Uterine Fibroids During Pregnancy: Signs, Symptoms and Treatment

By Kelly Burgess

Fibroid Signs and Symptoms Facts

Uterine fibroids are benign growths of the muscle wall of the uterus. Most likely genetic in origin, they are extremely common and usually symptom free. According to the National Institutes of Health, as many as 77 percent of women in the United States have fibroid growths. Of that number, it is estimated that 25 percent experience symptoms.

These symptoms may include heavy periods, bleeding between periods, pelvic pain or “fullness,” abdominal swelling and reproductive problems, including infertility and multiple miscarriages. Not surprisingly, uterine fibroids can make a woman’s life miserable. In fact, the NIH notes that “uterine fibroids not only affect the women who have them, they also impact the partners, spouses and families of these women, sometimes to a great degree. Despite the fact that they may affect one-quarter of all the women in the U.S., fibroids continue to baffle doctors and scientists.”

The reason they are “baffled” is because, while there are several treatments for uterine fibroids, no one treatment works for every woman. Also, some women respond wonderfully to at least one treatment, while others may never find relief.

Dr. William H. Parker, clinical professor of the department of obstetrics and gynecology at the UCLA School of Medicine, and author of A Gynecologist’s Second Opinion: The Questions & Answers You Need to Take Charge of Your Health (Plume, 2002), says fibroids are probably responsible for more unnecessary gynecologic surgery than any other condition. “There are several options now available for fibroid treatment and a woman needs to educate herself,” Dr. Parker says. “Hysterectomy was the only treatment for a long time and it was what doctors were trained to do. Our modern problem is that doctors are often too busy to keep up with new medical developments. Newer options are less invasive and have fewer long-term effects than hysterectomy.”

Fibroid Treatment Options

Choosing the right treatment option depends upon the age of the woman, the severity of symptoms, the woman’s desire to have children and her comfort level regarding surgery. The following is an overview of current options, from least to most invasive:

Watch and Wait: This is the course of action usually recommended when fibroids are found during a routine exam and are not yet causing bothersome symptoms, or in cases where the woman still feels the symptoms are bearable and is worried about other treatments impacting her fertility or overall health.

Medication: While medications can’t prevent or permanently shrink fibroids, some can help reduce symptoms. Low-dose birth control pills reduce periods from 13 a year to four. This is significant, Dr. Parker says, in women who have such heavy bleeding that they’re confined to their homes for days. Other medication options are Lupron and Synarel, which work by temporarily shutting off the ovaries’ ability to make estrogen and progesterone so that menstrual periods cease. Because of the risks of long-term use, these two medications are temporary solutions, used to ease a woman’s symptoms prior to menopause, to prepare her for surgery or to deal with anemia.

Uterine Fibroid Embolization: Barely a decade old, this non-surgical procedure is generally performed by an interventional radiologist. A small incision is made in the groin directly over the artery carrying blood to the leg. A catheter is then guided into the blood vessels to the uterus and blood flow is blocked with small plastic particles. The fibroids begin to die immediately and continue to shrink for three to six months. Dr. McLucas was one of the doctors that introduced this procedure to the United States and is one of the few gynecologists who performs it himself.

Myomectomy: Myomectomy is a surgical procedure in which the fibroids are removed and reconstruction and repair of the uterus is undertaken. It can be done either abdominally or vaginally, depending upon the circumstances. The outcome is generally good, and fertility is maintained in an estimated 50 percent of all cases. There are some caveats. Recovery can be difficult and painful. Scar tissue may impact fertility and cause its own problems. And, as Dr. McLucas points out, the fibroids can grow back, and do in up to one-third of all women. It’s probably not the best choice for younger women.

Hysterectomy: Removing the uterus certainly removes the problem but often leads to other issues. Both Drs. McLucas and Parker agree that this should be a treatment of last resort.

The bottom line is that not all treatments work for all women. A women needs to be informed and to work with her doctor to decide on her best course of treatment. Also, regular exams are important to catch fibroids while they’re still small.

“One thing women need to bear in mind is that regardless of the method of treatment chosen, it’s better to have it done earlier rather than later,” Dr. McLucas says. “If we start with a uterus that’s the size of a six-month pregnancy and get it down to four months it’s still big.”

Content provided on this site is for educational purposes only and should not be construed to be medical advice, diagnosis or treatment.


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