All women should have some basic knowledge about health issues that have a significant chance of impacting their lives. Many of my patients come to the office experiencing symptoms of one such common gynecologic problem, the growth of a non-cancerous tumor within or on the surface of the uterus.
These benign growths arise from the smooth muscle that forms the wall of the uterus. We call them leiomyomas, myomas or simply fibroids. By age 35, 30-50% of women will have developed fibroids. While the condition is extremely common for all women, it is somewhat more so for African-American women. Family history may also play a role.
What Problems do fibroids cause?
Uterine fibroids are usually detected by physical exam or sonography (an ultrasound exam) in the 30 to 40 year old woman. They may appear earlier or later. When present, they may never cause a problem. But more often, they eventually do create some discomfort. Uterine fibroids are, in fact, the most common reason for having a hysterectomy.
Fibroids may cause a variety of problems including abnormal uterine bleeding, heavy or painful periods, pelvic pain, infertility, or miscarriage. Sometimes the growing fibroid mass in a woman’s abdomen can present a health risk even if she has no symptoms. What specific symptoms a woman notices and their severity depend on the size of the fibroid and its position within the uterus. A small fibroid, located in the central part of the uterus, may cause extreme symptoms including abnormal or heavy periods, while a much larger fibroid on the outer surface of the uterus may cause no problem at all.
Our goal for your care is to solve the particular problem you are experiencing while maintaining the function of the uterus (fertility), if you desire. When fibroids are causing very difficult symptoms, treatment usually involves surgery since no medication will permanently reduce their size. If you may want to become pregnant in the future, the fibroids can be surgically removed without removing the uterus. This procedure is called a myomectomy. If you are sure that you do not want a future pregnancy, we usually recommend a hysterectomy. This is because a myomectomy can be as difficult as a hysterectomy, and it still leaves you with the risk that the fibroids can return. Thus, myomectomy is only preferred if you want to preserve the possibility of pregnancy.
Robotic Surgery to Remove Fibroids
The good news in surgical treatment of fibroids is the advancement of minimally-invasive surgery—especially robotic-assisted laparoscopic surgery (robotic surgery). When fibroids invade the uterus, it often becomes too large to remove through vaginal surgery. Before the robot, most women with a significantly enlarged fibroid uterus would have to undergo abdominal surgery with a large incision and a recovery of about 6 weeks. With the new technology, we are usually able to perform either myomectomy or hysterectomy through very small incisions. Most women experience a much faster recovery and return to their normal activities in about two weeks.
We strongly encourage an annual gynecologic exam to detect the appearance of uterine fibroids. It is important to investigate the cause of pelvic pain, heavy periods, or abnormal bleeding. These can also be signs of a more serious problem. If fibroids are detected, a consultation with your gynecologist will allow us to develop a management plan. We may decide to simply monitor the growth of the fibroids and their effect on the function of your uterus or we may consider surgery. (Options, also include a radiologic procedure that we can discuss with you). The 1 in 2000 risk that a fibroid tumor may be a malignant tumor (sarcoma) must also be weighed in deciding on the management of these mostly benign tumors.