Gynecologists at UT Southwestern Medical Center provide expert care for women with uterine fibroids and other conditions that cause heavy bleeding and painful periods. From medications to minimally invasive procedures to surgery, we deliver the services patients need to achieve their best health.
Latest Therapies for Uterine Fibroids
Uterine fibroids, a common condition also called myomas or leiomyomas, are noncancerous (benign) growths in or on the uterus. Fibroids almost never develop into uterine cancer, nor do they increase the risk of cancer, but they can affect women’s quality of life. They can range in size from microscopically small to large masses weighing several pounds that enlarge the uterus.
Uterine fibroids share some common symptoms with uterine polyps, but the two types of growths differ in several ways:
- Fibroids are growths of muscle tissue, whereas polyps are growths of the uterine lining.
- Polyps can lead to cancer; fibroids hardly ever do but can mask a rare cancer called leiomyosarcoma.
- Fibroids can shrink after menopause but do not go away on their own. Polyps are typically smaller than fibroids and often go away without treatment.
Our highly skilled gynecologists are at the forefront of research on treatment methods for uterine fibroids. We bring the latest research findings directly to our patients to help relieve their symptoms and improve their overall health.
Types of Uterine Fibroids
Fibroids can be categorized based on their location, such as:
- Intramural: In the muscle wall of the uterus
- Pedunculated: On a stalk on the outside of the uterus or inside the uterine cavity
- Submucosal: Under the inside uterine lining
- Subserosal: Under the outside uterine lining
Causes of Uterine Fibroids
The exact cause of fibroids is unknown, but certain factors might play a role in their development. These include:
- Genetic changes: Many fibroids contain genetic material that is different from that of normal muscle cells in the uterus.
- Hormones: Estrogen and progesterone might promote fibroid growth. Fibroids tend to shrink after menopause because of reduced hormone levels.
Symptoms of Uterine Fibroids
Many women have one or more fibroids during their lifetime, but they might not realize it because fibroids don’t always produce symptoms. When symptoms do occur, they can include:
- Bleeding between periods
- Constipation or difficulty with bowel movements
- Frequent urination or difficulty urinating
- Iron-deficiency anemia caused by chronic blood loss
- Longer or more frequent periods
- Lower back pain, typically dull aching
- Pain during sexual intercourse
- Painful periods and heavy bleeding, sometimes with blood clots
- Pelvic pain, cramps, pressure, or feeling of fullness
Diagnosing Uterine Fibroids
Our experienced gynecologists evaluate symptoms to diagnose fibroids and rule out other conditions with similar symptoms. We begin with a thorough evaluation that includes a:
- Discussion of symptoms
- Review of personal and family medical history
- Physical and pelvic exam
To confirm a diagnosis, we might recommend one or more additional tests, such as:
- Blood tests: Tests of a patient’s blood sample to check for signs of anemia or rule out other conditions
- Ultrasound: Imaging that uses sound waves to check inside the pelvic region for fibroids
- Magnetic resonance imaging (MRI) scans: Equipment that uses a large magnet and radio waves to produce detailed images that can show the size and location of fibroids
- Hysterosonography: Also called a saline infusion sonogram, an ultrasound procedure that injects sterile saline into the uterus to expand it, making it easier to see fibroids affecting the uterine lining
- Hysterosalpingography: Procedure that injects contrast dye to highlight the contour of the uterine cavity and fallopian tubes in X-rays
- Hysteroscopy: Procedure in which the doctor inserts a narrow, lighted camera through the cervix into the uterus to examine its interior walls
- Laparoscopy: Minimally invasive procedure in which a doctor makes a small incision near the navel to insert a narrow scope to view inside the pelvic area
Treatment for Uterine Fibroids
At UT Southwestern, we offer all available treatment options for uterine fibroids. Using the information from our evaluation, we develop treatment recommendations based on the:
- Size and location of the fibroid(s)
- Patient’s age
- Patient’s desire to have children in the future
- Patient’s desire to keep her uterus
Our nonsurgical treatment options include:
Watchful waiting: Women who have small fibroids, do not have symptoms, or are near menopause might not need treatment.
Prescription medications: Medications can regulate menstrual cycles and relieve symptoms such as heavy bleeding, pressure, and cramps. Some types of medications might also shrink fibroids but cannot eliminate them. Medication options include:
Over-the-counter medications and supplements: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain. Women who develop anemia might need to take vitamins and iron supplements.
MRI-guided focused ultrasound surgery: This noninvasive procedure takes place inside an MRI scanner to provide the location of the fibroids. The doctor uses an ultrasound transducer device to focus sound waves into the fibroids to destroy small areas of tissue. (While previously offered through clinical studies at UTSW, we do not currently offer this procedure.)
For women who have larger fibroids or worsening symptoms, our gynecologists specialize in minimally invasive gynecologic surgery, such as:
- Hysteroscopic myomectomy: During a diagnostic hysteroscopy, the doctor can remove submucosal or pedunculated fibroids in the uterine cavity using electricity or a laser.
- Laparoscopic or robot-assisted myomectomy: Fibroids are surgically removed from the uterus and the uterus is reconstructed. There are various methods for this technique; based on size and location of the fibroids, your surgeon might recommend laparoscopic myomectomy (the surgeon makes a few small incisions to insert the scope and miniaturized instruments to remove fibroids, leaving the uterus intact) or robotic-assisted myomectomy (a type of laparoscopic surgery in which a surgeon uses a robotic system with a console that provides magnified, high-resolution 3D imaging of the surgical site and controls arms with miniaturized instruments to remove fibroids). In some cases, an abdominal myomectomy may be recommended (the surgeon removes very large, very deep, or multiple fibroids using an open technique, leaving the uterus intact).
- Endometrial ablation: The doctor accesses the uterus through the vagina and cervix, using an instrument that uses heat, microwave energy, or electricity to destroy the uterine lining. This procedure controls heavy bleeding by slowing or stopping menstruation.
- Uterine artery embolization: In this minimally invasive procedure that shrinks the fibroid, interventional radiologists feed a catheter through an artery to the uterus. They then pass tiny particles through the catheter into uterine blood vessels.
- Laparoscopic ultrasound-guided radiofrequency fibroid ablation (Acessa procedure): This minimally invasive surgical treatment uses heat to shrink uterine fibroids.
We coordinate care with our interventional radiologists for uterine artery embolization, a catheterization procedure. The doctor accesses the artery that feeds the fibroid using a catheter (long, narrow, flexible tube). The doctor then injects embolic agents (tiny particles) through the catheter to cut off the fibroid’s blood supply, causing it to shrink.
If other treatments have not been successful, or for women with very large fibroids, we offer traditional surgery that uses one large incision to access the uterus:
- Hysterectomy: The surgeon removes the uterus for women who don’t want children in the future. This can be done through an open abdominal incision, laparoscopically, robotically, or vaginally, based on the size and location of fibroids and other medical conditions.
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Dallas, Texas 75390 214-645-3858