Uterine Fibroids (aka Leiomyomas)

Fibroids are a very common benign tumor of the uterus.  Nobody knows why they occur.  They can be located completely within uterine muscle (the myometrium), extend inward into the uterine cavity, or grow outward from the myometrium into the pelvis or abdomen.  They’re more common among Blacks than Whites, but over half of women in their late 40’s have them.

The most common symptom of fibroids is heavy, prolonged menstrual periods.  The heavier the bleeding, the more pain might be associated.  In between periods, women may feel a sense of discomfort or bulkiness in the pelvis.  Very large fibroids can interfere with urination, or cause constipation, by pressing on the bladder or bowel.  Painful sexual intercourse isn’t a common symptom.  They can, however, be a cause of infertility.

Fibroids grow at different rates in different women.ย  After menopause, it’s common for them to shrink.ย  Fibroids are only removed if they cause significant symptoms.ย  Bleeding can sometimes be controlled by a variety of hormonal medicines.ย  Pain medication can help if pain is the main symptom.ย  If these are inadequate, some sort of surgery will solve the problem. There is no evidence that they increase risk for cancer, or turn into cancer.

Hysterectomy can remove the entire uterus, by an open operation or by laparoscopy.ย  It is the most common treatment, but obviously only for women who do not desire more children (fibroids don’t usually present a problem during pregnancy).ย  The disadvantage of hysterectomy is that, since it’s an operation, complications can occur.ย  Its main advantage is that it ends the problem once and for all.ย  Procedures to simply remove or destroy fibroids have fewer complications, but fibroids can return.ย  These are the main issues to discuss with ones gynecologist.

An important concern is whether the supposed fibroid may actually be a type of cancer (a sarcoma).ย  In that case, convenient surgical methods that cut up the fibroid within the patient to extract it, thus avoiding a more major operation, may wind up spreading cancer cells.ย  However, sarcomas are very rare, and the chance of complication from hysterectomy seems greater than the chance of spreading a rare cancer.ย 

Unfortunately, there’s no good way to differentiate fibroid from sarcoma ahead of time.  Symptoms, or large size of the tumor, are not helpful.  Rapid growth is only worrisome after menopause, not in younger women.  Sometimes there are ways to suspect sarcoma during surgery, but they may not be reliable either.  In terms of endometrial and cervical cancer, these are usually tested for before any procedure, especially in older women.

Women contemplating removal of fibroids, or hysterectomy for any reason, should ask their gynecologist if their individual case looks like it may include a risk for any kind of cancer, and how that might affect selecting the type of surgical procedure.  One technique called morcellation, grinding up the uterus in order to extract it through the smallest operative incision possible, carries the greatest risk of spreading an unidentified tiny cancer.  But avoiding this may lead to more major surgeries being done instead, with an overall increase in rare bad outcomes.

In summary: fibroids are very common, not dangerous, and  only need treatment if symptoms are bothersome enough.  When treatment is necessary, there are various issues to discuss with the gynecologist ahead of time.

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