Understanding Fibroids: Symptoms, Diagnosis and Treatment

It is estimated that 70 to 80% of women will develop fibroids in their lifetime. While not all of them will have symptoms that require treatment, fibroids can be debilitating and cause symptoms ranging from pelvic pain to heavy bleeding. As a gynecologist with North Florida Women’s Care and Tallahassee Memorial HealthCare (TMH), this is a common diagnosis that I discuss with my patients.

Fibroids, or uterine leiomyomas, are the leading indication for a hysterectomy, which is a definitive and effective surgical treatment where the uterus is removed. However, many patients benefit from and choose management options other than hysterectomy. Multiple factors can influence the decision, including the desire for future fertility and keeping the uterus.

Fortunately for patients in our region, at TMH, we provide options for treating fibroids – including Acessa®, a minimally invasive alternative to traditional surgeries like hysterectomy and myomectomy, to preserve the uterus.

Understanding Fibroids

Fibroids are solid, noncancerous muscular growths made of smooth muscle cells and fibroblasts that develop in or on the uterus. They are common in women of reproductive age, which is roughly defined as the late teens until about 45 years of age. While their cause remains unknown, there are certain factors that increase the risk of their formation including premenopausal status, family history and obesity. Fibroids can range in size and location – some are as small as seedlings while others can grow to become as large as a melon.

Symptoms of Fibroids

Fibroids have various symptoms, depending on their size, number and location. Some patients may not experience any symptoms while others do. Common symptoms include:

• Heavy menstrual bleeding

• Prolonged menstrual periods or abnormal uterine bleeding

• Pelvic pressure or pain

• Frequent urination

• Constipation

• Backache

• Abdominal bloating or swelling

If you think you may have fibroids, you should consult with your healthcare provider. They can obtain a history of clinical symptoms, perform an exam and order additional diagnostic tests like an ultrasound or MRI to evaluate the size and location of the fibroids.

If you are diagnosed with fibroids, it is important to remember that they are almost always benign – cancerous fibroids are rare. When fibroids are symptomatic, there are treatment options. When considering those options, your specific symptoms and severity should be considered.

Treating Fibroids

We offer several treatment options for fibroids at TMH. Your provider can discuss these options and help you determine the best treatment plan.

Acessa

Acessa is a minimally invasive alternative to traditional surgeries like hysterectomy and myomectomy, or surgery to remove the fibroids. This advanced procedure uses radiofrequency ablation with ultrasound guidance to target and destroy fibroid tissue, while preserving the surrounding healthy tissue. Essentially, heat is delivered directly to the fibroid, decreasingthe size of the targeted fibroids over time. It is important for doctors to counsel patients who want to have children in the future that there is limited available data on reproductive outcomes after the Acessa procedure.

Acessa, therefore, is not recommended for women who are planning future pregnancy. Not all fibroids can be treated with this option.

Some of the benefits of Acessa procedures include:

• The uterus is preserved: The fibroids are targeted directly with the radiofrequency ablation while preserving the uterine muscle.
• It’s minimally invasive: Acessa is performed through a laparoscopic incision in the abdomen, resulting in minimal scarring and shorter recovery time. At TMH, this procedure is performed in our state-of-the-art M.T. Mustian Center on an outpatient basis – meaning you can go home the same day.
• Patients experience reduced pain and complications: Acessa offers patients a faster recovery time with less postoperative pain and fewer complications compared to other surgeries.
• Patients have a high success rate: Acessa is an effective treatment for fibroids with a high patient satisfaction rate. The surgery has demonstrated substantial reduction in fibroid size and symptoms with improved quality of life for patients.

Medications

There are multiple medication options for treating fibroids, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDS): These medications can help manage pain and reduce menstrual cramping.
• Hormonal contraceptives: Oral contraceptive pills in a variety of formulations and intrauterine devices (IUDs) with progesterone can help control heavy bleeding and alleviate fibroid symptoms while also preventing pregnancy.
• GnRH agonists: These medications can induce a temporary menopause-like state which decreases the size of fibroids, improves bleeding and reduces symptoms. These medications are typically used to reduce symptoms in the short-term or improve anemia before surgery.
• Tranexamic acid: This class of medication is an antifibrinolytic medication that prevents fibrin breakdown and is an effective treatment for heavy menstrual bleeding.

Hysterectomy

Hysterectomy completely removes the uterus and is a definitive treatment for fibroids. A hysterectomy eliminates the possibility of fibroids returning and removes the possibility of any future pregnancies. There are different procedure techniques for hysterectomy ranging from laparoscopic techniques to laparotomy.

Myomectomy

Myomectomy is done using laparoscopic, hysteroscopic, robotic techniques and through laparotomy at TMH. The surgical approach is determined by the size and location of the fibroids. This surgery is performed by injecting the fibroids to reduce bleeding and then surgically removing the fibroids from the uterus. The uterus is then repaired with sutures to close the uterine muscle and tissue.

Fibroids don’t have to be debilitating. There are multiple treatment options. If you’ve already been diagnosed with fibroids or you think you may have fibroids, talk to your doctor about diagnosis and treatment options.

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