Finding Out About Fibroids
Wide Range of Treatments Now Available to Treat Uterine Fibroids

Monique Washington feels like herself again after she underwent surgery to remove a uterine fibroid in July. The mother of a five-year-old had struggled with the fibroid since 2006. She is grateful for the treatment she received.

Monique Washington had been struggling with a uterine fibroid for several years. It began in July of 2006 — one month after she delivered a healthy baby girl. Washington, now 30, had abdominal pains so severe, she had to go to the emergency room. The diagnosis was a uterine fibroid, a benign (noncancerous) growth originating from the smooth muscle of the uterus walls. Approximately 20 percent of women have fibroids during their childbearing years; half of women have them by age 50.

"My OB-GYN, Tina Pham, MD, said it wasn't necessary to remove the fibroid, unless it caused problems," says Washington, an executive assistant at Inova Heart and Vascular Institute at Inova Fairfax Hospital. "So I decided not to remove it then." A few years later, however, the fibroid, which had grown to the size of a golf ball, was definitely causing problems. Washington experienced irregular, heavy periods, in addition to suffering a miscarriage in April 2011. She decided it was time to do something about it. Fortunately, Dr. Pham and Inova Alexandria Hospital were there to help.

Decisions to Make

Given Washington's situation, it's not surprising she had fibroids. "Fibroids tend to grow during pregnancy due to higher hormone levels," according to Dr. Pham. "Fibroids may also cause significant pain, and they increase the risk of miscarriage."
 
Fibroids are treatable, and there are many options available for women. However, there are a few factors to consider.

Fertility. You need to determine if you want to get pregnant again, as some fibroid treatments can diminish or end your ability to conceive.

Severity of symptoms. Fibroids can cause several problems (see sidebar for list) which can interfere with your health or quality
of life.

Size and location of fibroid(s). Fibroids grow from muscle in the walls of the uterus but can be located inside the cavity, inside the walls or outside of the uterus. Fibroids can be only millimeters small to 20 centimeters around or larger.

Getting Help

"There are several good treatment options available for fibroids," says Stella Lii, MD, an OB-GYN who specializes in minimally invasive surgical treatments of fibroids. "Treatment options need to be customized based on the size and location of your fibroids, as well as your desire to become pregnant again."
The most important point for a woman to remember
is that she needs to talk with her doctor and find out which treatment is best for her individual case. Arina van Breda, MD, of Inova Alexandria Hospital's Cardiovascular and Interventional Radiology Department advises, "No one treatment is right for all patients. Patients should do their own research about options before treatment so that they can make a fully informed decision." The range of treatments includes the following:

— Management with medication can sometimes help reduce heavy bleeding and menstrual cramps. However, this is often a temporary treatment until more definitive treatments can be completed.

— Myomectomy is the surgical removal of fibroids, either through minimally invasive techniques, open surgery or a combination of the two. Myomectomy is often the best solution if you want to get pregnant again.

— Uterine fibroid embolization (UFE) is a procedure that blocks the blood supply to the fibroids, causing them to shrink. This procedure also significantly decreases fertility. UFE can be an excellent nonsurgical option for patients with fibroids not amendable to myomectomy and who would like
to avoid a hysterectomy.

— Hysterectomy is the removal of the uterus including all fibroids, and is the only cure for fibroids. Many women associate hysterectomy with early menopause. However, the ovaries are generally left in place to avoid early menopause. Hysterectomy is an excellent option for women who have completed childbearing.
"If a healthcare provider says your fibroids are too large to remove laparoscopically, get a second opinion," advises Dr. Lii. "There are more options available."

In July of 2011, Washington underwent a myomectomy with Dr. Pham at Inova Alexandria Hospital. She is feeling much better these days, as her pain and bleeding are significantly reduced. Although she has to wait a few months before trying to conceive, she's glad she had the surgery. "I feel so much better," says Washington. "I told my husband that even if we don't have another baby, this surgery alone was worth it."

Watch videos to learn more about uterine fibroids
and treatment here.

Signs of Uterine Fibroids

There are several types of uterine fibroids. Intramural fibroids, the most common type, grow within the wall of the uterus. Subserosal fibroids push outward from the uterus and can distort its appearance. Submucosal fibroids develop just under or push into the glandular uterine lining.

If you have one or more of these symptoms, talk to your doctor.

• Heavy or painful periods, or bleeding between
  periods. Fibroids increase
  the amount of uterine
  tissue that prepares for implantation every month.
  
  
• Feeling "full" in the lower abdomen. Large
  fibroids can press on other abdominal organs.
  
  
• Frequent urination. If the fibroid presses on the
  bladder or ureters, the bladder can't empty completely.
  
  
• Pain during sex, or lower
  back pain.
  
  
• Reproductive problems,
  such as infertility, multiple miscarriages or early labor. Fibroids decrease the
  amount of space available for embryo implantation. Pregnancy hormones can make a fibroid grow, causing problems with the pregnancy.