Uterine Fibroids Treatments : Part 3

by Food and Drug Administration (FDA)

(Page 3 of 3)

Fibroid Types

Fibroids are classified by their position in the uterus. Intramural fibroids, the most common type, grow inside the uterine wall. Subserous or subserosal fibroids grow outward from the uterine wall into the abdominal cavity. Submucous fibroids grow inward from the uterine wall, taking up space within the uterus itself. This type of fibroid is the most likely to cause symptoms of heavy, prolonged menstrual bleeding. A fibroid can be as big as 20 centimeters (nearly 8 inches) in diameter and can weigh more than 20 pounds.

Small fibroids usually cause few if any symptoms. But, as a fibroid grows larger, it may press on the bladder and the ureters, the pair of tubes that connect the bladder to the kidneys. Pressure on the bladder can cause urinary frequency; pressure on the ureters can lead to kidney and urinary tract infections. Fibroids can sometimes be a cause of miscarriages and infertility.

A woman with a moderate-to-large fibroid may also notice a protruding stomach and a sensation of heaviness in the abdomen. For many women, the most distressing symptom is prolonged, heavy bleeding at the time of their menstrual periods, as well as spotty vaginal bleeding outside of the normal menstrual cycle. Women who lose too much blood may become anemic.

Sometimes a fibroid develops a thin stalk "like a balloon on a string," says David Barad, M.D., head of reproductive endocrinology at New York's Montefiore Medical Center. This is called a pedunculated fibroid. In some cases, the stalk can become twisted, cutting off its own blood supply, and causing severe pain.

Fibroids tend to grow in spurts, with periods of rapid growth punctuated by periods of no or very slow growth. As a woman approaches menopause, a fibroid may begin to grow rapidly. After menopause, however, fibroids stop growing and may start to shrink. n

One Woman's Decision

In 1983, Diane Trent (not her real name), 42, began experiencing pain on the left side of her abdomen during her monthly period. Then she began to have extremely heavy periods lasting as long as two weeks. She went to see her gynecologist, who performed a pelvic examination and told her she had a fibroid in her uterus. The doctor recommended a hysterectomy.

Trent requested an ultrasound examination, which showed that the fibroid was about 7 centimeters (2 3/4 inches) in diameter. She decided she only wanted to undergo a hysterectomy as a last resort and asked her doctor if there was a less drastic option.

In response, the gynecologist performed an endometrial biopsy, which showed no cancer, and a dilation and curettage (D&C), a procedure that involves dilating the cervix (neck of the womb) and scraping the uterine lining. The D&C stemmed Trent's heavy bleeding for a while. But after a few months the problem recurred. At times, she says, the bleeding "was so disabling that I couldn't go to work." Because the fibroid was pressing on her bladder, she had to urinate frequently.

Many women in Trent's situation would have opted for a hysterectomy. Instead, Trent consulted a reproductive endocrinologist, who agreed to monitor the fibroid's growth.

After three years, it had grown to 10 centimeters (4 inches) in diameter — about the size of a grapefruit. Her new doctor now recommended a hysterectomy.

"My feeling was that this was not life threatening and I didn't know what the long-term outcome of surgery would be," Trent says. "I decided I would rather put up with some discomfort that I knew would go away eventually." So she found another specialist who was willing to continue monitoring the fibroid.

The mass did not enlarge during the next five to six years. Trent is now 52. Since she reached menopause about two years ago, the fibroid has shrunk slightly. She continues to have an ultrasound examination every year. Her doctor says the fibroid should keep shrinking slowly, but it will never disappear completely.

Lisa Rarick, M.D., a medical officer in FDA's Center for Drug Evaluation and Research, says Trent's experience illustrates that the "best" treatment for a fibroid may be what the patient is most comfortable with.

"The issue is whether you can live with the symptoms. It's very individual. It depends how uncomfortable you are and how you feel about having surgery."

About the Author

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