How do patients know if they have fibroids?
A health care provider may discover that a patient has fibroids during a routine pelvic exam. The doctor can sometimes feel the fibroid with their fingers during the exam. Typically, a doctor will describe how small or how large the fibroids are by comparing them to fruits (like a grape or orange), nuts (like an acorn or walnut), or a ball (like a golf or tennis ball).
The health care provider will most likely do imaging tests to confirm that they, in fact, have fibroids. These tests create a “picture” of the inside of their body without having to perform surgery. These tests could include:
● Ultrasound – a machine that uses sound waves to create a picture. The ultrasound probe can be placed externally on the abdomen or it can be placed internally through the vagina.
● Magnetic resonance imaging (MRI) – a machine that uses magnets and radio waves to produce a picture.
● X-rays – a machine that uses a form of radiation to see into the body and produce a picture.
● Cat scan (CT) – a machine that takes multiple X-rays of the body from different angles for a more complete image.
● Hysterosalpingogram (HSG) – which involves injecting x-ray dye into the uterus and taking x-ray pictures.
● Sonohysterogram – which involves injecting water into the uterus and taking ultrasound pictures.
In order to know definitively that a patient has fibroids, they may also need one of two types of surgery:
● Laparoscopy – The doctor inserts a long, thin scope with a bright light and a camera into a tiny incision made in the navel area. This allows the doctor to view (and take pictures of) the uterus and other surrounding organs on a monitor during the procedure.
● Hysteroscopy – The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. With this procedure, no incision is needed and a camera can be used with the scope. The doctor can look inside the uterus for fibroids and other abnormalities, such as polyps.
If a patient has fibroids, what questions should they ask their health care provider?
● How many fibroids do they have?
● What size is their fibroid(s)?
● Where is their fibroid(s) located?
● Can they expect their fibroid(s) to grow larger?
● If the fibroids were known about already, how rapidly have they grown?
● How will they know if the fibroid(s) is growing?
● What problems can the fibroid(s) cause?
● What tests would be best to keep track of the growth of their fibroids?
● What are their treatment options?
● What are the doctor’s views on treating fibroids with a hysterectomy versus other types of treatments?
Patients shouldn’t hesitate to get a second opinion if their health care provider has not answered their questions thoroughly or they don’t feel like their doctor is meeting their needs.
How are fibroids treated?
Most women have fibroids that are asymptomatic which means they don’t experience any symptoms. For women who do have symptoms, they often find their fibroids are hard to live with, causing things like pain or heavy menstrual bleeding, and there are treatments that can help. Treatment for uterine fibroids depends on the symptoms so it’s important for patients to talk to their doctor about the best way to treat their fibroids. The doctor will consider many things before helping their patient choose a treatment plan. Some of these things include:
● Whether or not they are having symptoms from the fibroids
● If they might want to become pregnant in the future
● The size and location of the fibroids
● Their age and how close to menopause they might be
A patient may not need treatment if they have fibroids but aren’t experiencing any symptoms. Regardless, the health care provider will check during their annual exams to see if their fibroids have grown.
Doctors may recommend that women with fibroids who are experiencing mild symptoms should take over-the-counter medications such as ibuprofen or acetaminophen for mild pain. If a patient is experiencing heavy bleeding during their period, taking an iron supplement can help prevent them from developing anemia or help correct it if they already have anemia.
Several drugs that are commonly used for birth control can also be prescribed to help control fibroid symptoms. Low-dose birth control pills, injections, and IUDs don’t promote fibroid growth and can help control heavy bleeding.
Additional drugs can be used to treat fibroids like “gonadotropin-releasing hormone agonists” (GnRHa). These drugs, given by injection, nasal spray, or implant, have the potential to shrink fibroids and are sometimes used pre-surgery to make fibroids easier to remove. Most women tolerate GnRHas quite well but side effects can include hot flashes, depression, sleeplessness, decreased sex drive, and joint pain. Most women do not get a period when taking GnRHas, which can be a big relief to women who have heavy bleeding. This can also allow women with anemia to recover and achieve a normal blood count. GnRHas can cause bone thinning with long term use, so most doctors will only prescribe them for six months or less. These drugs also are very expensive, and some insurance companies will only cover a small percentage or none of the costs. GnRHas only offers temporary relief from the symptoms of fibroids; once they stop taking the drugs, the fibroids often come back quickly.
If a patient has fibroids with moderate to severe symptoms, surgery may be the best way to treat them. Here are the options:
● Myomectomy – a surgery to remove fibroids without taking out the healthy tissue of the uterus. This option is recommended for women who wish to have children after treatment for their fibroids because they can still become pregnant after myomectomy. However, if the patient’s fibroids are deeply embedded in their uterus, they might need a cesarean section in order to deliver. Myomectomy can be performed in a variety of ways, including; major abdominal surgery, laparoscopy, or hysteroscopy. The type of surgery depends on the type, size, and location of the fibroids. Unfortunately, after a myomectomy new fibroids can still grow. All of the possible risks of surgery are true for myomectomy but the risks depend on how extensive the surgery is.
● Hysterectomy – a surgery to remove the uterus and the only sure way to stop uterine fibroids. This surgery is used when a woman’s fibroids are large, if she has heavy bleeding, is either near menopause, post-menopausal, or does not want to give birth to children. The size of the fibroids determines the method of hysterectomy the surgeon will perform. Patients typically have the option of whether or not they want to remove their ovaries and their cervix during their hysterectomy. Women whose ovaries are removed go into menopause at the time of their hysterectomy. Although hysterectomy is usually quite safe, it does carry a significant risk of complications because it is a major surgery, and recovering from a hysterectomy can take several weeks.
● Endometrial ablation – is when the lining of the uterus is removed or destroyed in order to control substantial heavy bleeding. This can be done with a variety of methods and is typically considered minor surgery. Complications are still possible but are uncommon with the majority of the methods and most patients recover quickly. Approximately 5 out of 10 women who have had an endometrial ablation have no more menstrual bleeding and about 3 in 10 women have much lighter bleeding. However, a patient cannot give birth to children once they have had this surgery.
● Myolysis – is when a needle is injected into the fibroids, typically guided by laparoscopy, and some type of electric current or freezing is used to terminate the fibroids.
● Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE) – is when a thin tube is threaded into the blood vessels that supply the fibroid with blood. Next, tiny particles made of gel or plastic are injected into the blood vessels which block the blood supply to the fibroid, this causes the fibroid to shrink. Complications, such as early menopause, can occur but are uncommon. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed to substantiate these claims. Additionally, not all fibroids can be treated with UFE. The best candidates for UFE are women who don’t want to get pregnant in the future, would prefer not to have a hysterectomy and have fibroids that are causing heavy bleeding, pain and/or pressure.
The following methods are new treatments so they are not yet standard which means many doctors don’t offer them and/or health insurance may not cover them.
● Radiofrequency ablation where heat is used to destroy fibroid tissue without harming the surrounding normal uterine tissue. With this treatment, the fibroids remain inside the uterus but shrink in size. This procedure is fairly mild considering the majority of women go home the same day and return to normal activities within just a few days.
● Anti-hormonal drugs can provide symptom relief without more serious side effects like bone-thinning.
For more information about uterine fibroids, call our office at (530) 345-0064 ext. 281 or contact one of the following organizations:
● American College of Obstetricians and Gynecologists
● Center for Uterine Fibroids
● National Institute of Child Health and Human Development, NIH, HHS
Phone: 800-370-2943 (TDD: 888-320-6942)
● Office of Women’s Health
Phone: 800-994-9962 (TDD: 888-220-5446)