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Womens Health
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You might have heard about uterine fibroids, but what exactly are they and how do you know if you have them? Fibroids are noncancerous lumps, called fibroid tumors, which grow inside the uterus or within the uterine wall. At least 25% of all women in the United States have symptoms typical of fibroids, and some researchers have estimated that as many as 77% of U.S. women are affected. The majority of those affected are women of reproductive age. How can you tell if you are one of those women? Excessive vaginal bleeding is a common signal. So is unusual pain and pressure in the pelvic region. However, keep in mind that uterine fibroids also can grow without showing symptoms. Furthermore, not all fibroids require treatment. The size, location and symptoms of fibroids determine when to intervene. Sometimes bleeding from fibroids can be severe. I have seen women with such heavy bleeding that they required one or more blood transfusions to replace lost blood. Don’t let it get to that stage. At the first sign, or even before then, see an Ob/Gyn. Your doctor can detect uterine fibroids with a clinical exam, possibly using ultrasound or other imaging technology to determine the size and location of the fibroid(s). For a patient with heavy vaginal bleeding, it is vitally important to receive a thorough exam and blood tests to evaluate the cause of the bleeding. While uterine fibroids are kind of scary, there is good news. Until recently, hysterectomy was the standard treatment for fibroids. But today, treatments are available to eliminate the tumors while preserving a woman’s fertility. Hysterectomy is not always necessary, although the uterine-removing surgery remains a common method to combat fibroids. Uterine-sparing treatments include drug therapies, surgeries that cut out the tumors, a radiological procedure that “starves” the tumors by blocking nutrients flowing to them, and an innovative ultrasound treatment that destroys the tumors with heat. A look at the advantages and disadvantages of uterine-sparing treatments: Drugs: Therapies prescribed to control heavy menstrual bleeding such as oral contraceptives, progesterone hormone therapy and nonsteroidal anti-inflammatory medications are not very good at treating the fibroid tumors. One drug that does treat fibroids is a GnRH agonist. It can decrease the size of the tumor by 40% over three months and alleviate anemia caused by bleeding. However, because it can only be used for a short duration, it is used primarily before surgery to shrink the tumor. On the horizon is a new drug therapy called a selective progesterone receptor modulator that shows much promise in large clinical trials and could be available for approved use by the end of 2006. It is designed for longer-term use than the GnRH agonist. Abdominal myomectomy: This technique requires an incision through the abdomen to access the uterus. From there, the surgeon shaves the fibroid tumors from the uterine wall. It is effective, but invasive surgery results in longer hospital stay and recovery time. Laparoscopic myomectomy: The surgeon makes three small (5 mm to 10 mm) incisions, through which thin instruments are inserted and used to cut out the tumors. The minimally invasive approach reduces recovery and length of hospital stay. Effectiveness depends on the experience and technical skill of the surgeon, so it is important to find the right surgeon. Hysteroscopic myomectomy: Used only when the fibroid is submucusal, or below the lining of the uterus, the procedure requires no incision. The tumor is removed through the cervix. Uterine artery embolization: Microscopic spheres are injected through a narrow tube into the femoral artery. The spheres form a barricade that blocks blood flow to the fibroids, starving them to death. This is also not recommended for women desiring pregnancy. MRI-guided focused ultrasound ablation: FDA-approved in 2004, the noninvasive treatment involves ultrasonic waves that cause the fibroid tumor to die by intensely focused heat. No long-term results exist. This is not recommended at this point for women desiring pregnancy. Explore the option that is right for you. Make sure you determine not only whether you have fibroids, but also the location and size of the tumor(s). These last two factors determine how to best return you to full health.m Dr. Naghmeh S. Saberi is an Ob/Gyn who specializes in minimally invasive surgery at UCI Medical Center, Orange County’s only university hospital, which has been named one of the nation’s best hospitals for gynecology by U.S. News & World Report. Information: www.ucihealth.com or call 714.456.2911. For Letters: ocfamily.com |
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