Uterine Fibroid Treatments in Newport Beach, CA

What are Uterine Fibroids?

Uterine fibroids are simplest described as benign tumors that develop from the uterus’s smooth muscle tissue. Think of them as abnormally organized knots of muscle and fibrous tissue. Anywhere from 20% – 50% of reproductive aged women have uterine fibroids, and the National Institutes of Health estimates 80% of women will have uterine fibroids by age 50.  However, only about a third of these uterine fibroids cause clinical symptoms and are diagnosed by a healthcare provider. The majority of women remain undiagnosed  and have fibroids without even knowing it.  Nonetheless at the end of the day, many women will have uterine fibroids at some point in their lives.

Where Uterine Fibroids Can Grow  

There are four main types of uterine fibroids: subserosal, intramural, submucosal, and pedunculated – all which can vary in size from a few millimeters in diameter up to a few inches.  Each is classified by its location in the uterus which also impacts symptoms and treatment options. 

• Submucosal: Growing into the uterine cavity (endometrium), these often cause heavy bleeding.
• Intramural: The most common type, embedded within the muscular uterine wall.
• Subserosal: Protruding outward from the uterus, they can sometimes put pressure on other organs.
• Pedunculated: Attached to the uterus by a stalk, either inside or outside.

Submucosal Fibroids

Submucosal Fibroids fibroids develop underneath the endometrium (the lining of the uterus), protrude into the uterine cavity and even ones can cause significant problems due to their direct impact on the uterine lining.  Submucosal fibroids interfere with the normal growth and shedding of the uterine lining, leading to excessively heavy and longer periods, with occasional ‘in-between cycles’ bleeding.  This excessive blood loss can lead to iron-deficiency anemia, causing fatigue, weakness, and other ailments. A feeling of fullness or heaviness can create a sense of pressure being placed on the lower abdomen. Submucosal fibroids often cause severe cramping and pain during menstruation, worse than a woman’s typical period discomfort and can distort the uterine cavity to such a measure where it’s difficult for a fertilized egg to implant. Submucosal Fibroids are also associated with a slightly higher risk of miscarriage should pregnancy occur. Undergoing a transvaginal ultrasound and hysteroscopy where a thin camera is passed through the cervix allows direct visual inspection of the inside of the uterus to confirm a submucosal fibroid.  The severity of the symptoms they can cause, submucosal fibroids are usually treated with surgical removal (hysteroscopic myomectomy, see below).

Intramural Fibroids 

Intramural Fibroids are the most common type of uterine fibroid and develop within the thick muscular wall of the uterus (the myometrium).  Intramural fibroids can range from tiny or grow quite large and because they’re situated closer to the uterine cavity they tend to cause more symptoms compared to those deeper within the muscle including extended menstrual bleeding and more cramping – though some women with intramural fibroids have normal periods.  Larger intramural fibroids can press on the bladder, causing urinary frequency or urgency and/or a feeling of dull heaviness, pressure, or discomfort in their lower abdomen or pelvis.  Most intramural fibroids don’t significantly hinder pregnancy, especially if they’re small but larger fibroids and those distorting the uterine cavity, could make getting pregnant more difficult or slightly increase the risk of pregnancy complications. Undergoing a transvaginal or abdominal ultrasound is the primary way to detect intramural fibroids. If intramural fibroids are not causing problems, it’s possible they may only need to be monitored. Troublesome symptoms may be treated with medication and or a myomectomy (surgical removal, see below).

Subserosal Fibroids

Subserosal Fibroids develop on the outer surface of the uterus (the serosa), can be tiny or large and bulge outward into the pelvic area.  Since subserosal fibroids don’t directly impact the uterine lining they are less likely to cause heavy periods or severe cramps and may be asymptomatic entirely.  Subserosal fibroids can grow and press upon organs (or nerves) causing urinary frequency, constipation, difficulty emptying the bladder, pelvic, back or leg pain.  While most subserosal fibroids don’t pose a significant risk to fertility, large ones can slightly increase the risk of pregnancy complications. Undergoing ultrasound is the primary way to detect subserosal fibroids. If subserosal  fibroids are not causing problems, it’s possible they may only need to be monitored. Symptoms may be treated with medication to manage pain and large troublesome subserosal fibroids managed with a myomectomy (surgical removal, see below). 

