A lot of women and family members have asked me about when/how did I know I had fibroids. Actually it was a big surprise to me, BUT looking back I should of saw the signs. I thought it would be nice to start a list of all the things women and families have experienced when the uterine fibroids and uterus started to expand. I’ll start the list and I hope everyone will add to it so we can help others through their Journey.
This image presents a hysteroscopic view of normal tubal ostium.
Fibroids and Hysterectomies used to go together like Rogers and Hammerstein. Not anymore. If your physician recommends removing your uterus as the most effective treatment for severe fibroids without first considering less invasive therapies, start singing another tune and get a second opinion!
One of my favorite professors in medical school was fond of saying “There is nothing so constant in medicine as variation.” From my perspective, more than 25 years in clinical medicine, there is nothing so constant in medicine as change. At times the rate at which this change goes on is quite amazing. This can especially be said for the treatment of uterine fibroids over the last 100 years.
Have you ever noticed how easily misinformation develops and how eagerly it is spread by the ill informed? Of late I have heard and read all manner of seemingly authoritative pronouncements on uterine artery embolization (UAE) for the management of uterine myomas. I even saw an "authority" recently on OPRAH stating that UAE was experimental and not useful for tumors larger 4 cms.
I find myself frequently contemplating what the treatment for fibroids will look like in the future. There continues to be an explosion of both knowledge and technology that has left me with the firm conviction that in just a few years when one says "fibroid" the automatic word association will no longer be "hysterectomy".
More than 99 percent of fibroid tumors of the uterus are benign, and most require no treatment. However, if these growths get very large, they can become uncomfortable, enlarge the abdomen and bring on loner, heavier menstrual periods. Even some tiny fibroids can cause abnormal bleeding. Until recently, a woman with troublesome fibroids almost always ended up with a hysterectomy.
48 year old woman, a tumor in abdomen was discovered. No complaints now except anemia (Hb 4,4 mmol/l). After second delivery (17 years ago) period of abdominal pains. The cystic mass is WITHIN the fundal myometrium.
Ultrasound is widely used to locate and size uterine fibroids. According to the recent literature, 20% of women over the age of thirty-five develop uterine fibroids. Most women with fibroids do not develop problems and this abnormal uterine growth goes unnoticed.
One hundred and six pregnant women diagnosed with Leiomyoma during pregnancy were evaluated clinically and by ultrasound. Leiomyoma size changes were analyzed on the basis of trimesters. The common echotexture pattern and the different echotextures as well as any changes in the echogenicity were noticed during the follow up. The number and location of the myomata were observed with their impact on pregnancy outcome.
This is the 30 year old wife of a colleague, G2 P1, 19 weeks pregnant. This is a known myoma, posterior and left. Part of the placenta is implanted over this myoma.
The following images are of a 42 y/o woman with a chief complaint of DUB. She is not on hormones, due to mitigating factors.
First image is a longitudinal section of uterus and the second image is a transverse section at the level of the hypoechoic cervical mass.
K.C., a 44 year-old woman, called me from upstate New York. Over the past 15 years her uterus has gradually enlarged to the size of a seven month pregnancy due to the presence of multiple fibroids. She also suffered from asthma and her markedly enlarged uterus was contributing to her breathing difficulties. Her periods had become progressively heavier, leading to anemia.
As I arrived in my office early one morning, I received a phone call from a woman in great distress. D.W., a 43 year old woman, indicated that for the past ten months she had been suffering through increasingly heavy menstrual periods, passing large blood clots. She went on to explain that four months earlier she underwent a D&C (dilatation and curettage) because of this problem.
Mrs. Blumenthal*, a 40-year-old G1P1, had young twins at home and was also a full-time student. She delivered her twins in 1992 by C-section after conceiving through IVF. The patient had long-standing endometriosis, treated previously by three abdominal procedures (one laparotomy and two laparoscopies).
In late 1996 Mrs. Martin contacted our office and reported concern over the fact that her periods were occurring every 2 weeks. During the office visit, she stated that she was experiencing heavy bleeding with the passage of clots that lasted approximately 7 days, requiring the use of 10 or more pads per day. The problem was very upsetting to her and was interfering with daily life at home and at work.
One of the most effective treatments for bleeding is to stop the blood supply to the area that is bleeding by blocking the vessels from the inside, this is known as “embolization”. Embolization of the arteries to the uterus has been used as a treatment for severe uterine bleeding after surgery or childbirth since at least the late 1970s, and is used as a treatment for uterine fibroids.
afe abdominal entry and prevention of retroperitoneal vascular injuries during laparoscopic surgery are the ultimate goals of any laparoscopic surgeon. Dr. Linda Nicoll and colleagues very capably have been able to describe a new technique and technology that prevent almost all retroperitoneal vascular injuries during laparoscopic entry.
Laparoscopy is one of the most common surgical procedures performed in the United States today. It is the modality of choice for many physicians for removal of ectopic pregnancy, bilateral tubal sterilization, treatment of endometriosis, lysis of adhesions, cholecystectomy, appendectomy, splenectomy, prostatectomy, etc. It is becoming increasingly popular for more complex procedures, including laparoscopic hysterectomy and myomectomy.
Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. Every year a staggering 600,000 American women have a hysterectomy. And about 30 percent of those hysterectomies, 180,000 in all, are performed because of fibroids.
Hysterectomy is no longer the only treatment for uterine fibroids. Now, GnRH agonists and laparoscopic coagulation with lasers and bipolar needles are treatment options.
Obesity: to treat, or not to treat: that is the question? Recently I read a column in the Florida Sun Sentinel in which some ob/gyns in South Florida reported that they turned away obese patients-15 practices of the 105 polled stated that they had established a weight “cut-off” starting at 200 pounds. In the interest of transparency I must admit that I would have problems finding a doctor under these circumstances as I am 5′ 10.5″ and over these physicians’ set weight limit.
Transvaginal Ultrasonography, Sonohysterography, Hysterosalpingography And Operative Hysteroscopy In Predicting Endometrial Hyperplasia
Reproductive endocrinology, a relatively new subspecialty of obstetrics and Gynecology, came of age during the 1980s. The discipline has benefited greatly from substantial recent advances in reproductive biology and allied fields and technologic improvements in computers, ultrasonography, and surgical instrumentation. All of these developments have been applied to clinical practice at an unprecedented rate.
Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms can be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, I routinely do an Ultrasound of fibroid in endometrial cavity ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination.