Women’s Health & Fibroids
MIMIT Health specializes in minimally invasive, targeted Uterine Fibroid treatments that offer less risk, less pain and less recovery time compared to traditional surgery. MIMIT's world-class physicians, providers, and surgeons treat uterine fibroids that required surgery in the past and can now be treated less invasively by our doctors.
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What Are Fibroids?
Uterine fibroids are benign (non-cancerous) tumors that grow on or within the muscle tissue of the uterus.
Common Fibroid Symptoms
Some of the most common symptoms of uterine fibroids include heavy, excessive menstrual bleeding, pelvic pain and pressure, and urinary incontinence and frequency. If you are experiencing signs and symptoms of uterine fibroid tumors, you may find it difficult to perform your daily activities and maintain your way of life.
Excessive Menstrual Bleeding
Excessive menstrual bleeding is one of the most common symptoms of uterine fibroid tumors. It is the most prevalent symptom for two out of the four types of uterine fibroid tumors: intramural and submucosal. When experiencing the uterine fibroid symptoms like heavy menstrual bleeding or abnormal uterine bleeding, there are other components that directly result from it.
Passing clots is very common with excessive menstrual bleeding as well as prolonged cycles of bleeding and longer monthly periods. It can also cause frequent soiling, something that can interfere with everyday activities and lifestyle. Abnormal uterine bleeding that is prolonged can have some serious side effects over time. Untreated, it can lead to fatigue and anemia, which is the result of low red blood cell count. These factors can eventually lead to the need for blood transfusions.
Pelvic Pain and Pressure
As the fibroids grow they can put additional pressure on the surrounding organs, which can be extremely painful. The growth of the fibroids can cause consistent lower abdominal pain, as well as swelling which is sometimes mistaken as weight gain or pregnancy. If you are experiencing pelvic pain and pressure or any other type of uterine fibroid symptoms, a full gynecological exam should be done immediately to determine the cause.
Pelvic pain and pressure can be caused not only by the size of a uterine fibroid tumor, but the location as well. Additional conditions can accompany the uterine fibroid tumor, such as adenomyosis and endometriosis.
Adenomyosis occurs when the tissue that lines the uterus (endometrium) grows within the middle layer of the uterine wall and supportive vascular tissue (myometrium). Typically the uterine lining prevents adhesions from occurring. However, when uterine fibroids develop and begin to grow, the possibility for adhesions also grows, something that can also cause a great deal of pain.
Endometriosis occurs when the endometrial tissue is found outside of the uterus, and can be another painful and uncomfortable symptom occurring with uterine fibroids. Again, in order to properly diagnose uterine fibroid tumors and effectively determine the cause of these symptoms, a full gynecological exam should be performed.
Urinary Incontinence and Frequency (Loss of Bladder Control)
One of the organs commonly affected during the growth of the fibroid tumors is the bladder. As added pressure is applied to this organ, the risk of urinary incontinence, or the loss of bladder control, as well as frequent urination increases. Not only can this cause a great deal of pain and discomfort, but it can also become a hindrance in your everyday activities.
Another possible effect of uterine fibroid tumor growth can be increased pressure to the bowel. This can cause uncomfortable constipation and/or bloating. If you feel you are experiencing these potential symptoms of fibroids on a regular basis, consult with a medical professional in order to rule out or diagnose any potential serious medical conditions.
Pain in the back of the legs
Pain during sexual intercourse
An enlarged abdomen
In some cases, there may be no symptoms at all. Depending on the size and location of the fibroid tumors, symptoms can become so severe that they affect the ability to maintain daily activities. However, many women live with fibroid tumors and still maintain a good quality of life with the ability to manage and perform their everyday tasks.
If you are experiencing signs and symptoms of uterine fibroid tumors, and are finding it difficult to perform your daily activities and maintain your way of life, you should contact your local Interventional Radiologist immediately.
Talk with our fibroid specialists about treating your symptoms like heavy bleeding, pelvic pain, and urinary incontinence. Call MIMIT Health at (708) 486-2600.
Uterine Fibroid Symptoms discussed with Dr. Chopra
The uterus is a big tight muscle almost the size of a fist, and it’s essentially a bag. The uterus is like a garden. Every month it gets ready to accept the seed and if the seed works then you get a baby, and this bag now has to grow and accommodate the baby. Once the baby is ready and is mature enough to come into the real world, the uterus sends it out. So that’s your uterus, there’s a muscle in there that’s why the contractions are supposed to be able to squeeze things out.
A fibroid is when it’s called a leiomyoma which means that the smooth muscle of the uterus which is what we have other muscles for but which are not in our skeletal muscle. But the uterus muscle can sometimes turn abnormal, we don’t know why and they become like a little a little ball, it’s a benign tumor these are not cancers, they don’t spread anywhere but they stay within the uterus, we call them a fibroid.
Types of Fibroids
There are different types of fibroids and the size can range from very small (walnut size) to as large as a cantaloupe or even larger. It is common for a woman to have multiple fibroid tumors and it may be difficult to understand which fibroid is causing your symptoms.
Who is at Risk for Fibroids
Approximately 20-40% of women 35 years and older have fibroid tumors. Fibroids are more common among women of African-American descent. Some statistics indicate that up to 80% of African-American women will develop uterine fibroids. Find out if you are at risk for uterine fibroids.
If you have fibroids you have options. While some women do not experience any of the symptoms of fibroids, the location and size of fibroid tumors can cause symptoms that can affect a woman’s quality of life. Take a look at the treatment options available.
Fibroids are hormonally sensitive so symptoms are likely to be cyclical, like menstruation. As estrogen levels tend to increase prior to the onset of menopause, this may cause the size of many uterine fibroids to increase along with the symptoms. During menopause the levels of estrogen decrease dramatically, causing fibroids to shrink. However, women taking hormone replacement therapy (HRT) during menopause may not experience any symptom relief because the estrogen contained in this regime may cause fibroid tumors to enlarge and symptoms to return.
Uterine Fibroid Treatment
| Non-invasive | Less Invasive | Surgical |
If you and your care provider determine that you have uterine fibroids, it is a good idea to discuss the various alternative treatment options for fibroids that are available to you, including uterine fibroid embolization (UFE).
DIAGNOSIS AND WATCHFUL WAITING
If your fibroids do not cause symptoms, there is no need to treat them. Your doctor may want to watch them and monitor for any fibroid growth at each of your annual gynecological (OB-GYN) examinations. Some women may have fibroids, but not experience symptoms that affect their daily life.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. The side effects of using these medications are similar to the symptoms experienced as a result of hormonal changes during and after menopause. These include weight gain, hot flashes, vaginal dryness, mood swings, changes in metabolism and infertility. In almost all cases, once hormone therapy has been stopped, fibroids tend to grow back, possibly reaching their original size again. This often occurs if the use of hormone therapy is not accompanied by another treatment.
MAGNETIC RESONANCE GUIDED FOCUSED ULTRASOUND SURGERY (MRgFUS)
High intensity focused ultrasound waves are used to heat an area of the fibroid, causing cell death. Pulses of ultrasound energy are repeatedly applied to treat the fibroid. During treatment, magnetic resonance images are used to enable the doctor to see the fibroid and surrounding organs in 3-D, pinpoint, guide, and continuously monitor the treatment in a non-invasive manner. The procedure can take 3-4 hours and requires you to lie on your stomach. Sedation and pain-relieving medication will be given to help you relax. You will be conscious throughout the procedure and will probably feel some warm sensation over the abdomen during the treatment. Patients may experience some abdominal pain, cramping or nausea. You may experience some cramps, shoulder or back pain that may last a few days after the procedure. Most women are able to return to work within 1-2 days.
Less Invasive Treatment Options
UTERINE FIBROID EMBOLIZATION (UFE)
The uterine fibroid embolization procedure begins with a tiny incision in the groin area. This incision provides the Interventional Radiologist (IR) with access to the femoral artery in the upper thigh. Using specialized X-ray equipment, the IR passes a catheter (small tube) into the femoral artery, to the uterine artery, and guides it near the location of the fibroid tumor. When the IR has reached the location of the fibroids, embolic material (small spheres) are injected through the catheter and into the blood flow leading to the uterine fibroid tumors. The embolic material blocks the vessels around the fibroid, depriving it of oxygenated blood. The oxygen deprivation results in fibroids shrinking. The embolic material remains permanently in the blood vessels at the fibroid site. The catheter is then moved to the other side of the uterus, usually using the same incision in the thigh. Once the IR has completed embolization of the uterine artery on both sides, the catheter is gently removed and the IR places finger pressure over the small incision in your thigh. After holding the puncture site for a few minutes to help stop any bleeding, the IR may close the incision using a vascular closure device. The entire fibroid treatment typically lasts less than one hour, and is performed as an outpatient therapy. Patients usually stay anywhere from four to 23 hours after the procedure is complete.
A procedure called endometrial ablation destroys the endometrium – the lining of your uterus – with the goal of reducing your menstrual flow. In some women, menstrual flow may stop completely. No incisions are needed for endometrial ablation. Your doctor inserts slender tools through your cervix — the passageway between your vagina and your uterus. The tools vary, depending on the method used to destroy the endometrium. Some types of endometrial ablation use extreme cold, while other methods depend on heated fluids, microwave energy or high-energy radio frequencies. Endometrial ablation can only be used to treat submucosal fibroids that are less than one inch in diameter.
