I HAVE REMOVED:
- A basketball sized Fibroid Tumor in a woman extending all the way to her ribcage
- 14 separate tumors from one woman using a combination of special techniques to minimize bleeding
- Fibroid tumors through the Hysteroscope and Laparoscope since the 1990s
Sometimes Fibroid removal is desirable
to enhance fertility, reduce pain or bleeding
but most of the time
if a woman is having no symptoms,
I reassure her that no treatment is necessary
Raymond C. Lackore MD
FIBROID TUMORS: (Of the Uterus - also known as uterine leiomyomata) are benign (non-cancerous) tumors of smooth muscle cells and fibrous connective tissue arising within the uterus. They may be single or multiple, may range in size from 1 mm to over 15 inches in diameter. These are the most common tumors of a woman's pelvis. They have been estimated to occur in 20-25% of women of reproductive age and may be present in up to 70% of all menopausal women (if the uterus is very carefully examined).
DIAGNOSIS: is usually based on finding of a larger than average sized uterus with an irregular surface during a pelvic examination. Ultrasound may be helpful to reveal the number and location of tumors. MRI or CAT scans usually do not show further useful information or improve outcome.
SYMPTOMS: 10-40% of leiomyomata that are associated with symptoms. Abnormal heavy Uterine Bleeding, Pelvic Pain or Pressure, Lower Urinary Tract Complaints, or Infertility are most common.
MANAGEMENT: Most fibroid tumors do not cause symptoms. These are usually followed over time. Mild symptoms lead to treatments with medicine rather than surgery (see below). These tumors are responsible for an many major and minor conservative surgical procedures (dilation and curettage, hysteroscopy, endometrial ablation and myomectomy). Fibroids the most common reason for hysterectomy, causing approximately 30% of all such procedures in the United States. Hysterectomy can often be avoided.
FIBROID EVALUATION: History, Physical Examination, Endometrial Biopsy, Ultrasound, Blood count are the main steps to evaluation.
FIBROIDS AND CANCER: Approximately 1 in 300 fibroids have cancer (roughly 99.7% do not).
FIBROID TREATMENT: Many treatments are available and are chosen based on how large they are, what symptoms they produce, how quickly they are growing, whether childbearing is complete and what treatments are available in a community.
1. Watchful waiting: for worsening symptoms and growth. Involves re-measuring size and reviewing symptoms every 6-12 months.
2. Medical Treatments:
.....Motrin or Aleve: Reduces bleeding and pain.
.....Birth Control Pills: Reduces bleeding and pain.
.....Mirena IUD: Often effective. Reduces bleeding and pain. Higher expulsion and not useful with cavity distortion.
.....GnRh agonists: Many Side effects, high cost, short duration of use, tumors will recur.
.....Mifepristone: RU486 at a dose of 5mg per day. Not FDA approved. Effectiveness similar to Uterine Artery Ablation.
3. Surgical Treatments:
.....Submucous Myoma Resection: 16% require reoperation within 9 yrs. Fertility effect excellent.
.....Myomectomy: Removal of Just the tumor.
.....Laparoscopic Hysterectomy: Usually by Minimally Invasive Technique - Extremely high "cure" rate. Stops ALL bleeding.
4. Uterine Artery Embolization: (UAE or UFE). Around for 20 years. Within 3-5 years 20 to 30 % of patients need another treatment. Up to 10 % complication rate, 2% hospitalized. Ask the Radiologist about the "post embolization syndrome" - marked pain after the procedure. For an experienced local Radiologist who does this look at www.ufecenter.com/ (I have no business affiliation). GREAT NEWS!: Embolization is now considered compatible with future childbearing!!! - On the other hand: failure rates have been shown to be highest in women < 40 years old or who have had a prior myomectomy.
5. HIFU: (MRI focused high intensity ultrasound). Just treats the center of tumor. Takes up to three hours to build up heat. FDA approved. Not available locally.
MORE INFORMATION: visit WomensHealth.Gov