Uterine fibroids are common, noncancerous growths that develop in the wall of a woman’s uterus, especially during her childbearing years. Treatment ranges from non-surgical to surgical approaches, including minimally invasive robotic surgery.
Researchers don’t know exactly what causes the condition, but the female hormones estrogen and progesterone may contribute to their growth, and many fibroids show genetic changes not found in normal uterine muscle tissue. Your risk may be higher if your mother or sister had them, you are obese, or you began menstruation at an early age.
Women may have just one fibroid or several, ranging in size from a grain of sand to a softball. Fibroids may grow slowly or quickly, but they rarely develop into cancer. Small fibroids often cause no symptoms and may go undetected unless they are found during a pelvic exam or ultrasound. However, large or multiple fibroids can cause pain, bleeding and other problems.
Uterine fibroid symptoms include:
- Very heavy menstrual bleeding
- Lengthy periods or bleeding between periods
- Abnormal pelvic pain, pressure or swelling
- Frequent or incomplete urination
- Fertility problems
“If you have any of these symptoms, talk to your doctor,” says Catharine Marshall, MD, an OB-GYN at Scripps. “They may have other causes, such as a urinary tract infection or ovarian cyst, and it is important to find out what is going on and determine if you need treatment. Always call your doctor immediately if you have severe bleeding or sudden sharp pelvic pain.”
Also known as leiomyomas, uterine fibroids often do not require treatment and will shrink on their own after pregnancy or menopause. However, if they cause pain, heavy bleeding or other symptoms, treatment can range from medication to reduce pain and bleeding to procedures that destroy or remove fibroids.
Uterine artery embolization is a non-surgical procedure that cuts off blood supply to the fibroid. The physician does this by injecting a substance into the arteries that carry blood to the fibroid. Without blood, the fibroid dies.
Sometimes interventional radiology is used to shrink very large fibroids and help make them easier to remove surgically.
Uterine fibroid surgery, called myomectomy, removes uterine fibroids but leaves the uterus intact, allowing women to become pregnant if desired.
“There are several types of procedures, and the right one depends on the size, number and location of the fibroids,” says Dr. Marshall. “At Scripps, we perform minimally invasive uterine fibroid surgery whenever possible, often with robotic technology.”
While abdominal or open surgery may be required for very large or multiple fibroids or those embedded deep into the uterus, many fibroids can be treated without large incisions. Fibroids that bulge into the uterus can be removed through the cervix and vagina in a procedure called hysteroscopic myomectomy.
Laparoscopic myomectomy is a minimally invasive procedure. The surgeon removes the fibroids through a few, very small incisions, using small, thin surgical tools. Because the incisions are smaller, there is usually less bleeding and pain, less scarring, a faster recovery time and lower risk of complications.
In robotic myomectomy, robotic arms hold the surgical tools, and a specially trained surgeon directs their movements from a nearby computer. As the surgeon move their hands, the robotic arms perform the same movements. The robotic arms can bend and turn in more directions than human hands, giving the surgeon more dexterity, precision and control.
During robotic surgery, the surgeon controls every movement of the arms from the computer, so the robot never moves on its own. The computer also magnifies the surgical site and provides a high-definition, three-dimensional view of the fibroid and surrounding tissue.
Most women who have this type of surgery either return home the same day or spend the night in the hospital. Typically, they can return to normal activities in about a month, but individual recovery times vary.
“If you develop uterine fibroids, talk to your doctor about your treatment options and, together, you can decide what is best for you,” says Dr. Marshall.