FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

OBSERVATION IS USUALLY BEST TREATMENT FOR FIBROIDS

Question: I went to my doctor for my yearly exam the other day. She told me that I have a fibroid tumor on my uterus and has scheduled some additional tests because of this. What is a fibroid, and how serious is it?

Answer: Fibroids are tumors that originate from the muscular portion of the uterus. There are several terms that your doctor may use to describe these non-cancerous tumors, including "leiomyoma," "myoma," "fibromyoma," and the one your doctor used, "fibroid." All of these terms are used to describe the exact same growth. No wonder most people have trouble understanding doctor jargon. Sometimes I even have trouble, and I use these funny words every day.

Uterine fibroid tumors are a significant problem. Twenty percent of white women and nearly 50 percent of black women have them. And even though we don't understand what causes these common tumors, we do know that their growth is strongly dependent on the presence of female hormones.

Fibroids are rare before the beginning of menstrual periods when hormone levels rise dramatically from the low levels of childhood. These tumors grow rapidly during pregnancy because an expectant mother's hormone levels are higher than at any other time of her life. After menopause, when the level of female hormones decreases, most fibroids also reduce in size.

Fibroid tumors can produce a variety of symptoms. The most common are progressively heavier and longer menstrual periods, and occasional bleeding between periods. This excess blood loss can then lead to anemia with its symptoms of decreased energy, and easy fatigue. Sometimes the woman experiences cramping, pelvic pressure and a feeling of pelvic heaviness, but at times there are no symptoms at all. These symptomless tumors are usually discovered by the doctor at the time of routine gynecological examination, just as yours was.

The symptoms produced by a uterine fibroid or fibroids, since it is common to have more than one, are usually not related to size. A very small tumor located near the inner lining of the uterus may produce more symptoms than one as large as a grapefruit that's attached to the abdominal surface of the uterus. At times, fibroids may grow to immense size. Ones weighing over 100 pounds have been removed, but these, of course, create significant symptoms because of their size alone.

Fortunately, the risk of cancer developing within a fibroid tumor is very low. Cancer is found in less than one half of one percent of fibroid tumors that are removed.

Question: What is the treatment for uterine fibroids?

Answer: First, the diagnosis of uterine fibroids needs to be confirmed by tests such as pelvic ultrasound and magnetic resonance imaging (MRI). Once this is done, the treatment is largely dependent upon the symptoms. Periodic pelvic examinations are recommended to be sure that the tumor hasn't grown larger than a grapefruit and isn't producing excessive bleeding or pain. Since these tumors usually decrease in size and symptoms after menopause, the preferred treatment is just continued observation, or "watchful waiting."

Sometimes, however, the symptoms of a fibroid tumor are sufficiently severe to require surgery. This is particularly true when there is indication that the fibroid tumor is interfering with desired fertility. Surgical removal of only the tumor, a procedure called a myomectomy, is often effective.

In years past, most women with fibroids regardless of their symptoms were advised to have a hysterectomy. Today we know that this aggressive surgical treatment is usually not needed. In the most severe cases, however, surgical removal of the entire uterus along with the fibroid tumor is still the best treatment. I'm sure your doctor will discuss the options for your care with you when she has your test results.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.