Fibroids


Fibroids are not hereditary. They do have a strange genetic pattern, however, that many fibroids are monoclonal (derived from the same cell). In other words, if a woman has multiple fibroids, sometimes all of those fibroids come from a single cell as if that cell were cloned.

This has led some people to postulate that a virus is involved in producing the fibroid cells that then grow and replicate like a cancer, but in a controlled, non–invasive fashion. If that is true, (we’re really guessing) then people in the same family could be susceptible; not because of genetics, but because of exposure to the same virus.

Smooth Muscle Tumors of the Uterus Smooth muscle tumors of the uterus are often multiple. Here we discuss submucosal, intramural, and subserosal leiomyomata of the uterus. Fibroids are actually mostly in the muscle of the uterus (intramural) and by virtue of their size or position they “Impinge” upon the endometrium and cause bleeding. Those are the ones which need to be “Shaved” away and that is much more of a procedure than just removing ones that protrude into the endometrical cavity. One however doesn’t trust arterial embolization for fibroids because there have been major complications when blood vessels of the pelvis get embolized when they weren’t supposed to be during the procedure. Fibroids of the uterus are present in about 25% of women. They actually require no treatment in most cases. The only times they require any therapy at all are:

  • By position or size they cause irregular uterine bleeding that cannot be controlled with hormonal therapy or removal of a polyp–like fibroid (submucosal) from the inside of the uterus at time of hysteroscopy & D & C (an outpatient procedure).
  • They are so big (usually softball size or more) that they give either pelvic pressure, bladder or rectal pressure or pelvic fullness symptoms.
  • They are in a position (usually near the ovaries or they have grown so rapidly that there is a question they might be malignant. (Incidence of malignancy is way under 1%).
  • They cause recurrent pain due to the blood supply being compromised (infarction like a heart attack is felt). This is not common at all but when they cause pain, it is quite colicky like a kidney stone, not like menstrual cramps.
  • The fibroids cause distortion of the endometrial cavity and women have problems either during pregnancy or then they have frequent miscarriages.

Fibroil Treatments can vary from just removing the fibroid’s (myomectomy or submucosal resection) to hysterectomy. There are some medicines to help shrink uterine muscle and fibroids but they are only temporary treatments. Myomectomy (cutting fibroids out of the uterus) has been the standard treatment of symptomatic fibroids when women want to preserve their ability to have children.

Treatments can vary from just removing the fibroid’s (myomectomy or submucosal resection) to hysterectomy. There are some medicines to help shrink uterine muscle and fibroids but they are only temporary treatments. Myomectomy (cutting fibroids out of the uterus) has been the standard treatment of symptomatic fibroids when women want to preserve their ability to have children.

Today, this is done without performing large incisions by using specially designed scopes that can be inserted into the body. Treatment with drugs to temporarily shrink the tumors so pregnancy can be attempted before the shrinkage reverses has sometimes been successful. Uterine artery embolization also appears to be a possibility. Coagulation of the tumors through a laparoscope has also been used but is still considered controversial.