Uterine Fibroids: Symptoms, Treatment Options, and Risks

Uterine fibroids

I am 41 years old and have three children, the youngest being three and a half years old.
In early November of this year, I underwent a Pap smear and was found to have a uterine fibroid measuring approximately 7-8 cm (it was not detected in last year's examination).
Could you please tell me if the fibroid developed after having my youngest child, and is the growth rate too fast? The fibroid is located on the outside of the uterus, directly above the bladder, which is causing frequent urination.
My menstrual cycle is normal, occurring approximately every 25 days, occasionally coming early at 21 days or extending to 28 days.
However, generally, it is every 25 days with a normal amount of flow.
Should I consider surgery? If surgery is necessary, will it only involve removing the fibroid, or will a complete hysterectomy be required? Are there any long-term effects from having the uterus removed? I have also heard of another type of surgery, possibly laparoscopic or laser surgery; does this type of surgery cause less damage? Is this type of surgery suitable for a fibroid of this size? What are the pros and cons of these two types of surgeries? Additionally, if I choose not to have surgery and continue to monitor the situation, could this lead to tumor changes? If the fibroid grows larger, what consequences might arise? Thank you, Zhang Limei.

Zhang, 40~49 year old female. Ask Date: 2000/11/16

Dr. Xu Junzheng reply Obstetrics and Gynecology

Fibroids are 99.9% benign, so surgery is not necessarily required when there are no symptoms.
If surgery is being considered and the decision is made not to pursue further fertility, a hysterectomy may be considered to prevent recurrence.
Currently, laparoscopic surgery is the preferred approach for hysterectomy.
However, if surgery is not immediately indicated, regular monitoring should be conducted.
Thank you.

Reply Date: 2000/11/16

More Info

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the uterus. They are quite common, especially in women of reproductive age, and can vary in size, number, and location. Given your situation, where you have been diagnosed with a fibroid measuring 7-8 cm, it's essential to understand the symptoms, treatment options, and potential risks associated with fibroids.

Symptoms of Uterine Fibroids
Many women with fibroids may not experience any symptoms. However, when symptoms do occur, they can include:
1. Heavy Menstrual Bleeding: This can lead to anemia if not managed properly.

2. Pelvic Pain or Pressure: Depending on the size and location of the fibroid, you may feel discomfort or pressure in the pelvic area.

3. Frequent Urination: As in your case, if a fibroid is pressing against the bladder, it can cause increased urinary frequency.

4. Pain during Intercourse: Some women report discomfort during sexual activity.

5. Backache or Leg Pain: Larger fibroids can press on nerves and cause pain in the back or legs.

Treatment Options
1. Watchful Waiting: If your fibroids are not causing significant symptoms, your doctor may recommend monitoring them over time. Regular check-ups can help track any changes in size or symptoms.

2. Medications: Hormonal treatments can help manage symptoms, particularly heavy bleeding. Options include birth control pills, hormonal IUDs, or GnRH agonists, which can shrink fibroids temporarily.

3. Surgical Options:
- Myomectomy: This is the surgical removal of fibroids while preserving the uterus. It is often recommended for women who wish to maintain their fertility. The approach can be abdominal, laparoscopic, or hysteroscopic, depending on the fibroid's size and location.

- Hysterectomy: This involves the removal of the uterus and is a definitive solution for fibroids. It is typically recommended for women who are done having children or have severe symptoms that do not respond to other treatments. While it eliminates the fibroids, it also means you will no longer have menstrual periods and will not be able to conceive.

- Uterine Artery Embolization (UAE): This is a minimally invasive procedure that cuts off blood supply to the fibroids, causing them to shrink. It is an option for women who want to avoid surgery.

4. Minimally Invasive Techniques: Laparoscopic surgery and laser surgery are options that can reduce recovery time and minimize scarring. These techniques can be effective for smaller fibroids but may not be suitable for larger ones like yours.

Risks and Considerations
- Growth Rate: Fibroids can grow at different rates. It is not uncommon for them to develop or increase in size after childbirth due to hormonal changes. Regular monitoring is crucial to assess their growth.

- Potential for Malignancy: While most fibroids are benign, there is a small risk of them becoming cancerous, especially in postmenopausal women. Regular check-ups can help identify any concerning changes.

- Post-Surgical Risks: Both myomectomy and hysterectomy come with risks, including infection, bleeding, and complications related to anesthesia. Hysterectomy also has implications for hormonal changes and potential early menopause if the ovaries are removed.

Conclusion
Given your current symptoms and the size of the fibroid, it is essential to have a thorough discussion with your healthcare provider about the best course of action. They can help you weigh the benefits and risks of each treatment option based on your symptoms, reproductive plans, and overall health. If you are considering surgery, ask about the specific techniques available, their risks, and recovery times to make an informed decision. Regular monitoring is also crucial to ensure that any changes in your condition are addressed promptly.

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