Hysterectomy Not Only Answer for Uterine Fibroids

By Deborah Jeanne Sergeant

Approximately 20 to 80 percent of women develop uterine fibroids by age 50. The muscular tumors grow in the uterine cavity, in the wall of the uterus or on the outside of the uterus, either as a cluster of tumors or as a single tumor. They vary in size from tiny to the size of a grapefruit.

Sometimes, physicians discover fibroids by feeling their mass during a routine pelvic exam; however, since fibroids don’t lead to cancer, physicians leave them alone if fibroids remain asymptomatic.

“I never discuss surgery for a fibroid that’s asymptomatic,” said physician Gil Farkash, chief of OB-GYN for Kaleida Health. “Cancer is not my concern with fibroids. If you have no symptoms, you can just leave them alone.”

Fibroids can also cause abdominal pain, pressure on the rectum or bladder, painful sex and heavy menstrual bleeding. Fibroids may also cause infertility. Women presenting these symptoms usually seek medical help.

“Usually, the way they’re found is the presenting complaint of pelvic pressure, pain or irregular bleeding,” Farkash said. “Sonogram can show you have a fibroid. A lot of the treatment plans depend on where you are in your reproductive plan. If you’re older, hysterectomy is an option, but there are many non-invasive means.”

Hysterectomy represent major surgery that brings the risk of adhesions and infection. Recovery can take weeks.
Farkash said that hormonal agents can shrink fibroids and birth control pills may help.

Using interventional radiology to embolize fibroids involves cutting off the blood supply to the fibroid tissue. Since the uterus doesn’t require as much blood as fibroids, the unwanted tissue decreases in size. But the procedure leaves the uterus intact.

Physician Azher Iqbal, affiliated with Buffalo Vascular Care in Lancaster, calls it “one of the best kept secrets for treating fibroids. It’s an option not generally offered because most physicians are not aware of it. It’s an excellent treatment for women who don’t want to undergo major abdominal surgery.”

An artery in the leg or groin provides the entry point for embolizing fibroids. Because it’s just a nick to open the skin instead of major surgery requiring weeks of recovery time, patients experience little downtime. Some stay in the hospital overnight for pain control.

Undergoing major surgery for hysterectomy, combined with a more lengthy hospital stay, also increases a patient’s risk of infection.

Myomectomy can remove the fibroids. While more invasive than embolization, myomectomy leaves the uterus intact.

“It sometimes involves incision or laparoscope,” Farkash said. “It may be done through the cervices and vagina.”

Ultimately, women with fibroids should discuss all the options and how they may affect her before deciding which route to take.

Who Gets fibroids?

The US Department of Health and Human Services’  Office on Women’s Health states that several factors can increase a woman’s risk of developing fibroids. These include:

  • Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
  • Family history. Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
  • Ethnic origin. African-American women are more likely to develop fibroids than white women.
  • Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
  • Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.