Dr. Eric DePopas, MD
PainTheory Chief Medical Officer
Vascular & Interventional Radiologist
Table of Contents
Have you just been told that you have uterine fibroids? If so, your doctor will probably suggest or offer two options–each of which hinges on whether or not your fibroids (also called leiomyomas) have been symptomatic and the degree to which they are impacting your daily life, functioning, and, in some cases, your ability to get pregnant.
If you’re asymptomatic and your provider discovered your fibroids during a routine pelvic examination, then you and your doctor will just need to monitor your fibroids, their growth levels, and your symptoms going forward. However, if you have been suffering any or all of the typical symptoms, and fibroids are the verified or diagnosed cause, then your doctor will likely suggest one of the recommended pharmacological (medication) or surgical treatments.
Does “treatment” automatically need “operation?” No. Not necessarily. Thankfully,there are several non-invasive treatment options available. In other words, having fibroids doesn’t necessarily mean you’ll need an invasive surgery like a hysterectomy.
Naturally, if at all possible, you want to go the non-invasive route. Why? Because these options will be less traumatic for your body and will give you a shorter post-procedure recovery period. Post diagnosis, if your doctor is immediately (or exclusively) recommending a moderately or highly invasive surgery option we suggest asking them why.
Based on our clinical experience, an informed patient is an empowered patient, so we also suggest asking about potential non-invasive alternatives to treat your fibroids.
Fibroid Detection Methods
The Center for Uterine Fibroids at Brigham and Women’s Hospital lists a number of diagnostic examinations to assess the presence, size, and acuity of your fibroids.
Pelvic Examination
Based on your presenting symptoms such as cramping, heavy periods, or lower back pain, your healthcare provider can check for fibroids during a routine office gynecological exam. Using a bimanual (two handed) pelvic examination, your clinician will check your uterus shape and size and the surrounding pelvic structures by inserting two fingers into the vagina while palpating above your abdomen with the other hand. If you have fibroids, they can often be felt above the pubic bone.
Fibroid Ultrasounds
To confirm their pelvic examination findings or suspicions, your provider may refer you to a local imaging department for a transvaginal or transabdominal ultrasound–the most common way of diagnosing the existence, location, and size of your fibroids. While each of these two tests uses sound waves to produce images of the uterus, ovaries, and other pelvic structures, there are some differences.
During a transvaginal fibroid ultrasound, a technician places a device called a transducer in the vagina to take images from inside the vaginal canal.
If your doctor orders a transabdominal ultrasound, the technician will pass a transducer over your abdomen to get the required images of your uterine area.
Lab Testing
If you have very heavy or prolonged menstrual bleeding (a classic fibroid symptom), your provider may order some lab tests to determine some of the causes and effects of this bleeding. A complete blood count will help your doctor to determine if your heavy or long periods–or spotting between periods–have resulted in iron deficiency anemia.
Also, according to the researchers in this article at Endocrine Journal, there’s an estrogen-based connection between uterine fibroids and the occurrence of nodules in the thyroid glands. Based on this study of 925 women, and controlling for other demographic and lifestyle factors, 17.6% were shown to have co-occurring thyroid nodules and fibroids. Therefore, it’s important to have a doctor check your thyroid-stimulating hormone (TSH) level. . Additionally, your doctor may want to check your levels of follicle-stimulating hormone (FSH), testosterone, and dehydroepiandrosterone (DHEA). These tests can help determine if abnormal uterine bleeding is caused by a hormone imbalance.
Fibroid MRI
While ultrasounds are the most commonly used diagnostic tool, some providers will refer you for magnetic resonance imaging (MRI) because it can often distinguish fibroids from other intramural lesions. MRIs will give a more accurate snapshot or assessment of the uterine cavity. During an MRI, a technician positions you inside a large machine with a magnetic field, a scanner, and a set of coils. If your doctor orders an MRI with contrast, you’ll need to have an IV inserted into one of your veins before the test begins.
Other Options
There are four other fibroid detection methods or testing options: hysteroscopy, hysterosonography, hysterosalpingography, and laparoscopy.
While these four may sound a little alike, each of the diagnostic approaches is slightly different.
During a hysteroscopy, a doctor inserts a slender, telescope-like device and advances it into your uterus. Once the device is in place, the doctor will introduce saline into your uterus, expanding it and making it easier to examine.
Hysterosonography is typically used in women experiencing heavy menstrual bleeding. During the test, a doctor will introduce saline into your uterus. The saline makes it easier to take detailed images with a transducer and ultrasound machine.
Hysterosalpingography uses a special dye to make the uterus and fallopian tubes easier to see. During the test, you’ll lie in the same position used to perform a pelvic exam. Using a speculum, your doctor will pass a thin tube through your cervix and into your uterus.
Once the tube is in place, the speculum is removed, and you’ll be placed under an X-ray machine. As dye slowly fills your uterus and fallopian tubes, a technician will take multiple images. These images can help your doctor determine if you have blocked fallopian tubes or fibroids growing within the inner lining of your uterus.
Finally, laparoscopy involves introducing a small camera (laparoscope) on the end of a tube directly into the abdominal cavity to gain images of the outside of your uterus and the surrounding pelvic structures.
How to Treat Fibroids
In its clinical information on approved fibroid treatments, the American College of Obstetrics and Gynecology lists both recommended pharmacological (medications) and surgical interventions or treatments.
