Frequently Asked Questions About Uterine Fibroids
Can Fibroids Turn Into Cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.
What If I Become Pregnant and Have Fibroids?
Asymptomatic small or medium sized fibroids alone are unlikely to present significant risk to pregnancy. However, fibroids may increase in size as a result of increased levels of hormones and blood flow to the uterus during pregnancy. The growth of fibroids may cause discomfort, feelings of pressure, or pain. Additionally, large or multiple fibroids can increase the risk of:
- Cesarean section
The risk of needing a c-section is six times greater for women with fibroids. Breech Presentation- The baby is positioned with its legs down and head up rather than the head down.
- Placental abruption
The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus may not receive oxygen.
- Preterm delivery
Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.
Could My Fibroids Come Back After the Treatment?
Although this treatment may be successful in destroying the fibroids causing painful symptoms, at a later time, more fibroids may grow, become symptomatic and require additional treatment. This is true for all fibroid treatments, except hysterectomy where the entire uterus is removed.
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What are the Benefits of Uterine Fibroid Embolization?
- Effective alternative to surgery and hormonal treatment
- Completely non-invasive - no surgery and no blood loss
- Minimal hospital stay
- Quick return to normal activities
- Preserves the uterus, cervix and ovaries
- Significant improvement in your quality of life
- decrease in menstrual bleeding from symptomatic fibroids
- decrease in urinary dysfunction, pelvic pain and/or pressure
How Do I know For Sure That I Have Fibroids?
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina and for an annual cervical PAP smear. The doctor may be able to feel the fibroid with his or her hands during an ordinary pelvic exam, as a (usually painless) firm lump on the uterus. For medium and larger fibroids, your doctor will describe the size of your fibroids by comparing them to different stages of pregnancy. For example, you may be told that the size of your fibroids is similar in size to a uterus carrying a 20-week pregnancy (at the level of the belly button). Or the fibroid might be compared to fruit such as lemons, oranges or grapefruit to demonstrate a comparative size. One of several imaging test generally confirms the size, position, and dynamic of Fibroids. The two most common modalities include Ultrasound and Magnetic Resonance Imaging (MRI):
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Using sound waves with frequencies (pitch) much higher than audible sound, ultrasound is the most commonly used type of scan for pelvic evaluation. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to help scan the uterus and ovaries. It is quick and simple and generally accurate. However it relies on the experience and skill of the person performing the scan to produce good results and may not always demonstrate larger fibroids or other conditions such as adenomyosis.
- Magnetic Resonance Imaging (MRI)
MRI uses magnets and radio waves to produce the picture. It is considered the single best test for the uterus and can exactly demonstrate the number and location of fibroids as well as distinguish adenomyosis from fibroids. We rely primarily on MRI to triage patients to therapy.
- Hysterosalpingogram (HSG)
An HSG is usually used in women with trouble conceiving a baby to demonstrate the anatomy of the inside of the uterus (uterine cavity) and fallopian tubes. It does not evaluate the size of the uterus or uterine wall reliably. After a small catheter tube is placed in the uterus, x-ray dye is slowly injected via the catheter into the uterus and x-ray pictures are taken.
A hysterosonogram is used to see the inside of the uterus (uterine cavity) with ultrasound and injected fluid. After a small catheter tube is placed inside the uterus, water is injected while a series of ultrasound images are taken. This test can confirm the presence of uterine polyps or intracavitary fibroids that can cause heavy bleeding.
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If these tests don't adequately determine the source of your pelvic pain, you might also need surgery. The least invasive surgeries for diagnosis is know as laparoscopy
During laparoscopy, through tiny incision made in or near the navel, a long, thin scope is inserted into the abdomen and pelvis. The scope has a bright light and a camera and allows your doctor to see the uterus and surrounding structures to determine if you have conditions such as endometriosis, which can cause pelvic pain.
For suspected abnormalities inside the uterine cavity, a long, thin scope with camera and light is passed through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for cavitary fibroids or endometrial polyps.
Who are at Risk for Uterine Fibroids?
There are various factors that can increase a woman's risk of developing fibroids.
- Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
- Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin. African-American women are more likely to develop fibroids than white women.
- Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
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What is Radiofrequency Ablation of Fibroids?
The Acessa device is a new FDA approved surgical procedure that aims to effectively treat fibroids with a minimally invasive outpatient procedure. Acessa uses radiofrequency energy to heat fibroid tissue and cause instantaneous cell death. The necrotic cells are then reabsorbed by the lymphatic system resulting in decreased fibroid size and improved symptoms. The Acessa device is placed within the fibroid under ultrasound guidance during a standard outpatient pelvic laparoscopy.
In the pivotal trial for FDA approval of 135 women, fibroid symptoms decreased by 52% and fibroid volume decreased an average of 40% within 3 months of treatment. These therapeutic effects were persistent through 12 months of follow-up with 56% decrease in symptoms and 45% decrease in fibroid volume from pre-procedure values. Sixty one percent of study participants were very satisfied with treatment and 80% reported they would definitely recommend the treatment to a friend. The Acessa procedure resulted in minimal blood loss and an average return to normal activities of 9 days.
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