Fibroid Center

Gynecological/Surgical Options

What are fibroids?

Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus.

It is estimated that between 20 to 30 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 75 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a physician during a physical examination.

In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.

What causes fibroid tumors?

While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.

Who is at risk for fibroid tumors?

Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.

Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children.

Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.

What are the symptoms of fibroids?

Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids, however, each individual may experience symptoms differently. Symptoms of uterine fibroids may include:

In some cases, the heavy or prolonged menstrual periods, or the abnormal bleeding between periods, can lead to iron-deficiency anemia, which also requires treatment.

How are fibroids diagnosed?

Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:

Treatment for fibroids

Since most fibroids stop growing or may even shrink as a woman approaches menopause, the physician may simply suggest "watchful waiting." With this approach, the physician monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.

In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by your physician(s) based on:

In general, treatment for fibroids may include:

» Hysterectomy

Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy. There are several different surgical approaches to hysterectomies, including abdominal hysterectomy, laparoscopic hysterectomy, vaginal hysterectomy, and robotic hysterectomy. The type of hysterectomy will depend on the size of the uterus and several other factors.

The ovaries may also be removed, although this is not necessary for fibroid treatment. If the ovaries are removed along with the uterus, hysterectomy causes immediate menopause. Depending on the presenting medical condition, the cervix may be removed as well.

ACOG (American Congress of Obstructions and Gynecologists) FAQ on hysterectomy

Abdominal Hysterectomy
  • An abdominal hysterectomy is performed by removing the uterus through a horizontal incision (cut) on the lower abdomen, also called a "bikini cut". This procedure is best suited for women with large fibroids, when the ovaries need to be removed, or when cancer or pelvic disease is present.
  • If the uterus is very large or if there is a scar from an earlier operation, it may be necessary to make a vertical incision on the lower abdomen.
  • Post-surgery, most women stay 2-3 nights in the hospital, followed by 4-6 weeks reduced activity.
Vaginal Hysterectomy
  • A vaginal hysterectomy is performed by removing the uterus through the vagina. The surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, then removes the uterus through the vagina.
  • Post-surgery, most women stay 0-1 nights in the hospital, followed by 4-6 weeks reduced activity.
  • Of all hysterectomy procedures this involves the least post-operative pain.
  • Vaginal hysterectomies result in no visible scars on the skin.
Laparoscopic Hysterectomy
  • Laparoscopic hysterectomy is a procedure in which the uterus is removed through very small incisions on the lower abdomen. The surgeon inserts a laparoscope, or a small, lighted tube, through a cut in the belly button, and several other small incisions are made in the abdomen to place surgical tools. The uterus can be taken out in small pieces through the incisions or taken our through the vagina.
  • Small scars remain on the skin of the abdomen.
  • Post-surgery, most women stay 0-1 nights in the hospital, followed by 4-6 weeks reduced activity.
Robotic Hysterectomy
  • Robotic hysterectomy uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to improve a surgeon's ability to view, manipulate, and remove the uterus. Four-to-five small incisions are made in the abdomen to allow for slender robotic arms and tiny surgical tools to access the uterus.
  • Benefits of robotic hysterectomy over abdominal hysterectomy include smaller incisions and less post-operative pain.
  • Small scars remain on the skin of the abdomen.
  • Post-surgery, most women stay 0-1 nights in the hospital, followed by 4-6 weeks reduced activity.
» Myomectomy

A myomectomy surgically removes only the fibroids and leaves the uterus intact. Stitches are used to bring the walls of the uterus back together. For women with symptomatic fibroids who desire future childbearing, myomectomy is often the preferred treatment. Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids. Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss.

Myomectomy is not necessarily a permanent solution for fibroids. They can recur after these procedures. The younger a woman is and the more fibroids present at the time of myomectomy, the more likely she is to experience a recurrence of fibroids in the future. Women nearing menopause are the least likely to have problems from fibroids again.

The risks for myomectomy are generally the same of those for other surgical procedures, including bleeding and infection. A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, laparoscopic myomectomy, robotic myomectomy, or hysteroscopic myomectomy.

