An estimated 50 to 70 percent of women have uterine fibroids

noncancerous growths that tend to develop during childbearing years.
Most women are unaware that they have them, but 20 to 40 percent of women older than 35 experience symptoms, most commonly heavy menstrual flow.

Treatment options for uterine fibroids have increased dramatically in the last 20 years, according to UCLA obstetrician/gynecologist Michael Johnson, M.D. In the past, physicians were likely to advise removing the growths, but today the choice of treatment — including doing nothing — is largely driven by patient preference, Dr. Johnson says.

Uterine fibroid embolization, for example, cuts off the blood supply to the fibroid, causing it to shrink. The procedure is performed by an interventional radiologist and takes about one hour, says Cheryl Hoffman, M.D., director of interventional radiology at Santa Monica- UCLA Medical Center and Orthopaedic Hospital. Patients are back to their routine within one or two weeks, compared with four to six weeks following a surgical procedure, she says. Because of the potential but limited risk of inducing premature ovarian failure, the procedure is done less frequently for women who still want to become pregnant, Dr. Hoffman adds.

Another procedure to treat small fibroids and preserve fertility involves a simple outpatient surgery: hysteroscopic myomectomy. During the procedure, a fiber-optic scope is passed through the cervix to cut out the fibroid. The procedure can also be done laparoscopically in some patients.

With procedures like embolization and hysteroscopic myomectomy more commonly available, “patients now determine when they want treatment, and select the type of treatment that works best for them,” says Dr. Johnson. He notes that, in most cases, fibroids aren’t inherently dangerous and almost never turn cancerous, and they often disappear after menopause. “For most women, it just depends on whether the symptoms are bothersome,” he says.

One exception, Dr. Johnson notes, is when fibroids are present during the reproductive years. He explains that for the vast majority of women, fibroids don’t affect fertility or the ability to carry a pregnancy, but, depending on their size and location, they can pose a risk. Such cases need to be evaluated on an individual basis, he says.

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Reprinted With Permission UCLA Health System © Vital Signs, Summer 2009

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