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Fibroids
Fibroids are nonmalignant growths of smooth muscle and fibrous connective tissue, which sometimes grow to the size of a grapefruit, and are the most common cause of an enlarged uterus in women who are not pregnant. Widespread misunderstanding of this condition has been created by physicians' classification of fibroids as a disease, calling them "myomas," "leiomyomas," "fibromyomas," "leiomyofibromas," and "fibroid tumors." One woman's experience illustrates both some physicians' technical incompetence and the tendency of gynecologists to alarm their patients by using this scary terminology without explanation.

Many women have no symptoms to indicate that they have fibroids, and will find out they have them only when a medical pratitioner feels an irregularly large and rubbery uterus during a uterine size check or pelvic examination. Knowing the size and position of the fibroids will help keep track of their growth. Any number of women commonly live their entire lives with fibroids in their uteruses, bear children, and experience minimal inconvenience. Women who are aware of having fibroids tell us that their most bothersome problem is being misdiagnosed during pregnancy, being often told by physicians they are further along than they actually are. With the advent of sonogram (or ultrasound), this is less common than it used to be because fibroids can be seen on a sonogram.

Starting within the uterine wall, a woman can have man fibroids at the same time. They often move to the lining of the cavity (myometrium), or to the outer surface of the uterus. They sometimes grow out from the uterus on a stalk, and, if the stalk twists, the blood supply can be cut off, causing pain or vaginal discharge. Women often have an increase in the growth of the endometrium, and this results in longer, heavier, clottier and sometimes more painful periods. They can also cause very heavy uterine bleeding and discharge. Some women also suffer repeated miscarriages, because the fibroids fill the cavity and irritate the uterine lining.

Removal of the fibroids, in a procedure called a myomectomy, usually enables a woman to successfully carry a pregnancy. Many myomectomies can be performed under a scope, so the abdomen does not have to be cut into. However, if the fibroids are too large, a myomectomy may have to be performed abdominally. Also, some women may not be candidates for a myomectomy if the fibroids are too large, or if other organs are involved.
 
Although it is unusual, fibroids can cause further problems. They sometimes grow large enough to press against the bladder, which can create the annoyance of having to urinate more frequently. Also, they can press against the colon, interfering with normal bowel movement, or press against nerve endings, causing pain and creating an overall feeling of fullness in the abdomen. In addition, fibroids can grow on the ovaries which can be painful.

Fibroid growth is believed to be stimulated by hormones. Most physicians believe that they are stimulated in particular by estrogen. When a woman is having menstrual periods, they can grow a little larger each cycle. Birth control pills can also accelerate their growth, and during pregnancy, hormone levels are higher and the fibroids grow faster. With menopause, fibroids often shrink and even disappear. Physicians assume that when a woman stops ovulating, she no longer produces estrogen. However, even though estrogen continues to be produced throughout our lives, whether or not an egg is released each month, the absence of the corpus luteum (a progesterone-producing gland which develops from a ruptured egg sac) after menopause would result in lower progesterone levels. It therefore seems more plausible that if any hormone is related to fibroid growth, it is progesterone.

Many physicians will advise a sonogram to confirm the existence of fibroids or a D&C to rule out cancer. If the fibroids have grown very fast, some recommend immediate surgical removal to be sure the woman does not have a rare malignancy called sarcoma, cancer of the connective tissue. More and more physicians take a sample of the uterine lining to rule out cancer. This is less invasive than a D&C, and easier on the woman.

Physicians most often recommend hysterectomy for the removal of fibroids. Hysterectomy is technically less difficult than myomectomy (removal of the fibroids only) and, if a woman is over thirty, she is not always offered myomectomy as an option. Myomectomy removes the fibroids and preserves the uterus and fertility. If the fibroids are too large, a woman will have to have her uterus removed by an abdominal incision; however, if the fibroids are smaller, a woman can have a removal of the uterus through a scope placed into the cervix. This is a safer and less invasive method. It is best for a woman to get a second opinion regarding an abdominal hysterectomy vs. a hysterectomy performed through a scope.
 
To find out about various health conditions and treatments such as hysterectomy and alternatives, go to the HERS foundation web site.

Material is adapted from How to Stay Out of the Gynecologists Office, Woman to Woman Publications, 1986.
 
On the Web: For more information on Fibroids, visit Dr. Susan Lark's website www.drlark.com especially her book, Fibroids Tumors and Endometriosis.