Uterine Fibroids and Ablation

 

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Uterine Fibroids

"Fibroids, or "uterine myomas (short for leiomyoma)" are benign growths that affect 30% of women.  The terms "fibroid" and "myoma" are used interchangeably.  Most fibroids do not cause symptoms,  and do not require treatment.  Fibroids may require treatment in the following circumstances:

  1. Fibroids are growing large enough to cause pressure on other organs, such as the bladder.
  2. Fibroids are growing rapidly
  3. Fibroids are causing abnormal bleeding
  4. Fibroids are causing problems with fertility.

Types of Fibroids

Location of uterine fibroidsFibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated.  Fibroids that are inside the cavity of the uterus will usually cause bleeding between periods (metrorrhagia) and often cause severe cramping.  Fortunately, these fibroids can usually be easily removed by a method called "hysteroscopic resection," which can be done through the cervix without the need for an incision.  Submucous myomas are partially in the cavity and partially in the wall of the uterus.  They too can cause heavy menstrual periods (menorrhagia), well as bleeding between periods.  Some of these can also be removed by hysteroscopic resection. 

Fibroids and endometrial ablation

The real question that needs to be considered when treating abnormal bleeding caused by fibroids is whether or not additional surgery will be necessary even if the bleeding is controlled.  Fibroids that are inside the uterus (intracavitary or submucous myomas) can often be resected (removed) at the time of an ablation. Fibroids that are deep in the wall of the uterus cannot be reached with a resectoscope.  If large fibroids are causing pressure and pain, then endometrial ablation won't solve these problems, and other treatment would be necessary.

A more difficult questions is that of small myomas in the wall of the uterus that are not currently causing any problems.  There is a chance that they eventually may grow and need surgery even if bleeding is no longer a problem.  On the other hand, there is a possibility that they would never cause a problem.   Factors to consider are the recent rate of growth of the myomas and the age of the woman, since the closer she is to menopause the less time they will have to grow. Thus a 48 year old woman with moderately large fibroids that have been growing slowly may be a good candidate for treatment of heavy bleeding by endometrial ablation. On the other hand, a 32 year old women with moderate size fibroids in the wall of the uterus that have enlarged significantly in the last year would be very likely to need further surgery after an ablation.

Combining endometrial ablation with fibroid removalResectoscope used for hysteroscopic myomectomy

 

Over half of the women on whom I do endometrial ablations have fibroids.  Before deciding to do an ablation on someone with fibroids, we carefully look at the advantages and disadvantages of all treatment alternatives.

Many fibroids that are totally or partially in the cavity of the uterus can be removed with the resectoscope, allowing the ablation to be completed in the usual way.

 

 

 

Check out Dr. Indman's comprehensive web site:  All About Myomectomy for the Removal of Uterine Fibroids (will open in new window)


©2003, Paul Indman, MD. All Rights Reserved
15195 National Avenue, Suite 201; Los Gatos, CA 95032
Telephone : 408 358-2788 ; FAX : 408 356-5526

The medical information presented in this website represents the opinion of Dr. Indman,  and is based on his knowledge and experience. It is not applicable to all patients or physicians. Anyone visiting this or other related medical sites should discuss symptoms, findings, and alternatives with their personal gynecologist.