Fibroids are the single most common reason for a woman to have a hysterectomy. Some 30 percent of all hysterectomies are performed because of fibroids. But nowadays there are many treatment options available for fibroids before a woman needs to consider hysterectomy.
I spoke to Dr. Edward Wallach, chairman of the Department of Obstetrics and Gynecology at the Johns Hopkins Health Institutions about this common problem.
What are fibroids?
Fibroids, also called uterine myomas, grow out of the muscular wall of the uterus. They are a mix of fibrous and muscular tissue and usually grow in an oval or circular pattern. They can range from tiny, pinhead-size specks to large masses. Although they sometimes grow rapidly, fibroids are hardly ever malig
nant. Studies show that less than 1/10th of 1 percent of fibroids turn into malignancies.
What cause fibroids?
Fibroids have been the subject of much attention from gynecologists, but their cause is unknown. However they do seem to run in families, so there may be a genetic factor involved with their development. There is no evidence that diet or exercise can prevent or control the growth of fibroids. Their growth seems to be stimulated by estrogen production.
How do I know if I have fibroids?
Fibroids often do not cause any symptoms in some women. But in others they may cause pelvic pain and heavy bleeding during menstrual periods.
What is the treatment for fibroids?
A: Treatment depends on the severity of the condition. Hysterectomy is necessary only for a small percentage of fibroids. A less drastic treatment is myomectomy, a surgical procedure to remove just the fibroids, not the uterus as in a hysterectomy.
It is a delicate, difficult procedure.
Advances in fiber-optic technology mean that this operation can even be done through the vagina with no need for a large abdominal incision.
Is there any way to avoid surgery for fibroids?
Often, if the fibroids are tiny and not troubling you, they can be left untreated. Drugs such as Lupron, which blocks estrogen production and shrinks the fibroids, and Synarel, a nasal spray that has the same effect, can be particularly useful for women who are nearing the age of menopause.
Often these women can completely avoid surgery, since fibroids frequently spontaneously recede once they reach menopause. But by reducing estrogen production over a prolonged period, there is a risk of estrogen deficiency, so it is important that any drug treatment is monitored.
When should a woman consider having a hysterectomy?
A hysterectomy should be considered if the fibroids are so large they are putting pressure on other internal organs like the bladder or bowel; if they are causing pain and discomfort; or if they are growing so rapidly that there might be an undetected malignancy.
The good news about fibroids is that there are several treatment options. For younger women who want to have children, it is often possible to put off a hysterectomy at least until they are past their childbearing years.
Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.