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FIBROIDS

Fibroids are common, non-cancerous tumors of the uterus.

Why do they arise?

Some women have a genetic predisposition to develop fibroids. It is thought that perhaps higher estrogen levels or greater fluctuations of estrogen might predispose some women to develop fibroids. Fibroids can run in families, but it is not a 100% probability. Just because your mother or grandmother had significant fibroids, it does not mean that you are destined to develop them. Hormonal birth control is not thought to predispose fibroid tumors, nor does childbirth.

What type of problems do fibroids cause?

Not everyone with fibroids has symptoms or develops problems. About 40% of women over the age of 40 have at least one small fibroid tumor. However, some women have significant bleeding with periods or irregular bleeding during their cycles. Fibroids are a major cause of anemia in childbearing age women.

Also, fibroids can cause pain with menses and during sex. If the fibroids get really large (usually more than the size of a 4 month pregnant uterus), they start causing pressure-like symptoms, problems with constipation, and an increasing frequency of urination.

Can fibroids cause infertility?

Fibroids in a certain location, inside the cavity of the uterus, can very commonly cause infertility. They interfere with implantation and perhaps even insemination, much like the intrauterine device (iud) used for contraception.

Multiple fibroids in the body of the uterus also cause infertility by an unknown mechanism. They can even interfere with the success of an IVF procedure.

Can fibroids cause a miscarriage?

There is a higher risk of miscarriage and preterm delivery with fibroid tumors. However, the majority of women have completely uneventful pregnancies.

If I still plan to have children, what treatments are available?

Every patient at Women Center L.A. will be carefully and individually evaluated. Many do not require any other treatment other than close monitoring. However, when fibroid tumors begin interfering with daily life, cause anemia, infertility or significant pain, treatment becomes necessary.

WE BELIEVE IN THE LEAST INVASIVE TREATMENT OPTION AVAILABLE

Some women can manage with birth control pills, herbal supplements, progesterone and/or iron.

Hysteroscopic Resection of Fibroids

When fibroids are in the submucousal location (inside the uterine cavity), a simple procedure can take care of all the symptoms. Submucousal fibroids usually cause bleeding, pain during periods, and infertility. Hysteroscopy involves inserting a camera whose diameter is approximately that of a standard pencil into the uterus. Next, using a wire loop, the fibroid can be shaved down partially or completely depending how much of it is visible inside the uterin cavity. Hysteroscopic resection is an outpatient surgery that can be completed in under an hour. Usually the patient is fully functional the next day.

What is the recovery time post hysteroscopic resection of fibroids?

The recovery time is minimal. Usually the patient may work the next day. There is some cramping controlled with Ibuprofen or another similar analgesiac. Pelvic rest is recommended for 2- 4 weeks.

Laporoscopic Myomectomy

Laparoscopic Myomectomy is a laparoscopic procedure during which the fibroids are shelled out and removed and the leftover defect ("hole") is repaired. The problems begin when the fibroids are too large to be removed through the small (10-12 mm) incisions which are made for laparoscopy. Fibroids must be cut up in small pieces and then removed.

This significantly prolongs the procedure. The most important problem, however, is different. The remaining defect needs to be repaired and it is technically very difficult to perform the repair laparoscopically. Since most of the time it is impossible to repair the uterus laparoscopically as well as it is done during open surgery, we must be very careful selecting appropriate patients for this procedure.

Therefore we try not to perform this procedures on the patients that require a myomectomy to become pregnant. Since the uterus may rupture (tear) during the pregnancy if it is not repaired correctly. Several cases of uterine rupture have already been reported.

Laparoscopic Minilap Myomectomy (Laparoscopically Assisted Myomectomy - LAM)

Laparoscopically Assisted Myomectomy (LAM) is a combination of laparoscopic (laser) surgery with a very small conventional incision. This procedure solves both problems of laparoscopic myomectomy, but at the cost of making conventional, although very small, incisions on the abdomen. We can use this procedure to remove virtually any size fibroids, completely replacing the conventional myomectomy. Because the abdominal incision is so small (minilaparotomy) the patients leave the hospital and recover much faster then after conventional myomectomy. The recovery time is only slightly longer then after a pure laparoscopic myomectomy. To compare, a minilaparotomy incision is 1.5 to 2 inches (4-5 cm) and a conventional laparotomy for myomectomy incision is 5 to 7 inches (12 to 18 cm).

Conventional Myomectomy

Conventional Myomectomy is the most commonly performed procedure to remove the fibroids. It involves making a C Section-like incision in the lower abdomen, removing the tumors and then suturing the uterus. The recovery time is that of any conventional open surgery, approximately 4-6 weeks. Also it may be associated with significant adhesion (scar) formation that may be deleterious if you with to get pregnant. At Women Center L.A., we reserve open myomectomy for the biggest fibroids. Since we are adept at removing tumors through extremely small openings, we usually make the smallest incisions possible. In fact, we usually perform myomectomies on women that were offered a hysterectomy by their gynecologists.

If I don’t plan to have children, what treatment options are available?

All of the treatment options mentioned above are also available to women that do not desire childbearing in the future.

Ablation with Novasure

Uterine Embolization

This procedure cuts off the blood supply to the uterus, and thus its essential that you no longer plan to have children. In fact, we would recommend permanent sterilization prior to having this procedure. The complication rate in women that become pregnant after this procedure is unacceptably high.

Focused Ultrasound Surgery

This is the newest form of FDA approved treatment. Using MRI to guide ultrasound waves, fibroids are essentially heated up in an attempt to shrink them. Special care needs to be taken to avoid other organs, such as the bowel. Also there is less long term data then with other treatments, since this treatment is so new.

Laporoscopic Hysterectomy

If women choose to have a hysterectomy, many times it can be accomplished laporoscopically with tiny incisions which allows for less pain, faster recovery and return to normal function.

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