Now, let’s take a look at what each of these treatments may mean for you, their typical recovery times, and, ultimately, your prognosis and quality of life.
Uterine Fibroid Embolization
One of the most effective and low-impact uterine fibroid treatment options is a nonsurgical procedure called uterine fibroid embolization (UFE). Because this 90-minute procedure is minimally invasive, embolization has a short recovery time and doesn’t require a hospital stay. It also causes little, if any, blood loss, making it much safer than invasive surgical procedures.
In our experience, patients like to know what to expect during and after surgery. So if your doctor has approved you as a good candidate for an embolization procedure, here are the 4 typical steps:
Step 1: An interventional radiologist will administer a local anesthetic to numb part of your arm or upper thigh.
Step 2: Once the area is numb, the radiologist will advance a thin catheter into the arteries supplying blood to your uterus. Few or no “ouchies” are needed here. In fact, the catheter is so thin that it’s not even as wide as a piece of pencil lead.
Step 3: Using this catheter, the interventional radiologist will inject small beads into the arteries responsible for providing adequate blood flow to each fibroid.
Step 4: Blocking blood flow to the fibroids causes them to shrink, eventually and often quickly relieving your symptoms.
Am I a good candidate for UFE?
Which of these sounds like you?
- I have already been diagnosed with fibroids.
- My doctor has told me that my symptoms are caused by an overgrowth of my fibroids and these symptoms just aren’t going to go away or decrease.
- I’m tired of living with my painful symptoms (painful periods, heavy menstrual bleeding, frequent urination, pelvic pressure, longer periods, fibroid-induced anemia).
- Yes, I want relief, but I really don’t want to undergo invasive surgery or a long recovery time. Symptoms of fibroid overgrowth include
PHYSICIAN INSIGHT
Uterine fibroid embolization is especially helpful if you have more than one fibroid, as you only need one procedure to shrink multiple growths.
Fibroid Medication
According to this 2017 study published in Reproductive Sciences, high estrogen levels can increase your chances of developing fibroids and of having more severe symptoms. So lowering estrogen levels may cause your fibroids to shrink and diminish the related symptoms. Among the FDA-approved medications to treat fibroids, gonadotropin-releasing hormone (GnRH) agonists tend to be the most effective, as they reduce the amount of estrogen in your body.
Here’s our warning label advice: If your doctor recommends a GnRH agonist, you may need to take progestin or an estrogen/progestin combination to reduce your risk of osteoporosis.
DID YOU KNOW?
Birth control pills may be helpful if you have iron deficiency anemia caused by heavy menstrual bleeding.
Fibroid Ablation
Laparoscopic radiofrequency ablation uses radiofrequency energy to destroy smaller fibroids and shrink the blood vessels that feed them. During ablation, your doctor will insert a tiny camera through two small abdominal incisions to locate your fibroids. Next, once located, your doctor will insert a thin device that applies radiofrequency heat to shrink and destroy the fibroids. Post-ablation, this happens over a three – 12 month period.
Our Warning Label advice: Although it is possible to become pregnant after ablation treatment, it’s not usually recommended. Also, because your doctor must make two small incisions in your abdomen, it may take you two weeks or longer to recover from the surgery.
Fibroid Myomectomy
Myomectomy is a surgical procedure used to remove fibroids completely while leaving your uterus in place. Although it’s not as invasive as a hysterectomy, a myomectomy can cause scarring that can make it more difficult to get pregnant in the future.
Also, in terms of procedure and level of invasiveness, not all myomectomies are the same.
In its patient information, The Mayo Clinic lists four types of myomectomies, starting with the most minimally invasive options.
During the first type of myomectomy (laparoscopic), a doctor removes fibroids by inserting slender instruments through small cuts in your abdomen. In the second type (robotic), a surgical robot aides the laparoscopic myomectomy.
A little more invasive are the hysteroscopic and abdominal myomectomies.
The first (hysteroscopic) is used if the fibroids are inside your uterine cavity (or womb). In this procedure, a doctor can insert slender instruments through your vagina and cervix into the uterus to remove the fibroids.
If you have multiple, deeply located, or very large fibroids, your doctor may perform the second (abdominal myomectomy) option. This is also offered as an option for women for whom hysterectomies were previously seen as the only option. In an abdominal myomectomy, the fibroids are removed from the uterus through a “bikini cut” made on your lower abdomen. Recovery may take three to six weeks, but you may still be able to have children.
Fibroid Hysterectomy
A hysterectomy, which means the removal of the entire uterus, is the most invasive treatment option, with the most permanent outcomes. This procedure is usually recommended or indicated for women who have tried other fibroid treatments, but without any measurable outcomes or symptom relief.
In some hysterectomy cases, including endometriosis or pelvic infection, the surgeon may also remove your ovaries and fallopian tubes.
Your post-hysterectomy recovery time will depend on whether you have open surgery or a laparoscopic procedure. If you need to have open surgery, expect to spend at least one night in the hospital and an estimated recovery time between four to eight weeks.
Since hysterectomies completely remove the uterus, this procedure will end your ability to get pregnant. Based on this and the invasive nature of the procedure, hysterectomies should be considered as a last resort for treating fibroids.
Monitoring With Your Doctors
Once you have been diagnosed with fibroids, it’s important to work with your doctor to come up with a plan to monitor your condition and to watch for any changes or complications that will require one or more of the approved treatments.
If you’re looking for relief from fibroid symptoms, reach out to one of PainTheory’s Care Coordinators today.
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