Pedunculated Fibroids

Pedunculated Fibroids are rather unique, grow on a stalk-like base, growing from either the inner or outer surface of the uterine wall.  The means pedunculated fibroids can grow into the uterine cavity or bulge outward into the pelvic area.  Pedunculated fibroids can range in size and their stalk can sometimes twist, cutting off the fibroid’s blood supply producing sudden and severe pain. The sudden severe pelvic pain of twisting (torsion) pedunculated fibroids can sometimes mimic appendicitis or other abdominal problems thus any such experience warrants a medical evaluation to identify the cause. The pedunculated fibroids growing in the uterine cavity are prone to cause heavy bleeding, pain, and similar problems to other submucosal fibroids. The pedunculated fibroids growing outward into the pelvic area are more likely to cause pressure symptoms if they get large, and might be felt as a bulge.  Undergoing a transvaginal or abdominal ultrasound (and possibly as hysteroscopy) is the primary way to detect pedunculated fibroids. Due to their tendency for complications, pedunculated fibroids in the uterine cavity are often treated with hysteroscopic myomectomy (laparoscopic or open myomectomy for those on the outside of the uterus).

Uterine Fibroid Pain

Here’s a detailed description of the different ways uterine fibroids can cause pain, and what the pain might feel like:

Types of Fibroid Pain:

• Menstrual Cramps (Worse than usual): Fibroids, especially submucosal ones, can make period cramps far more intense and prolonged than usual.
• Pelvic Pressure or Heaviness: A constant ache, feeling of fullness, or pressure in the lower abdomen or pelvic area.
• Back or Leg Pain: Sometimes, large fibroids can press on nerves, causing pain that radiates into the lower back or down the legs.
• Painful Sex: Depending on fibroid location, sex might become painful (dyspareunia), particularly during deep penetration.
• Spotting or Bleeding Between Periods: While not technically pain, this often goes hand-in-hand with fibroid-related pain due to the disruption they cause.

How Fibroid Pain Can Feel:

• Dull Ache: A persistent, heavy feeling in your pelvis is common.
• Sharp or Stabbing: Sudden, intense pain might occur, particularly if a fibroid is outgrowing its blood supply.
• Cramping: Severe menstrual-like cramps, worse than your normal period.

Factors Making Pain Worse:

• Fibroid Location: Submucosal fibroids (inside the uterus) tend to cause worse pain and bleeding than other types. Large fibroids pressing on other organs can also be more painful.
• Your Period: Pain often intensifies around menstruation.
• Certain Positions: Pain might worsen in specific positions depending on where the fibroids are situated.

Important Notes:

• Not Everyone Has Pain: Many women with fibroids have no pain at all! Symptom severity varies greatly.
• Fibroid Pain vs. Other Things: Pelvic pain can have many causes. Getting an evaluation to confirm fibroids are the culprit is crucial.

If you’re struggling with pelvic pain, especially if it’s heavy during periods or accompanied by unusual bleeding, don’t hesitate to seek medical advice. It’s essential to rule out fibroids or other potential causes of your discomfort.

Uterine Fibroid Treatment

Here’s an overview of various treatment options for uterine fibroids,  including factors influencing the best approach for each woman:

1. Patiently Monitoring: In cases of small fibroids causing no or minimal symptoms, a prudent approach is ‘watchful monitoring’ with periodic ultrasounds to track any changes in size or symptoms.  This is often a measured and appropriate response to uterine fibroids that don’t worsen significantly and are minimally disruptive, if at all, to daily life. 

