What are Fibroids and How Common are they?
Fibroids are considered noncancerous tumors of the uterus, and are found in over 80% of women. Although 97% benign, there does exist a malignancy rate of approximately 1-3%.
Fibroid tumors are the most common uterine pathology and are the primary reason for approximately 80% of the hysterectomies in this country today. Also known as myomas, leiyomomas, fibromas, and fibromyomas, these tumors can have an extensive blood supply from within the uterus.
In this video, Dr. del Junco Jr. discusses a patient who had over 535 fibroid tumors and how he safely removed all of them.
Fibroid tumors usually present in four different types:pedunculated, subserosal,, intramural, submucosal.
- Pedunculated fibroids are those extending from the uterus on a stalk.This type of tumor may be found within the endometrial cavity or extending outside the uterus into the pelvis. These are the most easily removed tumors, and often the surgical removal can be performed through laparoscopy or hysteroscopy. The symptoms include pain or pressure in a specific area, or bleeding depending on where the tumor is located.
- Subserosal are those fibroids located just beneath the outer layer of the uterus. These are the tumors that are most easily accessible and are often removed via a simple or laparoscopic myomectomy. If allowed to increase in size, symptoms can include pelvic pain, back pain, urinary frequency, constipation, bloating and indigestion.
- Intramural tumors are those located deep in the uterus in the main body of the organ. These are the most common and the most difficult to remove, and are responsible for the highest percentage of hysterectomies. These tumors can produce bleeding problems, abdominal pressure, and painful intercourse, in addition to all the symptoms listed above
- Finally, submucosal fibroids are those directly adjacent to the endometrial lining. These are the tumors primarily responsible for heavy menstrual bleeding. These tumors impinge on the endometrial cavity and can produce long heavy periods, cramps, clots, and cervical
What Causes Fibroids?
The true etiology of fibroid tumors is unknown. Research has shown significant genetic correlation, as well as a strong cultural component: fibroids are 4-6 times more likely in the African American populations, and yet are rarely seen in the Asian culture. With the introduction of hormones into our general food supply, the incidence of fibroid tumor disease is increasing across the general population regardless
of race or culture.
We do know that these tumors are directly responsive to estrogen and exhibit their most significant growth spurts just prior to the monthly menses.Women that have a documented estrogen dominance have a much higher rate of tumor
growth, which is also witnessed during pregnancy. Conversely, women in the menopausal phase of life, demonstrate a reduction in the growth of tumors, with some fibroids even shrinking slightly in size.
The Signs and Symptoms of Fibroid Tumors
Signs and symptoms of fibroids are dependent on the size, number and location of the tumors. Many patients complain of menstrual problems like heavy periods, with extended days of flow, cramps and clots.
However, many women have absolutely no symptoms at all. The following symptoms are known (but not limited)to be associated with fibroids and will increase in severity based on size and number of tumors:
- heavy bleeding or increased flow
- abdominal pressure
- irregular and painful periods
- urinary frequency
- painful intercourse
- back pain
- pressure in the legs
How are Fibroid Tumors diagnosed?
Fibroids are usually detected on the basis of clinical findings during the annual pelvic exam, but are usually diagnosed via ultrasounds, MRI and CT Scan. Although ultrasound is the most common and inexpensive method of diagnosis, it is not the most accurate and many smaller tumors can go undetected. If the patient has extensive fibroid tumor disease with multiple and large tumors, MRI is the most accurate test and can clearly delineate size, number and location of most fibroids.
Fibroids and Fertility
Fertility outcomes with fibroids are dependent on the size, number and location of the tumors. In general, only -12% of fibroids are associated with primary infertilty so most women can have uncomplicated pregnancies with these tumors, and research has shown that if conception takes place only 10-15% of women will have complications with pregnancy.
Submucosal and intracavity tumors are an example of those that can produce complications and even pregnancy loss. Intracavity fibroids are in direct competition for space within the endometrial cavity with a developing fetus. This can create obstacles to development and miscarriage can occur. Submucosal tumors by nature of their location near the lining can also contribute to infertility by inhibiting implanation of the fertilitzed egg. Fundal fibroids are known to block fallopian tubes and are therefore a primary source of infertility by preventing conception.
No matter what type, the longer fibroid tumors are left untreated, the greater the chance of infertility.
Fibroid Tumor Treatments
For any long term relief, once symptommatic, most fibroids need to be surgically removed. Delaying removal of tumors usually allows the fibroids to grow in size and number. There are multiple treatments available from herbal supplements, birth control pills, IUDs, minimally invasive procedures like UAE to laparoscopic, Robotic and open surgeries.
The type of treatment recommended is often based on the size, number and location of the fibroids and the skill and philosophy of your physician. Please refer to our section on Types of Treatments for more indepth and comparative information and analysis.
