libraries are very common muscle tumors
of the uterus we know that over the
course of a lifetime probably close to
70% of Caucasian women and 80 percent
more than 80 percent of african-american
women will develop thyroid
now the vast majority of women that
develop fibers have no issues they're
found incidentally our up to a quarter
of women will actually have some
symptoms that will bring them in to seek
a physician's evaluation if you haven't
sent some some fibers there will
typically be heavy bleeding or pain or
pressure symptoms sometimes increase
your urinary frequency the options for
managing fibroids include watching and
waiting medical management or
interventional radiology procedures and
surgery Brigham Women's Hospital has all
of these options available most fibers
are usually discovered during a pelvic
exam either in primary care providers
office if the primary care provider does
the pelvic exam or in the animal
gynecologic exam and this often triggers
an ultrasound or some imaging modality
to get a sense of the size and location
of the fibroids alternatively some women
will presume with symptoms that trigger
this evaluation whether it's the heavy
bleeding or the pressure or the pelvic
pain that triggers an imaging that will
lead to diagnosis of fibroids medical
management is typically geared for
abnormal bleeding symptoms most of the
medications in that group affect
bleeding but do nothing for the size and
a bulk type symptoms that patient has
the only medication that is widely used
that effect size and bleeding is a depo
lupron injection overall medical
management of fibroids is not as well
studied as other interventions for
fibroids we know that it's sort of a
band-aid and a lot of patients will
respond to the medical management the
management but their symptoms will
return once they discontinue these 90
days and often they will end up needing
some other intervention in the future
the next set of options for patients are
procedures done by our interventional
radiology physicians
these procedures there are two common
procedures and both of these procedures
are offering and
Hospital the most common procedure year
light artery embolization or uterine
fibroid embolization essentially they
target the blood vessels that feed the
ears and include those vessels basically
to or decrease in blood supply to the
fibroid and overall shrinkage of the
fibroid and the size of yours and the
patient will notice usually a decrease
in bulk and umbria symptoms after these
procedures
the other option performed by our
interventional radiologists is the
magnetic resonance guided focus
ultrasound to qualify for a magnetic
resonance guided focus ultrasound the
fibroids usually have to be of a certain
size usually limited to one fibroid and
usually in the perfect spot meaning that
they can be behind the bladder or it can
be behind the bowel because the energy
of the ultrasound that's use can damage
those important structures if they're
not properly located the options for
surgery include removing the fibroid or
removing the years now removing the
fibroid can be approached in several
different ways
if the fibroid is located completely
inside the cavity of the uterus that can
be removed by an approach called
hysteroscopy where the camera and a put
metal place through the cervix in the
operating room and the fibroid is shaved
down from inside a cavity if the fibroid
is located in the wall of the uterus
this can be approached by either an
abdominal incision similar to an
incision for a c-section side to side in
the skin or up and down in the skin and
the fibroid is typically removed that
way alternative routes to the open
incision include laparoscopy for robotic
surgery both these techniques include
placing small and seeds in the wall of
the abdomen to remove the fibroids the
other surgical option is performing a
hysterectomy hysterectomy can perform
vaginally if the size of fibroid is
small enough with large
give awry with large fibroids oftentimes
the hysterectomy is performed with a big
incision on the abdomen or
laparoscopically or robotically as well
fibroid surgery can be performed by a
general
GYN it can be performed by a minimally
invasive gynecologic surgeon like myself
it can be performed by Reproductive
Endocrinology and infertility specialist
as well as a gynecologic oncologist
depending on the availability of closer
to where you are