Fibroids

Prevention

There are no proven measures you can take to prevent fibroids from developing. Studies show that athletic women seem to be less likely to develop fibroids than women who are obese or who don't exercise.

Treatment

If fibroids are small and are not causing any symptoms, they do not need to be treated. Your gynecologist may do a pelvic examination every six months to a year to make sure that your fibroids are not growing rapidly. In some cases, medications can be prescribed to control any abnormal bleeding and temporarily shrink the fibroids.

Medications used to shrink fibroids, such as leuprolide (Lupron), create a temporary menopause by stopping the ovaries from making the female hormone estrogen. While estrogen levels drop and menstrual periods stop, menopausal hot flashes appear and fibroids stop growing and slowly shrink. This helps to stop blood loss from heavy, prolonged periods. However, when the medication is stopped, periods return, hot flashes disappear and fibroids that have not been removed will start growing again. These medications usually are given by needle injection in a large muscle.

Fibroids may need to be removed if they cause significant symptoms or are large enough to interfere with fertility. Growths in your uterus also may need to be removed if it is difficult for your doctor to tell whether they are fibroids or cancer. There are several options for removing fibroids:

• Myomectomy - This means cutting the fibroids from the uterine wall. Myomectomy allows a woman to keep her entire uterus in case she wants to have children. However, because this surgery can leave the uterine wall weakened, future babies may have to be delivered by Caesarean section. Surgery to remove fibroids sometimes can be done by laparoscopy, which is surgery through several small incisions in the lower abdomen. When fibroids are too large or too abundant to perform a laparoscopic procedure, then a traditional approach through a larger incision in the lower abdomen is preferred.

• Hysteroscopic resection - In this procedure, a viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope are used to remove fibroids growing inside the uterus. This procedure sometimes is done in combination with laparoscopy, depending on the number and location of the fibroids.

• Uterine artery embolization - In this X-ray-guided procedure, material is injected into specific blood vessels to plug them and stop blood flow to a fibroid or fibroids. This procedure is available in the United States and Canada. It is an option for a woman who may not be medically cleared for surgery or who does not plan to have more children, but prefers not to have her uterus removed.

• Hysterectomy - Until very recently, most women with fibroids were treated by removing the uterus, (hysterectomy). This is no longer the case. Although hysterectomy remains the second most frequently performed operation in the United States, the number of procedures has declined since 1987. Both surgeons and patients now realize that other options are available to treat or remove fibroids. The physical and psychological needs of a woman must be fully considered before her uterus is removed. However, in some cases hysterectomy is preferred when fibroids are too numerous, too large or cause heavy, prolonged bleeding and severe anemia.