Although uterine fibroids are a common occurrence for many women, they’re very case specific. These benign tumors differ in location, size, and number from one individual to the next. For this reason, the therapeutic approach must reflect each unique situation in order to ensure the best possible health outcome.
Uterine fibroids can grow in any part of the uterus, whether it’s inside the uterine cavity (submucosal), within the uterine wall (intramural), or outside of the uterus (subserosal).1,2
Although the majority of fibroids grow within the intramural space, many variations are possible. “Fibroids arise from normal uterine cells which mutate and then grow in an abnormal way,” said Dr. James Spies MD MPH, Professor, Chairman and Chief of Service of the Department of Radiology at Georgetown University School of Medicine. “They’re benign tumors, but as they grow, they can cause symptoms, and these symptoms vary depending on the location of the fibroids within the uterus. They can affect everywhere from the inner portion of the uterus to the outer portion.”
Although single or multiple fibroids can grow anywhere in the uterus, these characteristics are often a secondary issue. How deeply embedded a fibroid is within the uterus is reason for concern, especially since this particular type of fibroid has been linked to severe symptoms. “The fibroids that cause the biggest problems are typically those deep within the uterus,” Dr. Spies explains. “One woman might only have one fibroid that’s small but deep that causes significant symptoms. Another woman may have very large fibroids but in a position where they don’t cause the same kind of symptoms.”
Yet, fibroid size can’t be entirely discounted. In conjunction with depth, large fibroids can bring on severe symptoms and diminish the effectiveness of treatments. This can be an obstacle for procedures where the goal is to shrink and destroy fibroid tissue.
According to one study, after UFE treatment, fibroids shrink by approximately 45% in diameter and turn into a scar.3 Although there’s no size restriction for UFE, relatively speaking, if a fibroid is already very large upon treatment, symptoms may not improve dramatically if the entire fibroid could not be completely destroyed. In cases like this, surgical removal of the fibroid, as seen with a myomectomy, may be a sound option.4
Medications are another therapeutic point of interest, but at this time more research is needed for them to be considered an effective stand-alone treatment. “There is not a pill you can take that’s going to control the growth of fibroids or solve fibroid problems long-term,” Dr. Spies continues. And again it depends on the woman. “A woman with fibroids deep within the cavity of the uterus—usually medication alone is unlikely to solve the problem.”
Medications like contraceptives may at times be prescribed in cases with smaller fibroids to alleviate symptoms such as heavy painful periods. Others such as gonadotrophin releasing hormone (GnRH) analogues are a short-term option that may be used to help shrink fibroids before a surgical procedure.5
Every woman is different and because of this there isn’t an umbrella treatment protocol to follow. “There are so many variables you really can’t easily distill it down to that.” Dr. Spies clarifies. “Patient preference is a strong issue.” Whether or not a woman even wants surgery or desires to preserve her fertility are very valid concerns that need to be taken into consideration.
As with any condition, it’s important to first be properly diagnosed and learn the benefits and risks associated with each therapeutic approach. “A woman can’t self-diagnose or choose a treatment option without guidance. It takes someone who practices in the field and who is experienced to be able to get a sense of which fibroids are key and which are not and which therapies are best for her particular fibroids.”
ABOUT THE AUTHOR Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a Registered Dietitian Nutritionist, a Certified Dietitian, and a Holistic Life Coach. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.
ABOUT THE DOCTOR James Spies is the Chairman, Chief of Service, and a Professor of the Department of Radiology at Georgetown University School of Medicine. He is an interventional radiologist whose primary clinical and research interest is in uterine embolization for fibroids. His specialty is in radiology and his special interests include uterine artery embolization and gynecologic intervention.
1. US Department of Health and Human Services, Office On Women’s Health. (2015). Uterine fibroids fact sheet. Retrieved April 21, 2015, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html?from=AtoZ
2. King, R., & Overton, C. (2011). Management of fibroids should be tailored to the patient. The Practitioner, 255(1738): 19-23, 2-3.
3. Lee, M. S., Kim, M. D., Jung, D. C., Lee, M., Won, J. Y., Park, S., Lee, D. Y., & Lee, K. (2013). Apparent diffusion coefficient of uterine leiomyoma as a predictor of the potential response to uterine artery embolization. Journal of Vascular and Interventional Radiology, 24(9): 1361-1365. doi:10.1016/j.jvir.2013.05.054
4. (2014). When is a myomectomy better than a uterine fibroid embolization (UFE)? Retrieved April 20, 2015, from https://ask4ufe.com/videos/when-is-a-myomectomy-better-than-a-uterine-fibroid-embolization-ufe/
5. Segars, J. H., Parrott, E. C., Nagel, J. D., Guo, X. C., Gao, X., Birnbaum, L. S., Pinn, V. W., & Dixon, D. (2014). Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Human Reproduction Update. doi:1093/humupd/dmt058