UTERINE FIBROIDS

WHAT ARE UTERINE FIBROIDS?

Uterine fibroids are tumors that grow from the muscular wall of the uterus. Sometimes referred to leiomyoma, fibroids are usually non-cancerous and vary in size, location, and number.

Fibroids are common among women, are may occur in up to 80% of women. Some women have little to no symptoms, while others may have very severe symptoms that make day-to-day activity difficult.

SYMPTOMS

Fibroid symptoms vary from woman to woman, but they include:

• Heavy menstrual bleeding (normal menses last up to 7 days).
• Pelvic or abdominal pain.
• Pelvic pressure on the bladder which can cause the bladder to feel full with little urine or require frequent urination.
• Pressure on the rectum, and in some can cause constipation or difficulty with bowel movements.
• Lower back pain.
• Pain during sexual intercourse.
• Difficulty achieving pregnancy.
• Pelvic or abdominal swelling or bloating.
• Potential complications during pregnancy, including
  • Preterm labor or preterm contractions.
  • Fetus in breech presentation requiring cesarean section.

DIAGNOSIS

• Sometimes fibroids can be palpated on pelvic or abdominal exam as large, firm masses.
• Fibroids can be seen on Ultrasound, CT Scan and MRI.
• Sometimes we will also perform a fluid-filled ultrasound (Hysterosonogram/Sonohysterogram) to better identify the location and number of all of the fibroids, especially if they are located inside the uterus.

TREATMENT

Treatment depends on the symptoms that you are experiencing, whether they are bleeding symptoms or symptoms associated to the bulk effect of fibroids.

 If your main symptom is bleeding, there are some medication options including:

• Non-steroidal Anti-inflammatory (Ibuprofen etc)
• Tranexamic Acid
• Birth Control Pills, Ring, Patch
• Birth Control Shot
• Intrauterine Device
• GnRH Agonist, also known as Lupron
• GnRH Antagonist (Oriahnn)

Surgical procedures can resolve bleeding and bulk symptoms. Options vary depending upon whether you desire future pregnancy.

Myomectomy, or surgical removal of the fibroids and preserves the uterus. Depending upon the location, number and size, this procedure may be performed via different routes.

• Hysteroscopy (only for fibroid located within the uterus): fibroids removed via a camera placed through the cervix (no incisions are made).
• Laparoscopy: fibroids removed via 3-4 small incisions made on the abdomen.
• Robotic: Fibroids removed again with 3-4 small incisions with the assistance of a surgical robot.
• Laparotomy: Fibroids removed via a larger incision on the abdomen.
• Radiofrequency Fibroid Ablation (shrinks the fibroids and preserves the uterus).
  • Accessa- Performed via 3-4 abdominal incisions.
  • Sonata– Performed via a handpiece placed through the cervix. This is an incision-free treatment that shrinks fibroids to reduce symptoms. Charles E. Miller, MD & Associates is one of the few teams in Chicago that offers the Sonata Treatment through Lutheran General Hospital.
• MRI guided High Intensity Focused Ultrasound: Uses high intensity ultrasound waves to shrink the fibroids. It is only available at certain centers in the United States.
• Uterine Fibroid Embolization (UFE): Performed by an interventional radiologist to block the blood vessels that feed the fibroid and cause them to shrink over time.
• Hysterectomy: Removal of the uterus and fibroids.
  • Resolves current symptoms and risk of future fibroid growth. At Charles E. Miller, MD & Associates, we perform these procedures almost entirely laparoscopically (through 3-4 small abdominal incisions approximately 1cm each).