usually occurs. The techniques used by CGS physicians do not require that fibroids “shrink” before surgery can be performed. Fibroids can be removed of all sizes without the need for Lurpron and the significant side effects it can cause. The only real indication for the use of Lurpon at CGS is to stop bleeding for a short period of time to increase blood levels before surgery. Usually only one to two months of Lurpron is needed to raise the blood levels of severely anemic patients before myomectomy or hysterectomy.
Surgical Treatment
Myomectomy
Myomectomy is the removal of the fibroids with preservation of the uterus. For women who are still planning on bearing children, this is an excellent option. The downside to a myomectomy is that fibroids can often recur, which might result in needing surgery again in the future. For larger fibroids, myomectomies are also associated with more blood loss, larger incisions, increased pain, and longer recovery compared to a hysterectomy. Therefore, this procedure should only be reserved for patients who are serious about preserving fertility.
At CGS, we specialize in the minimally invasive approach to removal of fibroids.
Click here to learn about different types of fibroid removal performed at CGS.
Hysterectomy
Hysterectomy is the removal of the uterus ONLY, and is the only permanent cure for fibroids. Hysterectomy does NOT also include removal of the ovaries. Hysterectomy is a word derived from Latin origin. “Hyst” means uterus, and “ectomy” means remove. Hysterectomy therefore means removal of the uterus ONLY. To remove the ovaries at the time of the surgery along with the uterus, a hysterectomy and bilateral (Two) salpingo (Tubes) oophorectomy (Ovaries) is performed.
Hysterectomy, Fibroids, and Hormones
Hysterectomy provides significant benefits to patients not interested in fertility who wish to treat their fibroids definitively. Definitive treatment means treatment that will never allow fibroids to come back. Since the ovaries ARE NOT REMOVED with hysterectomy, there are no menstrual changes, or “change of life” symptoms. This means that with hysterectomy only, a patient with normally functioning ovaries will not develop the following symptoms:
- Hot Flashes
- Night Sweats
- Vaginal Dryness
- Painful Intercourse after Hysterectomy
- Anxiety, Depression
- Mood Swings
- Irritability
- Bone Loss
- and many others.
These are symptoms that occur with removal of the ovaries, not with removal of the uterus. Hysterectomy, therefore, stops all the symptoms of fibroids such as bleeding, pain, urinary frequency, etc without causing menopausal symptoms.
Laparoscopic Hysterectomy and Recovery
There is NOT a six to eight week recovery with laparoscopic hysterectomy. In laparoscopy, the incision size and number generally indicate the length of recovery, not the procedure being performed. The greater the number and size of the incisions, the longer the recovery. CGS specializes in DualportGYN laparoscopic hysterectomy, using only two 5 mm (¼) inch incisions to remove the uterus with a total incision length of only one half inch in size. This is the smallest total incision length possible for hysterectomy. Recovery is very fast, with patients back to work on average in seven days. Dualport GYN hysterectomy is the least invasive way to perform removal of the uterus worldwide, with a recovery much faster than robotic, open, single site, or standard laparoscopy. The following is a comparison list of the total length of all incisions combined used during the surgery for CGS Dualport GYN procedures versus standard laparoscopy, robotic, single site, and open hysterectomy.
| DualportGYN | Standard | Robotic | SS | Open | |
|---|---|---|---|---|---|
| # Incisions | 2 | 4 | 5 | 1 | 1 |
| Length in Millimeters/Inches | |||||
| 10 mm | 30 mm | 50 mm | 30-40 mm | 250 mm | |
| ½ in | 1 ½ in | 2 ½ in | 1 ½-2 in | 10 in | |