Fibroids

There are about 600,000 hysterectomies performed in the United States each year. Of those surgeries 400,000 are done as a solution to fibroid surgery and fibroid removal. About 18% of Caucasian women and 30% of African American women will develop fibroids. 80% of women with fibroids have no symptoms.

Fibroids are tumors in the uterus that are mostly benign. They all start in the wall of the uterus and can grow either inside or outside the uterus. If they are on the outside of the uterus they are more of a nuisance; they will make your uterus feel irregular to a doctor during a pelvic exam but you will not necessarily need fibroid surgery or fibroid removal.

If you are diagnosed with fibroids via ultrasound (or any other method) and this is the first you are hearing of having fibroids, it is very important that you schedule a follow up with your doctor about 3 months after diagnosis to check on your fibroids. This is to check on the growth rate of your fibroids as cancerous fibroids grow at an accelerated rate in comparison to non-cancerous fibroids. The chance of having cancer in a fibroid is about 1/2500 (.04%). Removing fibroids that are suspicious or discussing cancerous fibroid removal surgery is important.

If you are aware that you currently have fibroids, it is not necessary to schedule follow up visits with your doctor unless you are experiencing symptoms (fibroid surgery is not always necessary). Symptoms of fibroids can include: heavy bleeding during your period, bleeding between periods, prolonged periods, bleeding after intercourse, and pain (due to the size of the fibroid). Sometimes women have concerns about fibroids after menopause. Whatever your age, when fibroids begin causing these kinds of problems it is time to do something about it. I am happy to discuss fibroid removal surgery at any time and let you know my professional opinion.

Your first option is, of course, to do absolutely nothing and NOT talk about removing fibroids. We can watch the fibroids and keep an eye on their progress with an annual ultrasound.

Ablation: This is a procedure where we burn off the lining of the inside of the uterus. You only want to consider this option if you are done having children or if you are experiencing fibroids after menopause. During this procedure, we use a tool with an electrical current to burn off the inside lining of the uterus and then shave down into the wall of the uterus in an attempt to destroy the lining of the uterus to prevent bleeding. Unfortunately a standard ablation will not remove the entire fibroid from the inside lining of the uterus (think of your fibroid like an iceberg - we can remove what you see above the water, but what is under the water will still exist). This causes the success rate of ablation to be fairly low, 35-40%. So you can see, ablation will help but will not necessarily cure the problem.

Uterine Artery Embolization (UAE): This procedure is an option for those women trying to avoid removing fibroids surgically. During this procedure you will go see an invasive radiologist. They will put a catheter into the artery in your leg that is responsible for delivering the blood supply to your uterus and they embolize it (they inject a foreign material in there that blocks the blood supply). Don't be alarmed - when you block the blood supply to an organ your body naturally finds a blood supply from somewhere else. The shock of your uterus having a decreased blood supply will frequently cause your fibroids to decrease in size. This doesn't happen overnight; it takes months in order to see results. While this procedure isn't perfect, it does help and is beneficial to those that are trying to avoid fibroid removal surgery for one reason or another.

Myomectomy: This is the procedure for removing fibroids. The majority of the time, fibroid removal through Myomectomy will be done by making a bikini incision. This fibroid surgery is a fairly large surgery and will require you to stay a day or two in the hospital. A robotic surgery for Myomectomy is also available for fibroid removal surgery. If you are considering fibroid removal surgery, make sure you go to a doctor who has a lot of experience in which ever method you choose.

Hysterectomy: The majority of women with fibroids choose to have a hysterectomy. This procedure can be done vaginally, laparoscopically, and abdominally. I encourage you to consider laparoscopy: a physician performing a vaginal hysterectomy does not have the opportunity to look around your abdomen for other potential issues such as endometriosis. During a hysterectomy the entire uterus will be removed instead of just fibroid removal; this option is also available to women who find fibroids after menopause.