Treatment Options Explained By Director, Jay Goldberg, MD, MSCP
What are fibroids?
“Fibroids (leiomyoma) are benign smooth muscle tumors that grow in the uterus,” explains Dr. Jay Goldberg, director of The Philadelphia Fibroid Center at Einstein. “They are fed by estrogen and progesterone. Some are the size of a pea, while others are the size of a grapefruit.
“The good news is that fibroids are rarely cancerous,” Goldberg says. “The other good news is that many women have fibroids, but don’t experience symptoms related to them. Other women have fibroids that cause an array of symptoms that affect their lives, sometimes severely.”
What are the symptoms of fibroids?
“There are three categories of symptoms: bleeding, bulk and infertility,” Goldberg says. “Women can experience one or several of them, and in different combinations.” Bleeding can manifest in heavy periods, irregular uterine bleeding and anemia. Bulk is the term for pelvic pressure or pain that can cause frequent urination, painful intercourse and abdominal distension.
How do fibroids cause infertility?
If fibroids are on the outer portion of the uterus, they should not interfere with a pregnancy, Goldberg says. “But fibroids inside the uterus can distort the shape of the endometrial cavity, making conception less likely and increasing the risk of miscarriage,” he explains.
What are fibroid treatment options?
“Treatment depends on how severely symptoms are affecting a woman’s quality of life and if she wants to have children,” Goldberg explains. “If the fibroids are asymptomatic, I usually recommend leaving them alone.”
Symptomatic patients, however, may elect to treat their fibroids. The wide range of treatment options includes medication, Mirena IUD, endometrial ablation, uterine fibroid embolization (UFE), myomectomy and hysterectomy.
Patients desiring pregnancy, however, have fewer treatment options. They either go without treatment or undergo a myomectomy.
What is a myomectomy?
“If the fibroid is inside the uterine cavity, an outpatient hysteroscopic myomectomy can usually remove it,” Dr. Jay Goldberg says. “The woman can be at work the next day. If the fibroid is within the uterine wall, however, removal may require abdominal surgical procedures, which may be done robotically, laparoscopically, via mini-laparoscopic or by a traditional laparotomy surgery. There is a one-night stay in hospital and about two- to three-week recovery.”
What are uterine fibroid embolization (UFE) and endometrial ablation (EMA)?
Endometrial ablation destroys the endometrium (inner lining) of the uterus to prevent future growth and shedding of the endometrium leading to decreased bleeding. With UFE, small particles are injected through blood vessels (embolization) which block the blood supply to the fibroids and leads to their shrinkage. According to a 2006 article by Goldberg published in the Journal of Clinical Outcomes Management, UFE will shrink fibroids by approximately 40 percent and successfully treat over three-quarter of patients.
Can fibroids grow back? Or go away on their own?
“Fibroids don’t grow back, but new fibroids certainly can grow,” Goldberg clarifies. According to a 2006 article by Goldberg published in the Female Patient, at most risk are patients with numerous or large fibroids. Symptoms eventually go away on their own — with the onset of menopause. “Fibroids feed on estrogen and progesterone, so when they diminish in the menopausal state, the fibroids will atrophy,” he says. The average age for the start of menopause is 51, so depending on a woman’s age and how severe the symptoms are, we do consider if she can wait for nature to do its work for her. If not, we have an array of treatment options to help improve her life.”