Fibroid Surgery

Fibroids are non-cancerous tumors that arise from the smooth muscle cells of the uterus. They are solid, as opposed to cystic, and vary widely in size. Often, they are microscopic. They can also grow to the size of a beach ball.

All fibroids originate from the wall of the uterus. The direction in which fibroids grow determines what type they are, and what sorts of symptoms they may cause.

Any woman can get fibroids, but some women are more likely candidates than others are. Fibroids most commonly appear during the years in which women produce estrogen and progesterone; in other words, the reproductive years. During the third and fourth decade of life is when most women develop symptoms as a result of their fibroids, but some women continue to have problems even after menopause. Many women assume (and bank on) that their fibroids will disappear after their periods stop. They generally don’t, but they usually stop growing, and over time, eventually shrink.

Symptoms from fibroids vary widely, from women who have no symptoms at all (the majority), to women who feel the fibroid is controlling their life. Typical problems in symptomatic women include:

  • Bleeding
  • Pelvic Pressure
    Large fibroids can push on the bladder, rectum, or cause abdominal distention.  Many women can feel their own fibroids just by resting their hand on their belly.  Many women are unaware of pressure symptoms due to their gradual onset.
  • Pain
    Pain can result from degeneration of a large fibroid in which a portion of the fibroid outgrows its blood supply and dies.  This is more common during pregnancy when fibroids grow quickly. Heavy menstrual bleeding also causes pain. The uterus contracts (cramps) in an attempt to expel the clots caused by the heavy bleeding.
  • Pregnancy Problems
    One-third of women with fibroids who become pregnant experiences significant growth, particularly in the first trimester.  This is actually when many women first become aware that they have fibroids.
  • Infertility
    Fibroids can certainly impact fertility, particularly if their location blocks the fallopian tube or prevents implantation from submucosal fibroids impinging on the uterine cavity.  This is a problem which has increased in magnitude due to the number of women who delay pregnancy until their 30s or 40s, giving their fibroids extra time to grow.

Virtually every treatment option for fibroids is dependent on knowing the precise location and size of the fibroids. Prior to any treatment plan, accurate diagnostic imaging is critical. We will start by evaluating the size and location of your fibroids. We utilize transvaginal and abdominal ultrasound, 3-D ultrasound, saline infused ultrasound, MRI, hysterosalpingograms, and hysteroscopy to gather information that will allow us to determine your best option for treatment.

Not every woman with fibroids needs treatments, but if fibroids are large or creating pain or other problems, we are all expert and experienced in all treatment options and alternatives.

Surgical technology has exploded in the last five years and many women are candidates for uterus-sparing options, such as endometrial ablation, uterine artery embolization, magnetic resonance ultrasound ablation or myomectomy (removal of fibroids with preservation of the uterus).

When a myomectomy is appropriate, we are all experienced at traditional myomectomy through an abdominal incision, laparoscopic myomectomy, robotic-assisted myomectomy, and hysteroscopic myomectomy.

For the woman who opts removal of her uterus, we make the experience a positive one by offering the least invasive procedure that is appropriate, including laparoscopic outpatient hysterectomy, robotic-assisted hysterectomy and procedures that offer preservation of the cervix and ovaries.

Dr. Streicher wrote the definitive book on treatments for fibroids. Detailed information about all of the above options can be found in The Essential Guide to Hysterectomy.

 

Watch Dr. Streicher talk about the treatment of fibroids on NBC's In the Loop with iVillage: