Uterine Fibroids (cont.)

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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 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 within is visualized in the endometrial cavity and can outline any masses that are inside, such as submucosal fibroids.

What is the treatment for uterine fibroids?

There are several options for the treatment of uterine fibroids that include surgery (hysterectomy, myomectomy, cryosurgery, MRI-guided high-intensity focused ultrasound (MRgFUS), and uterine artery embolization (UAE). Medical treatments include medications such as mifepristone (RU-486, danazol (Danocrine), raloxifene (Evista), GnRH analogs (Lupron and others), and low-dose formulations of oral contraceptives.

Surgery for fibroids

There are many ways of managing uterine fibroids. Surgical methods are the mainstay of treatment when treatment is necessary. Possible surgical interventions 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 hysteroscope, 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. Surgery is necessary if there is suspicion of malignancy in any case of a leiomyoma or uterine mass.

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.

Medically Reviewed by a Doctor on 1/8/2014

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Uterine Fibroids - Experience Question: Please describe your experience with uterine fibroids (benign tumors of the uterus).
Uterine Fibroids - Symptoms Question: What were the symptoms of your uterine fibroids?
Uterine Fibroids - Treatment Question: What was the treatment for your uterine fibroids
Uterine Fibroids - Surgery Question: If you had surgery to remove fibroids, describe the procedure. Are you satisfied with the results?
Uterine Fibroids - Diagnosis Question: What were the tests and exams that led to a diagnosis of uterine fibroids?