When to Treat Fibroids
If you’re a woman in your 20s, 30s or 40s, it’s likely that you have fibroids in or around your uterus — even if you don’t know it.
“Fibroids are typically benign tumors of the muscle wall of the uterus. We don’t really know what causes them, but they are especially common in women of reproductive age,” explains Cara King, DO, MS, a UW Health minimally invasive gynecologic surgeon.
Approximately 60 to 80 percent of women have uterine fibroids, but many are unaware of them until the fibroids show up on imaging or during a physical exam. African-American women are more likely to develop this condition, and a family history of fibroids can also increase your risk. Here’s what to know about fibroids and when and how to treat them:
Pay attention to any unusual symptoms. “The most common symptom is heavy bleeding, so if your periods are getting heavier or they’re lasting longer, or if you’re having bleeding between periods, that could be a sign of fibroids,” King says. “If you’re having a lot of pelvic pressure, having frequent urination or urinary retention, then you should definitely see your physician.” A transvaginal ultrasound can reveal the location and size of any fibroids, and your doctor will refer you to a specialist if necessary.
Size and location varies. Fibroids can grow inside the uterine cavity, embed within the uterine wall, or attach to the outside of the uterus. “They can grow extremely large, from pelvis to diaphragm,” King says. The increased bulk in your abdomen can put pressure on your bowels and bladder, causing other problems.
They may not require treatment. Only about 20 percent of fibroids require surgical intervention. “Most of the time, they aren’t a concern,” King notes. While fibroids typically won’t disappear on their own, you only need to remove them if they’re causing problems or impacting your fertility.
Concern increases with age. “If I see a fibroid enlarging in a postmenopausal woman, that’s a concern,” she says. “Our ovaries put out estrogen and progesterone, and fibroids are fed by those hormones. They should stop growing when you reach menopause.” A fibroid that continues to develop after menopause could be cancerous, but don’t stress: less than 1 percent of fibroids turn into cancer, she says.
Treatment can be relatively easy. Sometimes hormonal suppression can be enough to control bleeding symptoms, she says. If the fibroids are smaller and located within the uterine lining, a surgeon might be able to remove them via the vagina through a simple “no touch” hysteroscopic procedure that can be done in the office using a thin, lighted tube instead of holding open the vagina and cervix with surgical instruments that can cause patient discomfort. “This is a really nice technique to use if you can because it’s quick, around 20 minutes, and very well tolerated,” King says. Larger fibroids may need to be removed laparoscopically.
Consider your child-bearing plans. “Everyone has different priorities,” King says. If you want to preserve your fertility, opt for a minimally invasive laparoscopic procedure to remove only the fibroids and preserve your uterus. You can generally go home the same day and are usually fully recovered in two weeks.
If you’re done having kids, you may want to consider a hysterectomy to keep fibroids from coming back; the recovery time for that procedure is two to four weeks. “The most definitive way to take care of this long-term is taking out the uterus,” she says. In premenopausal women, the ovaries are often left in place to keep hormone levels normal.
Find the right surgeon. It’s best to go with a surgeon who uses laparoscopic techniques for even very large fibroids. “If they’re offering abdominal surgery or an open technique, get a second opinion,” King advises. “The outcomes are just night and day in terms of recovery.” A surgeon who has completed a fellowship in minimally invasive gynecologic surgery will be especially well versed in laparoscopic techniques.
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Date Published: 01/18/2019