Fibroids: Diagnosis and Treatment
These Uterine Tumors Can be Detected and Remedied
Fibroid tumors grow in the uterus, and they seem to be most common during a woman's fertile years, especially after the age of 30. Such uterine tumors are rarely cancerous, but they can grow to be quite large and uncomfortable. Fibroid tumors can range in size from quite small (measured in millimeters) to large (many centimeters.) Large fibroid tumors can distort the urterus, making it appear lumpy when visualized during a pelvic ultrasound.
Although they can distort the overall appearance of the uterus, uterine fibroids are actually quite smooth, rounded, and well-defined. These tumors are overgrowths of the muscular, middle layer of the uterus, the myometrium. When they project into the endometrium (submucosal), they can cause heavy menstrual bleeding. Fibroid tumors that project outward (subserosal) can press on the bladder or rectum, causing problems with these organs. One other type of fibroid actually grows outside of the uterus and is attached by a very narrow band of blood vessels. This type of fibroid is said to be "pedunculated." Fibroids can cause a heavy, full feeling in the abdomen and can be singular or multiple in number.
Fibroid Diagnosis
Many times, a gynecologist can detect uterine fibroid tumors upon examination. She or he may note that the uterus is enlarged or lumpy in shape. At this point, a pelvic ultrasound may be prescribed.
A pelvic ultrasound is the least invasive test to determine if a patient has uterine fibroid tumors. An ultrasound technologist scans a patient's pelvic area with a camera (a transducer) and views the uterus, the vagina, the ovaries, the fallopian tubes (if viewable), and the outer pelvic regions. Fibroid tumors are (usually) easily viewed during this test, and they can be measured.
Sometimes a transvaginal ultrasound will follow up a pelvic ultrasound. But large fibroids can distort this type of imaging, since it is a very magnified test.
A hysterosonogram, another form of ultrasound, expands the uterine cavity with sterile saline solution, and is useful to view smaller, submucosal fibroids (ones that protrude into the endometrial area.)
Hysteroscopy and hysterosalpingography examine the uterine cavity as well as the fallopian tubes. These tests are useful for infertile women to see if fibroids are present, or the fallopian tubes are damaged or blocked.
Bloodwork can also be done if fibroids are causing heavy bleeding. An iron deficiency (anemia), common for women with fibroids, can be diagnosed.
Fibroid Treatment
For smaller fibroid tumors, doctors often just monitor their size. If they don't cause any symptoms (heavy bleeding, pain, etc.), then serial pelvic ultrasounds are often done.
For troublesome fibroids, some treatment options include:
- Myomectomy: surgical removal of just the fibroid(s), not the entire uterus
- Endometrial eblation: a heat technique that destroys submucosal fibroids (ones that protrude into the endometrium)
- Uterine artery embolization: this technique cuts off the blood supply to the fibroid(s), thereby shrinking them
- Medications: these can shrink fibroids and help with heavy bleeding and pressure. Types include androgens (male hormones), oral contraceptives, and Lupron (a drug that reduces estrogen and progesterone levels)
- Hysterectomy: for more severe fibroids, a hysterectomy (removal of the uterus) can relieve troublesome symptoms, although doctors nowadays utilize this procedure as a last resort, due to fertility issues
References: Medline Plus Medical Encyclopedia, MayoClinic.com
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