In this procedure a long, thin scope with a light is passed through the vagina and cervix into the uterus. No incision is needed. A camera also can be used with the scope. Submucosal or intracavitary fibroids are easily visualized and can be resected or removed using a wire loop or similar device. Patients usually are sent home after the procedure.The hospital stay can last from 30 minutes to 2 hours and recovery time is generally 1-2 days. Generally only fibroids that are small and accessible through the cavity can be treated this way.
The laparoscope is a slender telescope that is inserted through the navel to view the pelvic and abdominal organs. Two or three small, half-inch incisions are made below the pubic hairline and instruments are passed through these small incisions to perform the surgery. Next, a small scissors-like instrument is used to open the thin covering of the uterus. The fibroid is found underneath this covering, grasped, and freed from its attachments to the normal uterine muscle. After the fibroid is removed from the uterus, it must be brought out of abdominal cavity. The fibroid is cut into small pieces with a special instrument called a morcellator, and the pieces are removed through one of the small incisions. Most women are able to leave the hospital the same day as surgery. For more extensive surgery, a one-day stay may be required. Patients can usually walk on the day of surgery, drive in about a week and return to normal activity, work, and exercise within two weeks.
In this procedure, four standard, quarter-inch incisions are made and ports are inserted for the robot’s camera and instrument arms. The surgeon first injects medication into the fibroids to decrease overall bleeding, and then makes an incision in the uterus. The surgeon then removes the fibroid(s) from the surrounding uterine tissue. Once the fibroid has been removed, the surgeon uses a special device called a morcellator to cut the fibroid into smaller pieces inside the patient’s abdomen. These pieces are then removed through one of the incisision ports. Patients typically go home the same day of the procedure and most patients are able to resume normal activities within two weeks.
In this operation, your surgeon enters the pelvic cavity through one or two incisions, depending on the size of the fibroid(s). A vertical incision is made from the middle of your abdomen, extends from just below your navel to just above your pubic bone. A vertical incision is recommended if your uterus has reached or exceeded the size comparable to if it were carrying a sixteen (16) week pregnancy. This incision might also be used if a fibroid is in a ligament between your uterus and pelvic wall. In other cases, a horizontal bikini-line incision is made that runs about an inch (about 2.5 centimeters) above your pubic bone. This incision follows your natural skin lines, so it usually results in a thinner scar and causes less pain than a vertical incision. Because it limits the surgeon’s access to your pelvic cavity, a bikini-line incision may not be appropriate if you have a large fibroid. Abdominal myomectomy usually requires a hospital stay of two to three days. Recovery takes four to six weeks.
The uterus is removed through the vaginal opening. This procedure is most often used in cases of uterine prolapse, or when vaginal repairs are necessary for related conditions. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vagina. However, if your uterus is enlarged, vaginal hysterectomy may not be possible.
LAPAROSCOPE-ASSISTED VAGINAL HYSTERECTOMY (LAVH)
Laparoscopically-assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope (a thin, flexible tube containing a video camera) to guide the removal of the uterus and/or fallopian tubes and ovaries through the vagina (birth canal). During LAVH, several small incisions are made in the abdominal wall through which slender metal tubes known as “trocars” are inserted to provide passage for a laparoscope and other microsurgical tools. Next, the uterus is detached from the ligaments that attach it to other structures in the pelvis using the laparoscopic tools. The fallopian tubes and ovaries are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina. LAVH typically requires a one to three day hospital stay. Complete recovery time is usually four weeks.
ROBOTIC-ASSISTED LAPAROSCOPIC HYSTERECTOMY
A robotic-assisted laparoscopic hysterectomy uses a computer to control the surgical instruments during the surgery. The surgeon controls the movements of the computer from a computer station in the operating room. At this point, three or four small incisions will be made near your belly button. Gas may be pumped into your belly to distend it to give your surgeon a better view and more room to work. The laparoscope is inserted into your abdomen; while other surgical instruments will be inserted through the other incisions. The surgeon will attach the laparoscope and the instruments to the robotic arms of the computer and then move to the control area to remotely control the surgery. Your uterus will be cut into small pieces that can be removed through the small incisions. Depending on the reasons for your hysterectomy, the whole uterus may be removed or just the part above the cervix. The fallopian tubes and ovaries attached to the uterus may also be removed. Most people stay in the hospital for a few days. Complete recovery may take anywhere from a few weeks to a few months.
The uterus is removed through the abdomen via a surgical incision about six to eight inches long. The main surgical incision can be made either vertically, from the navel down to the pubic bone, or horizontally, along the top of the pubic hairline. After the incision has been made through the layers of skin, muscle, and other tissue, the physician will inspect the organs and other structures in the abdomen and pelvis. The tissues connecting the uterus to blood vessels and other structures in the pelvis will be carefully cut away. The uterus will be removed, along with any other structures such as the ovaries, fallopian tubes, and cervix, as required by your situation. Abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. The recovery period is usually about six to eight weeks.
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