Monday, April 10, 2006

Fibroid Tumors

An estimated 40 percent of all reproductive-age women have fibroid tumors, which account for nearly 200,000 hysterectomies performed in the U.S. each year. Fibroid tumors grow in the uterus. While not cancerous, they can still result in difficulties for women – especially if the tumors are very large. Fibroid tumors can cause severe bleeding, pain during intercourse, infertility, incontinence, repeated urinary tract infections and miscarriage.
Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist. This can cause pain, nausea, or fever. Fibroids may become infected. This usually happens only when there is an infection already in the area. In very rare cases (far less than 1%), changes occur in the fibroid tissue that cause it to become malignant (cancerous). Very rapid growth of the fibroid and other symptoms may signal cancer. A very large fibroid may cause swelling of the abdomen. This can make it difficult to perform an adequate pelvic exam. Fibroids may also cause infertility. Other factors should be explored before fibroids are called the cause of a couple's infertility. But when fibroids are thought to be a cause, many women are able to become pregnant after they are treated.
Many women have uterine fibroid tumors but are symptom-free. These women do not require treatment. However, women with the symptoms described above should seek treatment.
Fibroids that do not cause symptoms, are small, or occur in a woman nearing menopause often do not require treatment. Certain signs and symptoms, however, may signal the need for treatment:
Heavy or painful menstrual periods
Bleeding between periods
Uncertainty about whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
Rapid increase in growth of the fibroid
Pelvic pain
Drugs, such as gonadotropin-releasing hormone (GnRH) agonists, may be used to shrink fibroids temporarily (which might make surgery easier or permit a more conservative approach such as a vaginal or laparoscopic surgical approach rather than abdominal) and to control bleeding prior to surgery (so that anemia might be corrected).
Once you are in good condition, surgery is required to remove fibroids. The fibroids may be removed with myomectomy (removal of the fibroids leaving the uterus in place) or hysterectomy (removal of the uterus). The choice of treatment depends on factors such as your own wishes and medical advice about the size and location of the fibroids.
Hysterectomy: the surgical removal of the uterus and, possibly, the fallopian tubes and ovaries. A traditional hysterectomy is very invasive, requiring significant incisions (cuts) and long recovery periods — up to eight weeks if there are no complications. While hysterectomy solves the problem of fibroid tumors, it results in infertility since the reproductive organs have been removed.
Myomectomy: The surgical removal of the fibroid tumors is another procedure that has been widely performed to treat fibroid tumors. Myomectomy may be used as an alternative to hysterectomy since it does not interfere with a woman’s fertility. The downside of myomectomy is that in about 25 percent of cases, fibroid tumors regrow.
Hysteroscopy can be used to remove fibroids that protrude into the cavity of the uterus. In this procedure, a hysteroscope is inserted into the uterus through the cervix. The fibroids may be removed with a resectoscope, a tiny wire loop that uses electric power, with a needle point electrode (Versapoint) or Vaporprobe which vaporizes the tumor, or with a laser. New instruments which can be used in saline based surgical media have recently been introduced which makes the removal of these tumors safer and faster than the older methods. These instruments can be inserted through the hysteroscope. If you are not intending to become pregnant, this can be combined with a
uterine ablation which destroys the entire lining of the uterus so that menstruation stops or is reduced to a bare minimum. This type of treatment is often done with general anesthesia, but you typically do not need to stay in the hospital. The typical recovery from this procedure is a long weekend. There is very little post-operative pain.
Both hysterectomy and myomectomy can often be performed laparoscopically. Laparoscopic surgery is less invasive than traditional surgery since it requires much smaller incisions. Often this means shorter recovery times with less pain and fewer complications.
Today, women with symptomatic fibroid tumors have more choices than ever. Besides hysterectomy and myomectomy, Einstein’s leading women’s healthcare team offers several minimally invasive treatment options for fibroid tumors. These alternatives offer several advantages over the traditional procedures described above.

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