Abdominal Myomectomy
  • Abdominal myomectomy is a major surgical procedure, utilizing normal abdominal incision for conventional "open" surgery. It is generally used for removal of subserosal or intramural fibroids that are very large and/or numerous, or when cancer is suspected.
  • An incision is made through the skin on the lower abdomen often called a "bikini cut". The fibroids are surgically removed from the wall of the uterus. The uterine muscle is sewn back together using several layers of stitches.
  • Post-surgery, most women stay 1-2 nights in the hospital, followed by 6-8 weeks reduced activity.
  • Risks for uterine scarring and blood loss may be higher with abdominal myomectomies than with the less invasive procedures.
  • A c-section may be required for delivery of pregnancies after an abdominal myomectomy. This is done to reduce the chance of trauma to the uterus during labor. The need for C-section will depend on how deeply the fibroids were embedded in the wall of the uterus at the time of removal.
Laparoscopic Myomectomy
  • Women who have a small number of subserous fibroids may be eligible for treatment with laparoscopy. In a laparoscopic myomectomy, thin scopes are used that contain surgical and viewing instruments. Laparoscopy requires only tiny incisions, and has a much faster recovery time than abdominal myomectomy.
  • Only certain fibroids can be removed by laparoscopy. If the fibroids are large, numerous or deeply embedded in the uterus, then an abdominal myomectomy may be necessary.
  • Small scars remain on the patient's abdomen.
  • The typical recovery involves 0-1 nights in the hospital and 4 weeks reduced activity.
  • Therefore, women planning to become pregnant in the future may be better candidates for open, abdominal myomectomy.
Robotic Myomectomy
  • Robotic myomectomy uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to improve a surgeon's abilty to view fibroids and the surrounding tissue, as well as enhanced ability to suture the uterus when removing uterine fibroids and reconstructing the uterine wall.
  • 4 small incisions are made in the abdomen to allow for slender robotic arms and tiny surgical tools to access the uterus.
  • Using careful techniques to continue minimizing the bleeding, the surgeon excises the fibroid(s) from the surrounding uterine tissue. Once the fibroid has been removed, the surgeon uses a special device called a morcellator to cut the fibroid into smaller pieces inside the patient's abdomen. These pieces are then removed through one of the ports.
  • Benefits of Robotic Myomectomy over abdominal myomectomy includes less post-surgical pain, quicker recovery and return to normal activities.
  • The typical recovery involves 0-1 nights in the hospital and 4 weeks reduced activity.
Hysteroscopic Myomectomy
  • A hysteroscopic myomectomy may be used for removal submucous fibroids found in the uterine cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed up into the uterine cavity through the vagina and cervical canal. Standard resection uses an electrosurgical wire loop to surgically remove the fibroid.
  • Only women with submucosal fibroids are eligible for this type of myomectomy. Fibroids located within the uterine wall cannot be removed with this technique.
  • Hysteroscopic myomectomy is an out-patient surgical procedure. Patients go home after several hours of observation in the recovery room. Recovery time is generally only few days.
  • There are no scars on the skin after the procedure.
  • Fibroids may return, especially for pre-menopausal women.
» Endometrial Ablation

Endometrial ablation treats abnormal uterine bleeding by destroying the lining of the uterus (the endometrium) using heat or other types of energy source. During endometrial ablation, a gynecologist may place a scope through the cervix into the uterine cavity to destroy the lining of the uterus, including uterine fibroid tumors that can be reached through the scope.

Not all uterine fibroid tumors can be removed with this technique. Endometrial ablation is generally used to treat women with small fibroids; it is not helpful for large fibroids or for fibroids that have grown outside of the interior uterine lining.

After an ablation procedure, monthly menstrual bleeding usually stops or is significantly reduced.

The procedure is typically performed on an outpatient basis. Recovery generally takes a few days, although women experience watery or bloody discharge that can last for several weeks.

Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and when there is a pregnancy after this procedure, there is increased risk of miscarriage. Women desiring future pregnancy should not have this procedure.

ACOG (American Congress of Obstructions and Gynecologists) FAQ on Endometrial Ablation

» Gonadotropin-releasing hormone agonists (GnRH agonists)

This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.

» Anti-hormonal agents

Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.

» Fibroid embolization

First introduced in the U.S. in 1997, fibroid embolization is a minimally invasive (requires no incision) technique that involves guiding a small catheter (1 mm-wide tube) into the arteries that supply the uterus. By injecting small particles that are the size of grains of sand, the blood flow to the fibroids is cut off, which causes them to shrink, while the health of the uterus is preserved. For younger women, the long-term impact on fertility is not fully understood, although normal pregnancies and deliveries are routinely reported.The potential for growth of new fibroids is related to age and the anticipated time of menopause.

» Anti-inflammatory painkillers

This type of drug is often effective for women who experience occasional pelvic pain or discomfort.

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