What are the different types of fibroids?

There are many different types of fibroids. Depending on their size and location, fibroids can present with a wide range of symptoms.

Fibroids can be divided into submucosal, intramural or subserosal:

• Submucosal fibroids: These fibroids are located just underneath the endometrium, or lining of the uterus, and protrude into the uterine cavity.  Submucosal fibroids can vary in how much of the fibroid protrudes into the uterine cavity and how much is in the muscle of the uterus. They often cause heavy bleeding and long periods, but they can also cause irregular bleeding.
  
  
• Intramural fibroids:  These fibroids are found predominantly in the myometrium, or muscle of the uterus. Depending on their size and location, these fibroids can also extend toward and distort the uterine cavity or protrude outside the uterus.  Intramural fibroids can be asymptomatic (causing no symptoms), cause bleeding abnormalities, or cause pressure and bulk symptoms.
• Subserosal fibroids: These fibroids are located near the outside of the uterus.  They can be partially in the myometrium (muscle of the uterus) or hanging off the outside of the uterus. They can cause bulk symptoms such as bladder or rectal pressure.

What symptoms do fibroids cause?

Most fibroids cause no symptoms at all. Depending on their size, location and number, fibroids can become significantly problematic.

Some common symptoms associated with fibroids include:

• Abnormal uterine bleeding, heavy or long periods
• Bulk and pressure symptoms
• Bladder pressure, frequent urination
• Rectal pressure, constipation
• Infertility or recurrent miscarriages/pregnancy loss
• Pregnancy complications
• Pain
• Anemia

What are the treatment options for fibroids?

There is a wide range of treatment options for fibroids.  Many factors influence treatment choice.  These include symptoms, fibroid location, size and number, age, reproductive plans and a woman’s preferences.

There is medical management:

• Gonadotropin-releasing hormone agonists (GnRH agnosits):This medication is given as an injection (shot), either every month or every three months, and puts you in a temporary state of menopause. While on the medication the fibroids shrink. Once the medication is stopped, the fibroids usually re-grow and symptoms return. GnRH agonists are usually used to prepare women for surgery or to bridge women close to their natural menopause. GnRH agonists are not usually used for long-term treatment.

Other hormone treatments, including:

• Progestins (oral, by injection or intra-uterine device [IUD]), oral contraceptive pills, androgenic agents (such as danazol) and anti-estrogens (such as raloxifene) have been used to try to control heavy bleeding in women with fibroids. However, these medications do not consistently decrease the size of the fibroids or uterus and are usually ineffective in reducing the amount of bleeding.

There is surgical management:

• The surgical procedures provided at the MIGS Center combine current technology, and medical and surgical expertise to treat fibroids on an outpatient basis.
• Myomectomy is a surgical procedure in which only the fibroids are removed, preserving the uterus. As an alternative to hysterectomy, one advantage of a myomectomy is that with the uterus in place, childbearing remains an option. A disadvantage of a myomectomy is that when the uterus remains in place, fibroids can recur, sometimes requiring additional surgery.

 

Fibroids can be removed by hysteroscopic myomectomy, laparoscopic myomectomy or an open abdominal myomectomy.

• Hysteroscopic myomectomy is a technique used to remove fibroids that are submucosal. A hysteroscope, a thin tube containing a video camera, is passed through the cervix and into the uterus. The fibroid is then removed by shaving it out. There are no incisions with a hysteroscopic myomectomy. It is a day surgery procedure (you typically leave the hospital 1 hour after the completion of the procedure) with a 1-day recovery period.
• Laparoscopic myomectomy is a technique used to remove fibroids that are intramural (deep in the muscle of the uterine wall), subserosal or pedunculated(on the outside of the uterus).  This minimally invasive technique uses a laparoscopic technique to remove the fibroids through very small incisions. It is a day surgery procedure (you typically leave the hospital 1-2 hours after the completion of the procedure) with a 1-2 week recovery period.
• Open myomectomy uses a traditional large abdominal incision to remove the fibroids. Most fibroids can be removed by minimally invasive techniques; the use of the open method is limited to women with specific situations where laparoscopic or hysteroscopic removal of fibroids is not appropriate.

• Uterine Artery Embolization/Uterine Fibroid Embolization (UAE/UFE) is performed by an interventional radiologist.  The blood flow to the uterus and/or fibroid is blocked, leading to necrosis and a gradual shrinkage of the fibroid.
• MR-Guided Focused Ultrasound uses ultrasound energy to heat and destroy the fibroid causing gradual shrinkage of the fibroid.
• Fibroids can be treated with a hysterectomy, which involves removing the uterus with the fibroids. The hysterectomy can typically be done in a minimally invasive way.