UTERINE MYOMAS

About Your Diagnosis
Uterine myomas also called “fibroids” are tumors that grow from the wall of the uterus. The wall of the uterus is made of muscle tissue, so a fibroid is a tumor made of muscle tissue. The fibroids start off very small, actually from one cell, and generally grow slowly over years before they cause any problems. Most fibroids are benign; malignant fibroids are rare. The cause of fibroids is unknown, although it is known that fibroids have a tendency to run in families. Fibroids are very common, with an estimated 50% of women having them. Fibroids can be diagnosed by pelvic examination or by ultrasound. Fibroids do not have to be removed unless they are causing symptoms such as heavy periods, irregular bleeding, or severe cramps with periods. Also, sometimes the size alone causes enough discomfort so that removal is necessary. Once women go through menopause, fibroids do not usually cause any further problems.

Living With Your Diagnosis
The most common symptoms are:
• Cramping with periods.
• Heavy flow or clots with periods.
• Discomfort, such as pressure, as well as being unable to lie on your stomach and being unable to button your clothing easily, caused by the mass of the fibroids. Other, less common symptoms include irregular bleeding and urinary frequency caused by the pressure on the bladder from the fibroids. If your periods are very heavy, you may become anemic and an iron supplement may be recommended.

Treatment
If fibroids become symptomatic enough, they can be removed surgically. The most common surgical approach is to perform an “abdominal myomectomy. An incision is made in the lower abdomen into the abdominal cavity, and the fibroids are removed from the uterus and the uterus stitched closed. If the uterus is no longer necessary (the woman is finished having her family) and the woman desires her uterus removed, a hysterectomy (removal of the uterus) can be performed. (A “hysterectomy” is removal of the uterus and cervix, not removal of the ovaries. Therefore, a woman who has a hysterectomy does not necessarily go through menopause.) If a “submucous” fibroid is diagnosed, then the removal of the fibroid can be performed through the cervix. This is called a “hysteroscopic myomectomy.” Because the instrument goes through the cervix, there is no cutting. It is usually a same-day procedure, which means you come in on the day of the procedure and go home the same day, with a minimal recovery period. If you are very anemic or the fibroids are very large, you may be treated before surgery with a medication called Depot Lupron. This medication puts you into a temporary menopause, thus decreasing your estrogen levels and causing the fibroids to shrink. Unfortunately, this medication does not shrink the fibroids permanently, so it can not be used as a permanent solution.

The DOs
• Keep your follow-up appointments so that your doctor can check your fibroids regularly.
• Take your iron supplement if one has been recommended. This will prevent anemia. It is also helpful to eat a diet rich in iron in addition to the iron supplement.
• If your period cramps are uncomfortable, overthe-counter ibuprofen can be very effective in relieving the cramps. Over-the-counter ibuprofen comes in 200-milligram tablets. You can start with 2 tablets every 4 hours. However, if this does not relieve the cramps enough, you can take 3 tablets (600 milligrams) every 6 hours or 4 tablets (800 milligrams) every 8 hours. You should always take ibuprofen with some food on your stomach to avoid stomach irritation. (Obviously, you should not take ibuprofen if you have an
allergy to it, have been told you should not take it or any aspirin-like products, or have a history of ulcer or gastritis.)

The DON’Ts
• If you take birth control pills, you and your doctor may want to consider another birth control method because the estrogen in the birth control pills sometimes stimulate the fibroids to grow more quickly.
When to Call Your Doctor
• If periods become heavier, either heavier flow or more or larger clots.
• If you have irregular periods/bleeding.
• If the ibuprofen does not relieve enough of the cramps.
• If you feel that the fibroids are suddenly larger, or the mass causes discomfort.