Uterine fibroids can be the size of a microscopic seed or grow to the size of a small basketball. The good news is that these tumors are almost always benign. This means that they do not lead to cancer. The bad news is that researchers are still not sure of the complete impact they have on fertility. Researchers do know that fibroids which grow inside the uterine cavity have the greatest impact on fertility. And they know that symptoms of uterine fibroids can cause debilitating pain and discomfort as well as constipation, heavy periods, urinary tract disorders and anemia.
Approximately 75% of women are able to live with the symptoms of their uterine fibroids without too much difficulty. However, researchers estimate that the other 25% of women suffer with chronic low blood counts (anemia), intolerable pain, constipation and significant lifestyle changes brought about by their symptoms. These are the women who are searching for treatment for their fibroids that will make sense in their current lifestyle.
Many of these fibroids grow to size which requires treatment when women reach their 30s and 40s, sometimes at a point when they are just trying to become pregnant. As women delay their childbearing years in an effort to improve their career choices they are running into difficulty with fibroids that impacts their fertility. The traditional treatment option, a full hysterectomy, will remove the uterus and permanently change a woman’s ability to start a family. This is not an acceptable option for women who would like to stay intact or who have not yet completed their families.
Because of improvements in medical technology there are now other fibroid treatment options that allow women to maintain fertility and are available on both an inpatient and outpatient basis. Fibroid tumors often shrink when a woman completes menopause because the tumors are dependent upon the estrogen in the bloodstream available prior to menopause. Researchers have also found that the tumors develop more often after the age of 35 and rarely before the age of 20. (1)
Surgeons often have a preference of one type of treatment over the other based upon their experience with the treatment option and their success rates. However, it is important that the woman is aware of all the options available so that she can make an informed choice about the treatment option that best fits her lifestyle.
In the early stages of development a woman is often not aware that she has fibroids. In fact, the physician may also not be aware if the tumors are small enough to not be picked up on physical examination. Sometimes women have no symptoms at all and the physician will find the fibroid tumors during an annual pelvic examination. In these early stages the best option is just watchful waiting. If there are no symptoms or the fibroids are not located near the openings to the vagina or fallopian tubes there is no need to start treatment in order to attempt pregnancy.
Women should however, monitor the growth of these tumors. In some women there isn’t growth and they never required treatment nor suffer significant symptoms. In other women the tumors will consistently grow over time and they will required treatments that may significantly reduce their chances of becoming pregnant.
Alternative medicine physicians may offer natural fibroid treatment options designed to decrease the symptoms women experience with fibroids. But, unfortunately, these treatments have not been shown to decrease the size of the tumors in any clinical trials. Options include changing your diet to reduce red meat or pork, nutritional supplementation and herbal remedies. Some women find it tempting to mix and match supplements and herbal remedies but without guidance from a practitioner who is well versed in the side effects of these chemicals, you will soon become frustrated with the results. While you would not dream of mixing and matching prescription medications, you should also not attempt this with natural remedies unless you have the assistance of a practitioner who is knowledgeable.
Pharmaceutical treatment options include the use of birth control pills that help stop excessive bleeding caused by the fibroids. However, they do have potentially dangerous side effects such as high blood pressure, stroke and heart disease. While birth controls have limited relief on the symptoms, once they have been stopped the fibroids tend to grow back in force.
Another option in the pharmaceutical arsenal of treatment options is a class of drugs called GnRH agonists. These are actually hormones used to decrease the production of estrogen which is then reduces the size of the fibroids. This is a short-term treatment (three to six months) because it also can cause rapid bone loss leading to osteoporosis. The best use of this treatment is to decrease the size prior to a planned minimally invasive procedure or to allow for a vaginal hysterectomy.
Uterine artery embolization or uterine fibroid embolization are procedures done in the x-ray department by an interventional radiologist. A catheter is inserted into the femoral artery and manipulated to the uterine artery where it delivers mechanical blocks that clot the blood supply to the fibroid. The procedure takes approximately 1 hour and data suggests that women are able to return to work within 10 to 14 days. This particular option preserves the uterus and attempts to preserve as much fertility as possible. (2)
Other surgical procedures include a hysterectomy which can be done either vaginally or abdominally. The end result of either route is a loss of fertility. Recovery time and the pain associated with each procedure, however, is vastly different. If the uterus is small enough physicians will opt to do a vaginal approach which will decrease recovery time and improve pain control.
Hysterectomies can also be total, meaning removal of the cervix as well as the uterus and ovaries, subtotal which leaves the cervix or partial which only removes the uterus. A radical hysterectomy in which the cervix, fallopian tubes and ovaries are also removed with the uterus, is usually reserved for cancer situation in which the spread of the cancer cells is a higher risk that must be addressed.
Another option is a myomectomy which is the surgical removal of the fibroids themselves while keeping the uterus intact. This works well for each either fibroids which are growing outside the uterus or those which are growing inside the uterus. Those fibroids which are growing inside the wall of the uterus do not respond as well to a myomectomy while still retaining fertility. This is a surgically challenging procedure and is not performed by all physicians.
There are several treatment options now available to maintain fertility and at the same time decrease symptoms. By becoming knowledgeable about the treatment options women have better options to maintain their current lifestyle.
(1) WomensHealth.gov: Uterine Fibroid Fact Sheet
(2) RadiologyInfo.org: Uterine Fibroid Embolization
MedlinePlus: Uterine Artery Embolization
Mayoclinic: Uterine Fibroids
University of Maryland Medical Center: A New Treatment Option for Uterine Fibroids
American College of Obstetricians and Gynecologists: Uterine Fibroids