Uterine fibroids (leiomyomata) are benign (non-cancerous) smooth muscle nodules that occur in the uterus. They are so common, that approximately 40 percent of women over 40 have them. They are round, rubbery in texture and can be single or multiple.
Fibroids can be located anywhere in the uterus, but when they distort the uterine lining (endometrium) abnormally heavy menses often occurs. Menstrual periods can become painful and prolonged, sometimes with passage of blood clots. Fibroids on the serosal (outside) surface of the uterus often do not cause any symptoms. Larger fibroids, however, can compress the urinary bladder and cause urinary frequency, urination at night, or bladder pressure. Fibroids can compress fallopian tubes and cause infertility or they can grow to be very large and cause abdominal distention, constipation or pain.
Fibroids are best diagnosed by ultrasound as they are easily missed by pelvic examination unless they are quite large. A special ultrasound – saline infusion sonography, gives very good imaging of the endometrium and can help the gynecologist determine the best treatment approach. CT scan and MRI can also visualize the size, location, and number of fibroids.
Fibroids that cause cramping or mildly increased bleeding can sometimes be treated medically with oral contraceptive pills, or the Mirena IUD. Both of these keep the endometrium thin so that menstrual periods are lighter. If medicines do not provide enough relief (often the case with submucosal fibroids) surgery may be needed for fibroid removal.
In many women, fibroids may be present and not cause any symptoms. Treatment is only required if problems occur. The most common symptom is abnormally heavy menstrual periods.
The surgical treatment of fibroids can sometimes be accomplished through hysteroscopy. A hysteroscope is a long cylindrical scope that is used to look inside of the uterus. It can be used simply to look, diagnostic hysteroscopy, or used to remove things that shouldn’t be there, like fibroids or polyps.
Smaller fibroids, less than about 3 cm, that protrude into the uterine cavity so that they can be seen hysteroscopically, can often be completely removed this way. Removal of such fibroids often makes the menstrual period lighter or improves fertility. Removing fibroids this way takes a lot of practice, and should be performed only by gynecologists that are specially trained or by reproductive endocrinologists who do this type of surgery frequently.
Fibroids that have any contact with the outside surface of the uterus (the serosa), and fibroids that are large or numerous, have to be removed from the outside of the uterus. Some fibroids may be able to removed with a laparoscope, while others require an open approach to surgery. When these types of fibroids are large or multiple and causing infertility, they are best removed by a gynecologist or reproductive endocrinologist with such experience. This procedure is termed abdominal myomectomy and is done when preservation of the uterus is desired.
Polyps are focal overgrowths of the uterine lining, and are composed of endometrium. Though they can look like fibroids on ultrasound, and cause the same symptoms of infertility or heavy menses, they are typically easy to remove with a hysteroscope.
Endometrial ablation is a procedure performed that uses thermal energy to kill the lining of the uterus. If the endometrium is destroyed, it can not go through the cyclical process of proliferating and shedding monthy. Endometrial ablation can be achieved with a hysteroscope, with the Novasure device, with a thermal balloon or by using a probe that freezes the endomerium. All are effective in the use of skilled surgeons.