UTERINE FIBROIDS – DO YOU HAVE ANY QUESTIONS? PART 2
by Ngozi Osuagwu, MD | July 16th, 2017
Will the fibroids turn into cancer? Fibroids are benign. They are not cancer. There is a cancer called leiomyosarcoma. It looks like fibroids. It is a rare cancer. Women at risk for this type of cancer are usually older, have had pelvic radiation therapy in the past, have been on the medication Tamoxifen or have a rare genetic condition. Majority of fibroids are not cancer. Usually an MRI will have features suggestive of this cancer. Also, taking a tissue sample from the uterus through an endometrial biopsy may help make the diagnosis. Typically before any major surgery for very large fibroids, the doctor will order an MRI and/or get a tissue biopsy to make sure there is no cancer.
What are the treatments for fibroids? I once read in a New York Times article – “diagnosing fibroids is simple, deciding what to do is hard”. The management of uterine fibroids will depend on your age, your reproductive plans (whether or not you want children), your symptoms, your long term goals, and the size, the number and location of the fibroids within the uterus.
The options include the following:
Doing nothing– Yes, this is an option especially if you are not having any symptoms. Now when I say nothing, I mean none of the medical or surgical interventions that I will list. Next week, we will talk about a holistic approach to managing fibroids even without symptoms.
Non-steroidal anti-inflammatory agents (NSAIDs) – An example would be Ibuprofen. Ibuprofen can help with the pain and can even help with the bleeding if taken at the onset of the menstrual cycle.
Tranexamic acid – Helps with heavy menstrual flow that is associated with uterine fibroids.
Hormonal intervention – any of the contraceptives that contain hormones may be helpful especially with the heavy menstrual flow. They can be helpful with pain management. The most commonly used are birth control pills or the levonorgestrel releasing IUD.
Gonadotropin-releasing hormone (GNRH) agonist – This medicine shuts down the ovaries so that you do not produce estrogen that is thought to feed the fibroid. This will cause the fibroids to get smaller while you are on the medication. Once you stop the medication, the fibroids will grow back. The reason we cannot use this medication more than 6 months is because it can cause your bones to be fragile. Typically this medicine is used for women who are close to menopause or in women ready to have surgery and need their fibroids smaller or women who are anemic (low blood count) and need to increase their blood count.
Endometrial ablation – this can help with heavy menstrual flow, however you may need to remove the fibroid that is in the inside of the uterus that is affecting the lining of the uterus. You should only get this procedure when you have decided not to have any more children.
Uterine artery embolization – this is where we use a material to block blood flow going to the uterus. Not recommended if you want to be able to have children in the future. This procedure is done by the radiologist. You will need an MRI before the procedure to see if you are a candidate.
MRI-guided focused ultrasound Surgery (MRgFUS) – Uses ultrasound technology to burn the fibroids. This is done by the radiologist. You will need an MRI before the procedure to see if you are a candidate.
Radiofrequency Ablation – Done in the operating room through little incisions made on your abdomen to burn the fibroids.
Myomectomy – This is surgery where we remove the fibroids. You will still have your uterus. You can still have children. There are various approaches to a myomectomy and it is dependent on where the fibroid is located. You can have a myomectomy through hysteroscopy where no cuts are made on your belly. It can be done laparoscopically, it can be done using the robot and it can be done making a large incision on your abdomen. There is a chance after the surgery, new fibroids will form and you may need this type of surgery again.
Hysterectomy – This is removal of the uterus. This is the most effective treatment for uterine fibroids. You will not have to worry about the fibroids again. Please remember a hysterectomy does not cause you to go into menopause. Click here for the blog titled, Gynecology 101: Does a Hysterectomy Cause you to go into Menopause. Once the hysterectomy is performed, you will not be able to carry a pregnancy.
I have a provided a brief summary of what is available in 2017. There are new medicines that are being tested and are available in Europe but not available in the United States. To find out more information on any of the above, please talk with your physician or go on the internet. The CDC and ACOG are good resources.
Next week’s blog will be the last part of this three part series on uterine fibroids.
If you missed last week’s blog – Uterine Fibroids – Do you have any questions? Part 1
This was very helpful. Are fibroids hereditary as well?
Heredity may play a role since it is common to find several family members with fibroids. It is so important to ask family members about their medical history. Thank you for asking the question.