Uterine Fibroids (cont.)
What are the usual ways of diagnosing uterine fibroids?
Uterine fibroids are diagnosed by pelvic exam and even
more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a
fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating
it from other conditions such as ovarian tumors. MRI and CT scans can also play
a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and
almost without question the best technique for imaging the pelvis. Occasionally,
when trying to determine if a fibroid is present in the uterine cavity
(endometrial cavity), a hysterosalpingogram (HSG) is done. In this procedure, an
ultrasound exam is done while contrast fluid is injected into the uterus from the cervix.
The fluid is visualized in the endometrial cavity and thus outline any masses
that are inside, such as submucosal fibroids.
What is the treatment for uterine fibroids?
Surgical treatments
There are many ways of managing uterine fibroids.
Surgical methods include hysterectomy, or removal of the uterus (and the fibroids with it). Myomectomy is
the selective removal of just the fibroids within the uterus. Myomectomy can be
done through a laparoscope or with the
standard open incision on the abdominal wall. Some treatments have involved
boring holes into the fibroid with laser
fibers, freezing probes (cryosurgery), and other destructive techniques that do
not actually remove the tissue but try to destroy it in place.
Another technique for treating fibroids is known as
uterine artery embolization (UAE). This technique uses small beads of a compound
called polyvinyl alcohol, which are injected through a catheter into the
arteries that feed the fibroid. These beads obstruct the blood supply to the
fibroid and starve it of blood and oxygen. While this technique has not been in
use long enough to evaluate long-term effects of UAE versus surgery, it is known
that women undergoing UAE for fibroids have a shorter hospital stay than those
having surgery but a greater risk of complications and readmissions to the
hospital. Studies are underway to evaluate the long-term outcomes of UAE as
opposed to surgical treatment. Uterine artery occlusion (UAO), which involves clamping the
involved uterine arteries as opposed to injecting the polyvinyl alcohol beads,
is currently under investigation as a potential alternative to UAE.
Next: Medical treatment for fibroids »
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