2. Medications: Birth control pills can decrease bleeding and sometimes control pain and Gonadotropin-releasing hormone (GnRH) agonists can  temporarily induce a menopause-like state, shrinking uterine fibroids.   However these hormonal medications come with side effects and uterine fibroids often regrow after stopping their use.  Other Hormonal Options such as Progestin-only medication, or a progestin-releasing IUD, can mainly help with heavy bleeding.  Non-Hormonal Tranexamic Acid can reduce menstrual bleeding but doesn’t shrink fibroids.  Pain relievers such as NSAIDs like ibuprofen can help with fibroid-related pain.

3. Non-Surgical Procedures: Uterine Fibroid Embolization (UFE) involves having tiny particles injected to block the blood supply to uterine fibroids, causing them to shrink. It’s minimally invasive but may not be suitable for all fibroid locations. Focused Ultrasound Surgery (FUS) uses ultrasound waves to destroy fibroid tissue, but is limited in who qualifies to receive treatment.  Radio frequency ablation destroys uterine fibroids using heat.  Endometrial ablation destroys the uterine lining, controlling heavy bleeding but does not treat the uterine fibroids themselves and eliminates the possibility of future pregnancy.

4. Surgical Options: Myomectomy is the surgical removal of uterine fibroids while preserving the uterus. This may be done hysteroscopically (through the cervix), laparoscopically with robotics (small incisions), or open (larger abdominal incision), depending on fibroid size, location, and number.  In women seeking pregnancy, myomectomy may be necessary to restore the anatomy of the uterus and help improve chances of implantation. Hysterectomy involves the removal of the entire uterus and while a definitive solution for uterine fibroids, eliminates the possibility of future pregnancy.

In choosing the best treatment for your circumstances, it’s prudent to consider the severity of symptoms such as level of bleeding, pain, and pelvic pressure; whether pregnancy is an option you want to preserve; fibroid quantity, size, and location(s) affects the feasibility of certain procedures, age and proximity to menopause since uterine fibroids often shrink after menopause and of course overall health.

There is no single “best” treatment and what works for one woman may not be suitable for another.  A thorough evaluation and discussion of your goals is essential for choosing the most appropriate treatment plan.  If you’d like to explore any of these treatments in more detail, or discuss how to weigh the pros and cons of each option for your specific situation, feel free to reach me.  

Myomectomy Surgery to Treat Uterine Fibroids

Myomectomy surgery aims to relieve heavy bleeding, pain, pelvic pressure, bladder/bowel issues, and potential fertility problems caused by uterine fibroids.  The primary goal is to remove the uterine fibroids while leaving the uterus intact, allowing for future pregnancy.

The type of myomectomy depends on the size, number, and location of the uterine fibroids:

1. A Hysteroscopic Myomectomy treats submucosal fibroids protruding into the uterine cavity.  This procedure involves a thin scope with a camera (hysteroscope) inserted through the cervix, tools are passed through to shave or cut away the fibroids from inside the uterus.  There are no external excisions and the procedure is performed entirely through the natural vaginal opening.

2. A Laparoscopic Myomectomy treats intramural and subserosal fibroids of various sizes. The procedure involves small incisions made in the abdomen where the laparoscope (camera) and surgical instruments are inserted. The fibroids are removed, and the uterine muscle is carefully repaired.  The robotic approach is typically used. This procedure is minimally invasive and offers a swift recovery compared to open surgery.

3. Open Myomectomy (Laparotomy) treats very large fibroids, multiple fibroids, or those in difficult-to-reach locations. The procedure requires a larger abdominal incision to access and remove the fibroids.  Recovery time is generally longer than other approaches.

General Procedure Steps:

• Anesthesia: Usually done under general anesthesia (you’ll be asleep).
• Fibroid Removal: Varies by technique, but involves carefully cutting fibroids from the uterus.
• Uterine Repair: Meticulous stitching to close the muscle layers where fibroids were removed, minimizing scarring and strengthening the uterus.
• Recovery: Hospital stay length varies, pain medication is prescribed. Full recovery can take several weeks, depending on the surgical approach.