Fibroid Tumor Recurrence Rates
Current research appears to support a wide range of fibroid recurrence, 12-60+%, following most traditional myomectomy (fibroid removal) procedures. The reason for this wide variance is based on several factors. One is the chronological and hormonal age of the patient. Women that are in their 20s and 30s have many years to reach menopause and therefore have a greater amount of time for the tumors to regrow. Second is the amount of estrogen being produced by the ovaries. Younger women have higher and more consistent levels, older women, those 40 years and beyond are beginning to experience dwindling hormonal levels that will not be able to support fibroid growth. Hence, older women tend to have a reduce chance of the tumors recurring.
More problemmatic however is the fact that most recurrence rates are not attributed toactual regrowth of fibroids, but due to the sad reality that many fibroids are not removed during the intial surgery. The larger the tumors, the more in number and the deeper in the uterus can result in extensive bleeding during the procedure. Gynecologists do not have extensive experience handling potential hemorrhage crises during surgery. Therefore, many will take the tumors that are most accessible on the outer myometrium but knowingly leave larger or deeper tumors due to the concern of extensive uncontrollable bleeding. From patient reports, many women have been told that their procedure was a success only to have recurrent symptoms within 6 months to a few short years. These patients did not have a regrowth of fibroids..instead they had an incomplete myomectomy. Any physican that advocates a hysterectomy to resolve fibroid tumor disease is probably concerned about the possibilty of not getting all the tumors and ultimately subjecting the patient to future untoward symptoms and the need for another major surgical procedure.
From our experience with over 2000 patients, most have difficulty finding a surgeon who is willing to operate on any women with a potentially difficult case without forcing the patient to “sign a consent for possible hysterectomy”. This leaves many women with a very unsettled emotional concern going into surgery: they do not know if they will come out of the procedure with or without their uterus. At the Institute, hysterectomy is not consented for and has never performed!
Fibroid Tumor Disease: The Emotional and Psychologist Effects
Unfortunately, not only do fibroids present physical challenges, but many women experience significant lifestyle changes that can effect emotional and psychological well being. Many patients begin to feel very ”trapped” without a way to escape this disease. As fibroid tumors grow, many patients find they now have to coordinate their lives around their monthly cycles. Often women need multiple changes of clothes for a single day and many defer to wearing black or dark colors for most of the month. They cannot schedule important events around “that time of the month” and pain and prolonged bleeding with fatigue destroys intimacy and the pleasures of sexual intercourse. I have had many patients report to me that this disease has ‘just taken over my life”. It is at this point that many women seek out treatment. Once fibroids are diagnosed, many women can have a sense of relief. They finally have an answer as to what has been disrupting their life!!! The next step to resolution is treatment. Sadly, this can be another step toward insecurity and disbelief. Depending on your gynecologist’ training and philosophy most patients experience one of two recommendations: the “wait and see” philosophy or hysterectomy.
The first does nothing to solve the current signs and symptoms and only allows the fibroids to get worse with time…The second is often an unwanted surprise and/or a complete shock! Since many women have no idea they have fibroids until they have a visit with the gynecologist, when results return, as mentioned above, many have a sense of relief that a reason for their daily struggles has been identied. However, all too often the relief of a discovered diagnosis can turn into a shocking and emotionally devastating reality when the recommended treatment is hysterectomy.
Even when fertility is no longer a consideration, women often are not psychologically prepared to part with their uterus. We, here at the Institute, are not advocates of hysterectomizing women for fibroid tumors. With so many treatment options available, we feel its extremely important to thoroughly research all types and their potential outcomes to determine what is best for you!
How can the Institute’s Female Alternative Surgery help you???
Female Alternative Surgery is a multidimensional myomectomy that uses both vascular surgical techniques, lasers and uterine reconstruction to accomplish our goal of removing fibroids without hysterectomy. Our philosophy for all patients is to treat the disease, not just the symptoms.
All too often, gynecology will use “bandaid” treatments like birth control pills, D&C and ablation therapies like the rollerball or Novasure procedure to treat the untoward symptoms of fibroid tumors. Even UAE (Uterine Artery Embolization) only shrinks fibroids; the tumors never completely resolve or disappear. Unfortunately, these techniques dispense a false sense of security and do not directly effect the fibroids. Women may experience a reduction in bleeding but the tumors will continue to grow and spread over time. Symptoms like abdominal pain, pressure, urinary frequency and an enlarging uterus are not reduced. Removing fibroids is the only way to effectively treat this disease long term…once appropriately treated, by surgically removing the tumors, the symptoms will be resolved.
Our Female Alternative Surgery has safely removed over 500 fibroids from one patient without removing her uterus. We are one of the very few advocates for women that recommend and perform a safe surgical option for the removal of fibroids without hysterectomy. If you are interested in our procedure, please visit the rest of our website for further information and/or contact us directly at firstname.lastname@example.org.
Remember: Every form of treatment should be tried before a hysterectomy is ever considered.
For over a decade the Institute and Dr. del Junco Jr. have advocated treating “fibroid tumors” without hysterectomy. At no cost to you, we have a Surgical RN on staff available to answer any questions you might have pertaining to your diagnosis and our Female Alternative Surgery procedure. Please contact Patricia Marshall BSN RN CNOR directly by E-Mail or at: 1-800-505-4326.