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

FIBROID TREATMENT DEPENDS UPON SEVERITY, REPRODUCTIVE DESIRE

Question: I’ve been diagnosed with fibroids of my uterus. I’ve heard other women say that the non-surgical treatments and less invasive surgeries are a waste of time. They have tried them and ended up having a hysterectomy anyway. Should I attempt having any of the less invasive surgeries or just resign myself to having a hysterectomy and removal of my ovaries? Also, do fibroids cause any health problems besides low iron because of the bleeding?

Answer: Ultimately the decision about the best treatment for you is something only you and your surgeon can figure out. That said, let me try to provide some background that may help you understand your choices.
A fibroid, which is often referred to by the more technical name “leiomyoma,” is an abnormal growth originating from the uterine muscle. These non-malignant tumors occur in 25 to 30 percent of women. They are rarely first diagnosed before puberty or after menopause. They can be microscopic in size, but these cause no symptoms. They can also grow to be as big as a large grapefruit. These huge tumors can -- and usually do -- cause symptoms. The most common of these are heavy or painful menstrual periods, infertility, postmenopausal uterine bleeding, backache, constipation, urinary difficulties, and even miscarriage. Less than 1 percent of fibroids become cancerous.
There are several choices for the treatment of a woman with fibroids. If the symptoms are mild, continued observation and adequate iron to compensate for the blood loss may be all that is necessary. A slightly more aggressive treatment option is to use hormone-modifying medicines. These reduce the amount of estrogen that is produced by the ovaries. This is helpful because estrogen stimulation is what makes fibroid tumors grow. With low estrogen levels, many fibroid tumors simply shrink in size and are no longer a problem. That is why when a women with fibroids reaches menopause -- and her body’s estrogen production decreases -- she often finds “natural” relief from the bothersome symptoms of this disorder.
Individual fibroid tumors can be surgically removed. This operation can be accomplished using a variety of high-tech surgical tools, with the results of one method being about the same as all others. In one specific technique, the surgeon blocks off the blood supply to a fibroid and without nourishment it dies.
Surgery is particularly useful when there are only one or two fibroids and when there is a desire to preserve the ability to have children. Despite the effectiveness of these high-tech surgeries, additional fibroid tumors form in 30 to 40 percent of women, thereby, making additional surgery necessary. This is probably what has happened with your friends rather than a “failure” of the original surgery.
Hysterectomy, the surgical removal of the uterus, is the second most common surgery in women, and the most common reason for this procedure is fibroid tumors. After a hysterectomy the uterus is no longer present so subsequent fibroids can’t form. Unfortunately, it also eliminates the possibility of having additional children. The decision about keeping or removing your ovaries at the time of hysterectomy is influenced by your age. In postmenopausal women it is common to remove the ovaries, while in reproductive age women they are often left in place.
Again, only you and your doctor can determine the best treatment for you. Talk with him or her about your fibroids and the treatment options available for you.

"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.