About Uterine Fibroids

If you have been diagnosed with fibroids and are unsatisfied with the information or options your doctor has given you, and conventional medical treatments recommended by most medical practitioners, this may be the most important information you'll ever read.

Since doctors don't know the cause of uterine fibroids, they also don't know what causes them to grow or shrink. Some research and clinical experience point to genetic changes, hormones and other growth factors such as insulin-like growth factor. They do know that uterine fibroids are under hormonal control — both estrogen and progesterone, and that they grow rapidly during pregnancy, when hormone levels are high. They also know that most fibroids shrink when anti-hormone medication is used, and they also stop growing or shrink once a woman reaches menopause. It is also believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.

Researchers found that many fibroids contain changes in genes that differ from those in normal uterine muscle cells. They also found that uterine fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do.

Because fibroids tend to shrink after prignancy or when woman approaches menopause due to a decrease in hormone production, some health care providers may simply suggest watchful waiting, which means that the health care provider will monitor the woman's symptoms carefully to ensure that there are no significant changes or unwanted developments and that the fibroids are not growing.

Most fibroids do not cause any symptoms, but some women with fibroids can have:

• Heavy bleeding (which can be heavy enough to cause anemia) or painful periods
• Feeling of fullness in the pelvic area (lower stomach area)
• Enlargement of the lower abdomen
• Frequent urination
• Pain during sex
• Lower back pain
• Complications during pregnancy and labor, including a six-time greater risk of cesarean section
• Reproductive problems, such as infertility, which is very rare

If you have fibroids and have mild symptoms, your doctor may suggest taking medication to target hormones that regulate your menstrual cycle. Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Medications for uterine fibroids can treat symptoms such as heavy menstrual bleeding and pelvic pressure, but they don't eliminate fibroids, and sometimes (if you are lucky) they may shrink them. The same is true of progesterone-like injections (e.g., Depo-Provera®) and an IUD (intrauterine device) called Mirena® which contains a small amount of progesterone-like medication, usually used to control heavy bleeding as well as for birth control. Nonsteroidal anti-inflammatory drugs (NSAIDs), may be effective for women who experience occasional pelvic pain or discomfort, but they don't reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.

Other drugs used to treat fibroids are gonadotropin releasing hormone agonists (GnRH). The most commonly used are Lupron® and Synarel, which are typically used for no more than three to six months. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, not being able to sleep, decreased sex drive, depression, and joint pain. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. Most women do not get a period when taking GnRHas and tolerate GnRHas quite well, but GnRHas offer only temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.

Other medical treatments for fibroids may include:

Myomectomy – Surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy, but if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy fibroids do not regrow, but new fibroids can develop and cause trouble later and more surgery may be needed. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.

Hysterectomy – Surgery to remove the uterus is done when other treatments have not worked or are not possible or the fibroids are very large and if she has heavy bleeding. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks. This surgery is the only sure way to cure uterine fibroids.

Uterine Artery Embolization (UFE), or Uterine Artery Embolization (UAE) - This is a newer minimally-invasive technique which blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed. Not all fibroids can be treated with UFE. The best candidates for UFE are women who: have fibroids that are causing heavy bleeding or fibroids that are causing pain or pressing on the bladder or rectum.

Endometrial Ablation – This procedure is considered a minor surgery and it is usually used to treat small fibroids. The lining of the uterus is removed or destroyed to control very heavy bleeding. Endometrial ablation can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding, but, a woman cannot have children after this procedure.

Myolysis – In this procedure a needle is inserted into the fibroids, usually guided by laparoscopy, and electric current, laser or radiofrequency is used to destroy the fibroids. If freezing is used to destroy the fibroids, the procedure is called cryomyolysis.

MRI-guided focused ultrasound surgery (FUS) - In this new noninvasive approach, guided ultrasound waves are used to destroy fibroids. This procedure requires no incision, the waves are directed at the fibroids through the skin with the help of magnetic resonance imaging, and the procedure is performed while patient is inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. When the precise location of the uterine fibroid is located, the fibroid is targeted, and the ultrasound transducer focuses sonications (sound waves) into the fibroid to heat and destroy small areas of fibroid tissue. Since this is ewer technology, researchers are learning more about the long-term safety and effectiveness. So far studies and data collected show that that FUS for uterine fibroids is safe and effective and women have improved symptoms up to 1 year after having the procedure. Whether this approach provides long-term relief is currently being studied.

Learn more about uterine fibroids:
Uterine Fibroids
What Are Uterine Fibroids?
What Causes Uterine Fibroids?
The Symptoms of Uterine Fibroids
Natural Remedies for Uterine Fibroids

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FACT: Most women diagnosed with fibroids are being offered medical treatments that merely mask their symptoms… only a handful of alternative healthcare professionals have a clue about how to treat the root cause of fibroids (and you'll be lucky if you ever find them.)

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