Fixing Uterine Fibroids
You have some serious pelvic pain going on. You have a growth there as well. You experience heavy periods and frequent urination. You could have uterine fibroids.
Uterine fibroids are benign tumors in or around the uterus that tend to disappear after menopause. Many women do not know they have them and only seek treatment when they are bothered by symptoms such as heavy menstrual bleeding, clotting, pelvic pain, bloating, weight gain, painful intercourse and constipation or urinary problems.
About 20 to 80 percent of women develop fibroids by the time they reach age 50. Fibroids become more common as women age, especially during the 30s to 40s through menopause. After menopause, fibroids usually shrink. African American women are more likely to develop them than white women. Only a small percentage actually become symptomatic.
The cause is baffling. Genes do play a role because they run in families. Hormones influence their growth. As evidence of that, they enlarge during pregnancy and usually regress after menopause, when estrogen production wanes.
The number and size of fibroids vary: A woman can have one to many fibroids, ranging from the size of a pea to larger than a cantaloupe.
Fibroids can sometimes cause infertility, repeated miscarriages or pregnancy complications. There are a number of treatment options available, including hormone therapy. If those don’t work, there is always surgery to remove the fibroids or the entire uterus.
In fact, there are several treatment options available:
§ Hysterectomy-this is major surgery to remove the uterus, along with the fibroids it contains. It is done with an incision in the lower abdomen, although it is sometimes performed vaginally. Typically, a woman stays in the hospital for two or three days, followed by a six-week recovery period. A hysterectomy has all the usual risks of surgery but is unquestionably effective at curing fibroid-caused symptoms. After the surgery, a woman will no longer menstruate, although she will not enter menopause unless her ovaries are removed at the same time. The procedure is recommended for women who are done with childbearing, especially if you don’t want to bother with birth control. An infrequent delayed side effect is a drop in the pelvic floor, which can cause urinary incontinence.
§ Myomectomy-this operation removes just those troublesome fibroids, leaving the uterus intact, and therefore is a choice for women who wish to become pregnant. It sometimes cures infertility or repeated pregnancy loss. However, the fibroids can and do grow back. How a myomectomy is done depends on the size, number and location of the fibroids. Most often an abdominal incision is used, with a recovery period similar to a hysterectomy. A myomectomy can sometimes be done as an outpatient procedure through a laparoscope or hysteroscope, with lighted surgical tubes inserted near the navel (for the laparoscope) or through the vagina (for the hysteroscope).
§ Drugs-before resorting to more involved treatments, many women try one or more medical approaches to reduce bleeding, including nonsteroidal anti-inflammatory drugs taken either alone or with the hormone progesterone. Some try an IUD that contains synthetic progesterone. The relief is temporary; the fibroids shrink, but can also regrow. A drug marketed as Lupron, a synthetic form of gonadotropin-releasing hormone, shrinks fibroids by reducing their supply of estrogen and progesterone. It is sometimes used before a myomectomy to simplify the surgery. It can be used only for a limited time because it results in osteoporosis. Once it is stopped, the fibroids grow back.
§ Embolization-this nonsurgical procedure is perhaps the most viable alternative to a hysterectomy for women who have completed childbearing. It works by cutting off the blood supply to fibroids, causing them to shrink though not necessarily disappear. A catheter is inserted through the femoral artery and guided first to one uterine artery, then to the other. Tiny pellets—particles of polyvinyl alcohol, gelatin microspheres or gelatin sponge—are then inserted through the catheter, preferentially cutting off the blood supply to the fibroids, which have larger blood vessels than the uterus itself. In one study published in The New England Journal of Medicine, the authors weighed the advantages and disadvantages of embolization. They found that the procedure eased fibroid-caused symptoms in 85 to 95 percent of women but did not necessarily eliminate them. The hospital stay for the procedure is short, usually one or two days, and most women return to their normal lives within a week. But fibroids can regrow or new ones can develop, and in clinical trials one-fifth to one quarter of patients had to repeat the procedure or have a hysterectomy. The authors also found that 80 percent of women with fibroids were eligible to have embolization. Relief of symptoms gradually occurs over two or three months. Women may experience pelvic pain, fever and malaise during recovery. One rare complication is pulmonary embolism, which is also a risk of surgery.
§ MRI-Guided Ultrasound-women may have to pay out of pocket because insurance may not cover it. It uses magnetic resonance imaging to direct high-intensity ultrasound beams to the fibroids, heating them and destroying their outer layers. A sedative but no general anesthesia is given, recovery requires little or no time. But as with the other alternatives to a hysterectomy, the fibroids can regrow and symptoms return, necessitating a repeat procedure or an alternative like a hysterectomy. The procedure takes several hours, during which a woman must lie very still face down in an MRI machine with her head outside the machine and her belly in a pool of water.
Bottom line: You should consult an expert in these procedures before making a decision of which one to choose. He may suggest a program of hormone-balancing diet and exercise. For example, fish such as salmon, tuna and sardines are good for anti-inflammatory properties. Yoga and meditation may be stress reducing. Fibroids can be worrisome but with the right solution you can be healed.
