A surprising 70 to 80 percent of all women develop uterine fibroids, benign growths in the muscle of the uterus, at some point in their lives. While most women with uterine fibroids do not experience symptoms, some women suffer from severe symptoms that can be relieved with treatment.
“While the exact cause of uterine fibroids isn’t certain, it is generally believed that hormones play a key role,” explains Dr. Mobolaji Ajao, a specialist in the Division of Minimally Invasive Gynecologic Surgery at Brigham and Women’s Hospital. “They also seem to be more prevalent in certain families, so there is a genetic component as well.”
Risk Factors and Symptoms
Uterine fibroids are most common in women in their later reproductive years (30s and 40s) and occur somewhat more frequently in African American women – though they can impact all women. Symptoms may include heavy or irregular menstrual bleeding, back pain, increased frequency of urination, pelvic pain or pressure, and fertility or pregnancy complications. Fortunately, women with symptomatic uterine fibroids have a wide range of treatment options available to them.
Treatment selection for uterine fibroids should be based on the patient’s symptoms and interest in preserving fertility. It is important to look for a center that offers a range of treatment options that can best meet a patient’s individual needs.
Medical Management for Fibroids
Numerous medications have been found to be useful in the treatment of abnormal bleeding associated with uterine fibroids. Tranexamic acid is a non-hormonal option that can reduce the volume of bleeding. Additional medical management options to control heavy or irregular bleeding include oral contraceptives, intrauterine devices (IUDs), and hormones. Women with abdominal pain and pressure or fertility issues often do not experience adequate resolution of these symptoms from medications alone. In addition, preliminary results of a new class of medication that blocks the ability of the hormone progesterone to cause fibroid growth have shown promise.
Embolization and High Intensity Focused Ultrasound
Uterine artery embolization, uterine fibroid embolization, and high intensity focused ultrasound are performed by an interventional radiologist and provide alternatives to medical or surgical management of fibroids. Embolization works by targeting the blood vessels that feed the uterus. These treatments limit the blood supply to the uterus, leading to shrinkage of the fibroid and a decrease in symptoms like abdominal pressure, pain, bleeding, and frequent urination. Magnetic resonance imaging (MRI) is used to guide high intensity focused ultrasound treatment for fibroids. This option, which generates tissue-killing levels of heat using narrowly targeted spots of ultrasonic waves, may be suitable for fibroids that are in specific locations and limited in size and number.
Surgery for Fibroids
Surgical treatment for uterine fibroids is provided by gynecologic surgeons and gynecologic oncologists, with many specializing in minimally invasive approaches. Most often, surgical treatment includes either removal of the uterus or removal of the fibroid. Surgical approaches to remove the fibroid are impacted by the location of the fibroid. If the fibroid is in the uterine cavity, a minimally invasive approach using hysteroscopy can be employed. Robotic and laparoscopic approaches are available to either remove the fibroid (such as robotic myomectomy) or the uterus and cervix (such as robotic hysterectomy).
“Treatment selection for uterine fibroids should be based on the patient’s symptoms and interest in preserving fertility,” said Dr. Ajao. “It is important to look for a center that offers a range of treatment options that can best meet a patient’s individual needs.”