By Dr. Susan G. Bornstein, M.D., PLLC
Uterine Fibroids, often small, non-cancerous tumors, are quite common. It’s estimated that about 1 in 5 women of childbearing age will experience fibroids, with up to 50 percent of women diagnosed by age 50. While the cause of fibroids is unknown, they can often be treated symptomatically and do not interfere with fertility or general reproductive health.
Most women discover their diagnosis through a combination of symptoms. While symptoms can vary depending on the location and size of a fibroid, most women experience heavy, prolonged periods, bleeding between periods, the need to urinate often, cramping and abdominal pain and pressure or bloating. While it is uncommon, some women may experience pain during intercourse in addition to other symptoms.
While fibroids can be difficult to detect, they can sometimes be found through an irregular uterine shape during a pelvic exam. Ultrasound or pelvic MRI can also be used to detect a fibroid.
Treatment Options Vary
Your doctor may recommend a different treatment option depending on a variety of factors including your age, overall health, severity of symptoms and interest in future fertility.
Most often, fibroids can be treated through medical management—treating the fibroid symptomatically. If a fibroid isn’t causing symptoms, there is no real reason to treat it. Oftentimes, prescription hormone therapy, including birth control pills, can manage symptoms in most patients.
Especially in women who are interested in maintaining their fertility, a variety of birth control pills can be used to manage the symptoms of a fibroid. Progestin only birth control methods can be the most effective, as some studies have shown a link between fibroids and estrogen. The Mirena Intrauterine Device (IUD), depo-provera shot, or progestin only pills are often used to medically manage the symptoms of fibroids.
When medical management is not enough, your doctor may suggest removing the fibroid. One of the most common methods is myomectomy, using an intrauterine morcellator, which is a safe and effective way to remove an sub-mucosal (on the interior wall of the uterus) fibroid. A myomectomy uses a mechanical apparatus, which, with the size of a pin point, simultaneously cuts and removes the fibroid from the uterine wall, while reserving the specimen for future testing if needed. Prior technology used electricity or laser to remove the mass.
Laprascopy and Robotics improve accuracy
When fibroids are found outside of the uterus, other surgical techniques may be used to remove them. While traditional open case surgery can be employed, laparoscopic surgery, especially those done with robotics, are the used most commonly.
We’ve seen some tremendous success with robotics used in laparoscopic surgeries. The technology allows for highly precise results.
While most fibroids can be treated in a minimally or non-invasive manner, depending on a woman’s age and interest in future-fertility may lead a doctor to recommend a more permanent solution.
Some articles suggest that hysterectomies are unnecessary, this is simply not true for the patient with persistent fibroid symptoms, no interest in fertility, and unsuccessful prior treatments, hysterectomy has nearly a 100 percent success rate.
I have also seen great advances in making hysterectomies as minimally invasive as possible. In most cases, hysterectomies can be done vaginally or laprascopically, minimizing recovery time and pain for a patient.
Dr. Susan G. Bornstein, M.D., PLLC, practices in Louisville, Kentucky as a division of Premier Gynecology and Obstetrics (PGO). PGO is affiliated with Jewish Hospital Medical Center East for leading-edge diagnostic imaging and gynecological surgical procedures and part of Jewish Centers for Excellence in Women’s Services.