For women who are experiencing heavy and/or prolonged menstrual bleeding, a careful gynecological evaluation should include the presence of uterine fibroids. Also known as leiomyomas, those benign growths of the uterus may cause pelvic pressure, constipation, changes in urination and discomfort. Fibroids are very common and it is estimated that approximately 70% of women have a uterine fibroid at some point in their lives. Most of the time, they are small and do not cause any symptoms especially if they are located within the wall of the uterus itself. Fibroids growing into the uterine cavity may cause heavy periods. Large fibroids projecting out in the abdominal cavity can cause abdominal symptoms. Fibroids can be palpated during a pelvic exam or found on ultrasound, when investigating a gynecological problem.
Fibroids are best left alone if they do not cause any problems. They do tend to decrease in size after menopause. Otherwise, treatment includes medications such as oral contraceptives (to help alleviate heavy bleeding). The only definitive treatment for fibroids is surgery. Depending on its location and size, a fibroid can be shaved off the wall inside the uterus (hysteroscopic resection), removed from the uterus (myomectomy), or the uterus can be removed all together (hysterectomy).
In very rare cases (about one in 350), what is thought to be a benign fibroid turns out to be a sarcoma, which is a malignant (cancerous) tumor of the uterus. Therefore, before undergoing a minimally invasive surgery (laparoscopic hysterectomy), women must understand that using a technique called power morcellation to remove the uterus can unknowingly spread cancer cells inside her abdomen. It is impossible to know ahead of time if the fibroid is a sarcoma or not but certain signs can help differentiating the two. If a fibroid uterus grows rapidly, or grows after the age of menopause, this can be more concerning. If you are not comfortable with those risks, you can discuss with your doctor the possibility of an abdominal hysterectomy (where the uterus is delivered intact via a larger abdominal incision) or simply by avoiding the use of the power morcellator during surgery.