Innovative Treatments for Uterine Fibroids

What Are Uterine Fibroids?

In almost all cases, fibroids are benign (non-cancerous). Fibroids are not linked to any gynecologic cancers and don’t increase the risk of uterine cancer. They can range in size from smaller than a pea to as large as a small grapefruit. Only about one-third of fibroids are large enough to be found through a physical exam by a medical provider.

The exact cause of fibroids is unclear, though genetics and prolonged exposure to estrogen have been studied as potential risk factors. Other risks for developing fibroids include:

• Perimenopause and menopause
• Obesity
• African American ethnicity
• Diets high in red meat
• High blood pressure

Uterine Fibroid Symptoms

Some women with fibroids may not experience any symptoms. For those who do have symptoms, they can range from mild to severe. Common symptoms include:

• Abdominal discomfort
• Abnormal bleeding between periods
• A firm mass felt near the middle of the pelvis
• Constipation
• Heavy, lengthy or very painful periods
• Frequent urination
• Low back pain
• Pain during intercourse
• Pelvic pain

When left untreated, uterine fibroids may affect the reproductive system, causing infertility, increasing risk of miscarriage, or causing problems during pregnancy.

How Are Uterine Fibroids Diagnosed?

Most fibroids are found during an abdominal or pelvic exam. The women’s health provider conducting the exam may be able to feel a hard mass in the pelvis that indicates the presence of a fibroid. Other tests that may be needed include:

• Ultrasounds: An ultrasound uses sound waves to view the uterus. When the ultrasound device, or transponder, it passed over the outside of the abdomen it is called a transabdominal ultrasound. With a transvaginal ultrasound, the ultrasound device is placed inside the vagina.
• Lab tests: Blood tests may be needed to check for anemia or other blood disorders if the fibroid is causing heavy bleeding.
• Magnetic resonance imaging (MRI): This imaging test can provide further information on the size and location of fibroids.
• Hysterosalpingography: This X-ray exam uses dye to highlight the uterus and fallopian tubes. It can be performed if there are concerns about the fallopian tubes being blocked.
• Hysteroscopy: This test uses a viewing devise called a hysteroscope, inserted through the vagina, to view the cervix and the uterus.
• Endometrial biopsy: For this procedure, the healthcare provider takes a sample of tissue through a tube inserted into the uterus.

Fibroid Treatments

Not all fibroids require treatment. Often, fibroids stop growing or shrink as a woman gets closer to menopause. In some cases, a “watchful waiting” approach may be recommended, in which the fibroid and the symptoms are carefully monitored to make sure there is no significant change is severity of symptoms or the fibroid’s size. If symptoms become severe, or if the fibroid is affecting fertility, treatment may be required.

Women seeking treatment for uterine fibroids typically need to make appointments with several specialists to explore fibroid treatment options. UH makes that process more convenient through our dedicated Fibroid Center, where women meet with a gynecologist and an interventional radiologist during a single appointment. There, our team will discuss treatment options with her and develop a personalized plan based on the woman’s age, health, fertility preservation preference, and the size, number and location of the fibroids.

Treatment options for uterine fibroids include:

• Hysterectomy: Surgery to remove the uterus, or hysterectomy, has been the traditional procedure for effective treatment of uterine fibroids. Women who have a hysterectomy will no longer be able to get pregnant.
• Myomectomy: Another surgical option is to remove the fibroids through a procedure known as myomectomy. In contrast to a hysterectomy, the uterus remains intact in a myomectomy, preserving the woman’s fertility. A myomectomy can be done as a traditional open procedure or can use minimally invasive, laparoscopic techniques.
• Da Vinci Robotic Surgery: The gynecologic surgery experts at UH are skilled at performing robotic myomectomy with the da Vinci robotic surgery system. Da Vinci uses an advanced set of surgical instruments that the surgeons is able to manipulate in real time during surgery to remove fibroids. The system gives the surgeon a magnified 3-D view of the surgical area, allowing her to use smaller incisions and precise techniques. Robotic surgery has many advantages over traditional open or laparoscopic myomectomy, including less pain and blood loss, lower risk of complications, shorter recovery times, and better outcomes.
• Uterine artery embolization: With this procedure, the arteries supplying the fibroid with blood are blocked off (embolized) with small plastic particles injected through a catheter. This will help shrink the fibroids.
• MRI guided ultrasound: This procedure uses sound waves to shrink the fibroids through the guidance of MRI.
• Gonadotropin-releasing hormone agonists (GnRH agonists): These medications are used to lower the estrogen level, triggering “medical menopause.” Sometimes GnRH agonists are used to shrink the fibroid to make surgery easier.
• Antihormonal medicines: Certain medicines can block the hormones estrogen or progestone and can help treat fibroids.

Uterine Fibroid Treatment Research and Clinical Trials

Surgery to remove the uterus has long been the gold standard in effective treatment of uterine fibroids. As a leader in clinical research, the Department of Obstetrics & Gynecology at University Hospitals is at the forefront of exploring new treatment options to shrink fibroids and eliminate uterine fibroid symptoms such as heavy menstrual bleeding and fibroid pain. We also offer several national clinical drug trials focused on treating uterine fibroids with medications. Targeting fibroids with high intensity focused ultrasound (HIFU) is another promising innovation.