Fibroids of the Uterus | Pain and Bleeding

How do I know if I have fibroids?

Uterine fibroids make their presence known most commonly by pelvic pain and/or heavy menstrual bleeding.

Fibroids are usually detected in patient’s 30’s or 40’s, when the growth of the benign tumors has reached a stage where pressure upon adjacent organs may be felt. This can include the intestines and the bladder. Patients often complain of more frequent urination also, as the bulk of the enlarged fibroid uterus diminishes bladder capacity. Additionally, fibroid growth within the anatomic confines of the uterus can generate significant pain and pressure. The increased weight of the uterus itself can lead to ligament strain and lower back pain.

The increased menstrual flow is from a number of mechanisms including an enlargement of the lining of the endometrial cavity, stretched over a fibroid. This provides a greater surface area from which to bleed. Additionally, the adjoining fibroid disrupts the normal blood flow to the uterine lining, depriving the lining of the normal blood-borne hormonal messages the ovary makes, in its regulation of menses.

Why should I worry?

The disruption of blood flow can be significant enough to create tissue death, or necrosis, of the lining, with resulting heavy unregulated menstrual flow.

What does treatment look like?

A first-line attempt of treatment is often the “D and C.” This dilatation and curettage scrapes the lining from within the uterus. However, if there is an underlying fibroid, which is contributing to the clinical picture, the D & C usually cannot remove the fibroid, and the results may not be adequate.

The Acessa procedure is an exciting new outpatient treatment for fibroids that destroys (or ablates) fibroids using radio frequency. This does not require surgical excision. It is uterine-sparing, and is a very significant advancement in fibroid treatment.

Patrick Diesfeld, MD

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