What are the symptoms of a fibroid?
Most fibroids are "silent," that is, they produce no symptoms, and are either never picked up or are diagnosed by a doctor doing a routine pelvic examination.
When fibroids produce symptoms, the most common are abnormal bleeding, such as excessive bleeding with menstruation, painful periods, bleeding between periods, and pain with intercourse. Large fibroids can produce a sense of fullness in the lower abdomen, and low back pain. Fibroids can also press on the bladder leading to symptoms such as frequent or painful urination.
Fibroids are also associated with infertility and recurrent miscarriages.
How are fibroids diagnosed?
Most fibroids are picked up during routine pelvic examinations. The diagnosis is usually confirmed with an ultrasound examination, and if necessary, a hysteroscopy, a look into the uterus with a scope by way of the vagina, which also allows the doctor to take a biopsy of the tissue.
How are fibroids treated?
Most fibroids can be left alone until menopause when they tend to regress.
Pain can usually be treated with nonsteroidal anti-inflammatory medications such as ibuprofen.
The use of oral contraceptives can often control excessive bleeding associated with fibroids, but is not known to slow the growth of fibroids.
GnRH agonists are other drugs that are used to control fibroids, but they lead to many side effects and potential complications and should be reserved only for special cases.
Studies that involve the antiprogesterone medication RU-486 (the "abortion" pill) are currently being conducted to see if it can help fibroids regress.
Surgical choices for dealing with fibroids have improved greatly. The simplest surgical procedure that leads to temporary improvement in some symptoms, especially heavy bleeding, is a dilatation and curettage (a D & C).
With many fibroids, it is now possible to remove only the fibroid and leave the rest of the uterus in place, and this can now be done with a minimally invasive procedure such as through a laparoscopy or hysteroscopy.
For larger fibroids, the standard therapy has long been a hysterectomy, and these operations were often done for even minimal symptoms. Happily, however, the rate of hysterectomies has been decreasing in North America. Although hysterectomies are now reserved for only the most troublesome cases or when there is a worry that the fibroid may be hiding a uterine cancer, hysterectomies are still (after caesarean section) the second most common surgical procedure in women.
In a subtotal hysterectomy, only the uterus is removed, while the cervix, fallopian tubes, and ovaries are left in place. Total hysterectomy involves removing the uterus and cervix, and most often the ovaries, too. This can be done through the vagina, or through the abdomen.
A procedure known as uterine fibroid embolization has become increasingly popular the last few years. In this procedure, a physician guides a long thin tube from a leg artery into the arteries in the uterus that also feed the fibroid. The blood flow in these arteries is then blocked with a gel, and when the blood flow to the fibroid is cut off, it shrinks. Most fibroids treated with embolization seem to eventually disappear altogether, although this is a relatively new procedure so there is not yet enough long-term data to know if those fibroids stay away.
Another new therapy still being studied but showing promising results is the use of lasers to heat and shrink fibroids.