Uterine fibroids, or uterine myomas, are benign tumors that that grow inside or outside the uterus. These tumors can be smaller than a pea or grow as large as a cantaloupe. Most uterine fibroids have no symptoms, but a large fibroid can create pressure on other organs which can lead to discomfort, urinary incontinence, or constipation. Large myomas can also cause heavy menstrual bleeding and affect fertility.
Fibroids are generally caused by high levels of estrogen during pregnancy or menstruation, or from estrogen in birth control pills or hormone replacement therapy. Most fibroids tend to go away on their own after menopause, and most women don’t even know they have them until they are found in a routine pelvic exam.
Unless a fibroid is growing very quickly or causing unpleasant symptoms, many doctors opt not to treat them. Treatments for a large fibroid have varying degrees of invasiveness. Some procedures are short outpatient surgeries while others have lengthy recovery periods. Hysterectomy is the only way to prevent the recurrence of uterine fibroids, although it should be a last resort operation. In a hysterectomy, the woman’s uterus is removed, and often the ovaries are removed as well. This surgery is usually limited to women who no longer want to have children.
Some treatments for large fibroids involve removing the tumor altogether, while other types of surgery aim to shrink it. Surgeries to remove fibroids are called myectomies. One type of myectomy uses a small telescope called a laparoscope that is inserted into the naval to locate the tumor. The surgeon then cuts up the fibroids with instruments inserted through the abdomen. In another type of myectomy, a large fibroid is removed through an incision in the abdomen. These types of surgeries are generally done on fibroids that are outside the uterine wall.
Operations to shrink and destroy fibroids by cutting off their blood supply are another option. In one procedure, a laser fiber is inserted directly into the large fibroid through a laparoscope. The laser is used to make scar tissue on the blood vessels leading to the tumor, which eventually starves it of blood. Another procedure to shrink the tumors is called uterine artery embolization. The surgeon runs a catheter through the woman’s groin into the artery that supplies blood to the tumor. Small plugs are inserted that block the tumor’s blood supply, causing it to shrink.
