Uterine Fibroids

Uterine Fibroids Causes & Treatment

What are uterine fibroids?

Every organ in your body has different tissue types. Each tissue type within a given organ can develop its own set of tumors, both benign and malignant. When an organ develops a tumor, it will be of a tissue type normally contained within that organ. A muscular organ like the uterus makes muscle tumors. Therefore, there is nothing fibrous about fibroids. Fibroids are muscle tumors. We refer to them as myomas (“myo” means muscle; “oma” means new growth or tumor). Sometimes you will see the term leiomyoma, which refers to the fact that it is the smooth muscle of an organ as opposed to the striated muscle of the skeleton. Myomas can become malignant in less than half of 1% of cases, so myomas are generally benign, and polyps (benign growth of the endometrium) have the same low risk of malignancy. 

Fibroids can be deep within the uterine wall (Intramural), expand from inside the uterine cavity, through the uterine wall to the outside of the uterus (Transmural). They might also be mostly on the outside of the uterus (Subserosal). Fibroids can be safely removed with minimally invasive surgery. Our goal is to manage the uterine fibroids safely with minimally invasive surgery and preserve fertility whenever possible. 

4 Indications to Intervene on Uterine Fibroids

Uterine fibroids when large can cause pelvic pressure, back/hip/leg pain, and urinary frequency and/or urinary incontinence. The bony pelvis is a fixed amount of space, and the uterine muscle tumors are solid and relatively heavy, so that normal organs (bowels, bladder, and ureters) can be pressed upon. But when a person with fibroids has too much pain, then you need to consider the possibility of an additional cause for pain, such as endometriosis. 

There are 4 indications to intervene on uterine fibroids: 

  1. Discomfort; 
  2. Heavy bleeding; 
  3. Uterine size greater than a 3 month pregnancy (because the fibroid tumors may press on other organs); 
  4. Rapid uterine growth (because of the small risk of malignant change).  

Treatment Options for Uterine Fibriods

Treatment options include:

  1. Fibroids within the uterine cavity, we can do a Hysteroscopic Myomectomy and shave the fibroids out from the inside. 
  2. Fibroids that are deep within the uterine wall, trans-mural, or subserosal, we can do laparoscopic myomectomy, where the uterine fibroids are removed and the uterine wall is repaired. 
  3. Fibroids that are very large or the uterine wall is filled with many fibroids, then the uterine body along with all the fibroids is removed and the patient can keep the cervix and ovaries. 

All pelvic supports will be protected and there will be no adverse effect on bladder function. Hormones are a function of the ovaries, not the uterus, so hysterectomy, total or supracervical, will not make you menopausal or alter sexual function. 

In the small chance that a uterine fibroid is malignant, morcellation (removing the tumor in pieces) could spread and upstage the uterine fibroid malignancy. Therefore, morcellation of uterine fibroid tumors is not an option, and  Mini-laparotomy (minimal enlargement of one of the incision sites) is required to remove the specimen. I have found that as long as the procedure is accomplished by laparoscopy, and the abdominal incision is only used to remove the specimen, the patients have very minimal pain from the mini-laparotomy incision. 

Controversy Regarding Laparoscopic Myomectomy

*** There is currently a controversy with laparoscopic myomectomy. In the small chance that a uterine fibroid is malignant, the process of morcellation could spread and upstage the uterine fibroid malignancy.

Therefore, morcellation of uterine fibroid tumors is currently not an option, and a mini-laparotomy incision is required to remove the specimen. 

Frequently Asked Questions About Uterine Fibroids

  1. What are uterine fibroids?
    The uterus is a thick-walled muscular organ with an inside lining called the endometrium (“metri” means uterus; “endo” refers to inside lining). Although the uterus is primarily a thick-walled muscle, it is the lining that bleeds, not the uterine wall. To cause heavy uterine bleeding, fibroids need to involve, or be up against, the uterine lining. Fibroids are muscle tumors, called myomas (“myo” means muscle; “oma” means new growth or tumor). Leiomyoma refers to the smooth muscle of an organ as opposed to the striated muscle of the skeleton. Myomas are generally benign, but can become malignant in approximately 0.5% of cases.

  2. Where are uterine fibroids typically found?
    Fibroids can be on the outside of the uterus (sub-serosal) or the inside of the uterus (sub-mucosal or intra-cavitary). Small fibroids can be just in the uterine wall (intra-mural) or they can be large enough to extend from inside the uterine cavity through the uterine wall to the outside of the uterus (trans-mural). 

  3. What are common symptoms of uterine fibroids?
    Uterine fibroids, when large, can cause pelvic pressure, back/hip/leg pain, urine frequency and/or urinary incontinence. The bony pelvis is a fixed amount of space, and the uterine muscle tumors are solid and relatively heavy, so that normal organs (bowels, bladder, and ureters) can be pressed upon. But when a person with fibroids has too much pain, then you need to consider the possibility of an additional cause for pain, such as endometriosis.  

  4. What is the relationship between uterine fibroids and endometriosis?
    There is no cause-and-effect relationship between endometriosis and uterine fibroids. Endometriosis and uterine fibroids tend to occur together only because they both do well in the same environment of estrogen and blood flow. 

  5. When would I know it's time to deal with my uterine fibroids? 
    There are four indications to intervene on uterine fibroids: 1) discomfort, 2) heavy bleeding, 3) uterine size greater than a three month pregnancy (because the fibroid tumors may press on other organs), 4) rapid uterine growth (because of the small risk of malignant change).  

  6. What are some treatment options for uterine fibroids?
    Treatment options for uterine fibroids: 1) hysteroscopy to shave fibroids from inside the uterine cavity, 2) laparoscopic myomectomy to remove remove fibroids through an incision and repair of the uterine wall, 3) laparoscopic hysterectomy for large and/or multiple fibroids. Cervix and ovaries can be conserved.

Do you have unanswered questions about uterine fibroids?
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