What are Uterine Fibroids?
Uterine fibroids are very common — a problem many women experience. They are benign tumors that form on the uterus.
It is known that genetic predisposition is a common cause of uterine fibroids. In most patients, more than one uterine fibroid forms. Since it is known that estrogen causes uterine fibroids to grow, these benign tumors especially occur in childbearing years. These tumors typically shrink during menopause if the patient is not taking hormone medication.
Uterine fibroids form in different parts of the uterus. They can be inside the uterine wall, in the ovary, or they can extend into the uterine cavity. When they are outside the uterus, they connect themselves to the uterine wall via thick stalks.
Uterine fibroids inside the uterus may cause infertility in 2 – 3% of infertility cases. Miscarriage rates may reach to 40% in women with uterine fibroids. Uterine fibroids vary in sizes from quite small ones to ones with diameters of 10 – 15 centimeters. As they get bigger, they may deform the outside as well as the inside of the uterus. In some cases uterine fibroids grow large enough to fill the lower abdomen or the entire abdominal cavity.
During pregnancy large uterine fibroids may cause bleeding due to pressure and may even lead to preterm birth. Finally, fibroids growing into the tissue inside the uterus may cause infertility and miscarriage.
Uterine fibroids are most commonly observed in women between the ages of 35 – 45. Uterine fibroids are rare in women at puberty and the rate is lower after menopause. Still, in some cases the condition progresses if the patient was diagnosed with uterine fibroids just before menopause.
What are the symptoms of uterine fibroids?
In many cases women have no symptoms of uterine fibroids. When symptoms do appear, however, the most common are abnormal bleeding, pain and pressure in the pelvic area, and changes in the menstrual period. In addition, women may experience, as they do during pregnancy, pressure and pain in the lower abdominal area. This decreases urinal capacity, causing the patient to urinate more frequently. Iron deficiency, anemia, is another condition women with uterine fibroids may suffer from due to abnormal bleeding. As a result, fatigue and shortness of breath may occur.
Following are some symptoms of Uterine Fibroids:
- Painful menstrual period
- Prolonged menstrual bleeding
- Intermenstrual bleeding
- Frequent urination due to pressure on the bladder
- Constipation due to pressure on the rectum
- Pain in the pelvic area
- Sore back and legs
- Pain during sex
Diagnosing Uterine Fibroids
Uterine fibroids may be diagnosed during routine pelvic exams, although in some cases ultrasound may be necessary for diagnose.
During ultrasound, if a uterine fibroid larger than 7-8 centimeters is detected, or if more than one are found, and, if the symptoms are severe, an MRI scan is necessary. With the MRI scan, the exact number and location of fibroids is detected. In addition, the MRI scan helps diagnose other potential conditions (such as adenomyosis) and enables the examination of surrounding tissues and the ovary. MRI scans have become a routine procedure for patients with the above-mentioned symptoms and for patients embarking on a treatment process.
Treating Uterine Fibroids
Uterine fibroids generally do not cause harm for pregnant women or the baby. Small uterine fibroids with no symptoms, or those that occur close to menopause, usually do not require treatment. In cases where the patient experiences none of the mentioned symptoms, and, if the uterine fibroids are not growing, routine examination and ultrasound treatment should suffice. This being said, certain findings or symptoms may obligate treatment and, in severe cases, it might be necessary to remove the uterus with the uterine fibroids.
In some cases, if uterine fibroids are not treated, the ones that are attached to the uterus wall may become twisted, causing pain, nausea, and/or fever. In addition, uterine fibroids can get infected and can also cause infertility.
Whether uterine fibroids should be removed or not is determined by the severity of symptoms and the possible consequences of the condition. Treatment is necessary if the diameter of any uterine fibroid is greater than 5 centimeters, negatively affecting the patient’s day to day life by causing any of the symptoms mentioned above.
What should a myomectomy be performed for?
Many women who need to have fibroids surgically removed from the uterus will consider a hysterectomy. However, that procedure not only eliminates the fibroids, it removes the entire uterus so that the patient can no longer get pregnant.
A way to clear fibroids without removing the uterus is through a myomectomy – removing fibroids without removing the uterus. This surgical procedure can be an excellent treatment option for women who have fibroids and want to have children in the future. This approach to fibroid removal can actually increase a woman’s ability to get pregnant.
Myomectomy: Fibroids and fertility
Fibroids can interfere with conception and prevent implantation of a fertilized egg. They can also block the fallopian tubes, which can prevent the embryo from passing into the uterus and keep it from growing normally. Fibroids can also cause pre-term labor and premature birth. Those are some of the reasons why myomectomy can aid fertility.
In many cases, infertility specialists will refer patients to Dr. Bozdogan for a myomectomy procedure before attempting in vitro fertilization.
Dr. Bozdogan often uses robotic surgery to improve the effectiveness of minimally-invasive myomectomy procedures. Robotic myomectomy uses specially-designed instruments that the surgeon controls while viewing the surgery on a computer screen. Using this state-of-the-art technology, Dr. Bozdogan makes much smaller incisions than the ones needed in traditional surgery. The incisions can be made in the pelvic area; or, in some cases, internal incisions can be made through the vaginal wall so that no external incisions are needed.
When he performs robotic-assisted surgery, Dr. Bozdogan uses the da Vinci robotic surgical system, which is considered the “gold standard” in robotic surgery.