ASK THE DOCTOR: Fibroids are not dangerous but can be a nuisance
By DR. JIM MITTERANDO
The Patriot Ledger

Q. I am 40 years old and having heavy periods because of fibroids. Should I have a hysterectomy?

Q. Can fibroids grow back after a person has had a total hysterectomy?

A. Fibroids are common. Between 20 percent and 40 percent of women over the age of 35 have fibroids. Fibroids are noncancerous growths of the uterus that appear during your childbearing years. Also called myomas, fibromyomas or leiomyomas, fibroids can appear on the inside or outside lining of your uterus, or within its muscular wall. They usually develop from a single smooth muscle cell that continues to grow.

You may have a single fibroid or several. Fibroids can range from pea-sized to the size of a grapefruit. Although most fibroids remain small, their growth can be unpredictable. Some grow slowly, and others may grow very quickly. Fibroids are not dangerous. They are not associated with cancer of the uterus.

Fibroid growth seems to be controlled by hormones, especially the production of estrogen. Fibroids tend to grow during your reproductive years and may expand rapidly during pregnancy when your estrogen levels are very high. They generally shrink after menopause as estrogen levels decline. Other hormones, such as progesterone, also may affect fibroid growth.

In general, most fibroids do not cause symptoms and do not require treatment. Unfortunately, some women do experience problems from fibroids including heavy periods, painful intercourse, lower abdominal pain or pressure and occasionally infertility or miscarriages.
In the past, hysterectomy was the automatic choice for women with symptomatic fibroids.

Today, medications are often tried to help with the symptoms. If medications are ineffective there are several surgical options now available. And, of course, the standard alternative for many women is to do nothing. Symptomatic fibroids almost always become nonproblematic after menopause when they shrink and fade away due to decreasing estrogen levels. Women in their late 40s or early 50s may choose to simply wait for time to take care of the problem.
In making a diagnosis, your healthcare provider will conduct a pelvic exam to feel for fibroids.

n some cases, he or she may recommend an ultrasound, a painless exam that uses sound waves to image your uterus and evaluate the growths.

Oral contraceptives may help control heavy menstrual bleeding and have reduced the need for surgery. The hormonal treatment danazol (Danocrine) also may be useful to control excessive menstrual flow. However, these therapies do not control fibroid growth.

Other drugs, known as gonadotropin-releasing hormone(Gn-RH) agonists (Lupron, Viadur) may be used to shrink fibroids by reducing the amount of estrogen in your body. This form of drug therapy is not a long-term solution. Unfortunately, Gn-RH agonists cause all of the symptoms of real menopause - including hot flashes, mood swings, headaches, vaginal dryness and bone loss. If you need prolonged treatment, your doctor can add other medications to reduce your menopausal symptoms.

Fibroids often return after drug therapy is discontinued.

If medications are not helpful and you are not approaching menopause, surgery may be recommended. If you are not planning to have any more children, a hysterectomy (removal of the uterus) may be recommended. If you would like to become pregnant in the future, a myomectomy may be done instead. This is a less invasive surgery often done through a scope that removes only the fibroid keeping the uterus in place.

Fibroids can often grow back after a myomectomy. If a hysterectomy was done, no fibroids can develop. If the ovaries were removed with the uterus, hormone replacement therapy with estrogen may be necessary.

Uterine fibroid embolization may be another option for some women who want to avoid surgery. It is designed to shrink fibroids by cutting off the blood supply that feeds them by injecting tiny particles of plastic or gelatin to block blood flow inside the fibroids. This relatively new procedure is less commonly done and not as readily available as hysterectomy or myomectomy. Long-term results of this procedure are not yet known.

One final note: It can be difficult to discern if smaller fibroids are innocent bystanders or the actual culprit causing abdominal or pelvic discomfort. Sometimes, women can undergo surgical treatment of their fibroids and still experience discomfort because the fibroids may not have actually caused the discomfort in the first place.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible.Readers should see their own doctors about 'specific problems.

Copyright 2002
The Patriot Ledger
Transmitted Tuesday, July 02, 2002