ENDOVAGINAL SONOGRAM

The doctor send to do a endovaginal sonogram and the results was Myomatous uterus.  What is this?  This is serious?  Has any treatment?  What is the cause of it?

[Keith Downing, MD]

Hello,

Your ultrasounds shows you have uterine fibroids.  These are benign (non-cancerous) growths of the muscular tissue that makes up the uterus.  They are present in 50-75% of women and can have none or a significant impact on a woman's health.  

Below is a patient handout on uterine fibroids you may find helpful.

Best regards,

Dr. Downing

Uterine Fibroids
What are uterine fibroids?

Uterine fibroids are rubbery nodules made of muscle cells bounded by fibrous tissues. They grow slowly and unevenly and generally range from the size of a walnut to the size of an orange. They can develop singly or in clusters. Fibroids are almost always benign but they can cause a variety of problems depending upon their location in or around the uterus.

What are the symptoms of uterine fibroids?

Many women don't have any symptoms with uterine fibroids. But when fibroids do cause symptoms, they may include:

Heavy bleeding or painful periods
Bleeding between periods
Feeling bloated; feeling pressure in the lower abdomen or pelvis
Frequent urination or constipation
Pain during sex
Lower back pain
Reproductive problems, such as infertility, multiple miscarriages and early onset of labor during pregnancy
What causes fibroids?

No one knows exactly why fibroids form and grow. One theory links fibroids to estrogen levels, because fibroids don't occur before puberty, they tend to grow larger when women use birth control pills or during pregnancy, and they tend to shrink after menopause. Scientists think that genetic factors also play a role. You are more likely to develop fibroids if they run in your family.

Who gets fibroids?

Most of the time, fibroids grow in women of childbearing age. African-American women are at higher risk for developing fibroids than white women are. Women who are overweight or obese are also at slightly higher risk than women of average weight.

Are there different kinds of fibroids?

There are three types of fibroids, named for the areas where they grow:

Submucosal fibroids grow just underneath the uterine lining.
Intramural fibroids grow in between the muscles of the uterus.
Subserosal fibroids grow on the outside of the uterus.
Some fibroids grow on stalks (also called pedicles) that grow out from the surface of the uterus or into the cavity of the uterus.

The location of a fibroid often has more to do with the trouble it causes than its size does. Small tumors that block the fallopian tubes or distort the cervix may cause infertility. They can also be responsible for miscarriage or preterm delivery. Fibroids pressing on a pelvic nerve may be a source of chronic hip or back pain.

How do I know that I have uterine fibroids?

Unless you start to have symptoms, you may not know that you have fibroids. The primary care doctor or gynecologist often finds them during a routine pelvic exam. If you have fibroids, your uterus may feel larger than normal. It may also be shaped differently and extend into places it should not.

If your doctor thinks that you have fibroids, he or she may order an ultrasound of your uterus. In ultrasound images, fibroids usually appear as discrete, irregular masses attached to the uterus. Sometimes, the ultrasound picture does not provide enough information. Then, the doctor may order an MRI (magnetic resonance imaging) test for a clearer view. If the picture is still unclear, the doctor may suggest a laparoscopy. In a laparoscopy, a surgeon makes a very small cut into the abdomen and inserts a tiny video camera with a light on it to look for fibroids.

What are the treatments for fibroids?

Most fibroids do not need any treatment at all. If your fibroids are small and symptoms are not bothering you, your doctor may simply watch the situation through pelvic exams and ultrasounds and wait to see what happens. In most cases, over-the-counter pain-killers such as aspirin, ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) are enough to control any pain associated with fibroids. However, when fibroids cause serious problems such as persistent anemia from heavy bleeding, bowel or bladder trouble, chronic pain, or infertility, more aggressive treatment is in order.

There are two types of treatment for fibroids: medical and surgical.

Medical treatment is usually the first approach. This may include non-steroidal anti-inflammatory drugs (NSAIDs) or drugs such as birth control pills or progestins to manipulate hormone levels. The most successful are drugs called gonadotropin-releasing hormone (GnRH) agonists. These drugs stop the body from making the hormones that cause women to have their periods. As a result, fibroids shrink and symptoms decrease. Because they bring periods to a halt, GnRH agonists can raise blood counts for women who are anemic. However, they can also produce menopausal symptoms like hot flashes, vaginal dryness and reduced bone density. For this reason, doctors sometimes add back small doses of estrogen and progestin to eliminate side effects without stimulating fibroids to grow. Even when women are scheduled to have surgery, medical GnRH treatment is often used first to slow or stop the growth of fibroids.

Surgical treatment may be the best solution for women who are suffering moderate to severe symptoms of fibroids. There are several options available.

Myomectomy removes only the fibroids and leaves the healthy areas of the uterus in place. This procedure can preserve a woman's ability to have children. A myomectomy may be done through the vagina under local or general anesthesia or through the abdomen.
Laparoscopic myolysis is similar to a laparoscopic myomectomy except that instead of removing the fibroid, the surgeon cauterizes it with a needle. Surgeons may use this technique when a fibroid is near a major blood vessel.
Uterine artery embolization (UAE) is a minimally invasive procedure that has been used for more than two decades to treat postpartum and other pelvic bleeding problems but only recently for treating fibroids. UAE shrinks fibroids by cutting off their blood supply. The patient is put under mild sedation and local anesthesia, and the surgeon threads a catheter from the groin up into the uterine artery. The blood vessels supplying the fibroids are identified and an embolic agent is used to block blood flow.
Hysterectomy is used when a woman's fibroids are large or when she has heavy bleeding, and when she is either near or past menopause or doesn't want children. Hysterectomy is the surest way to cure uterine fibroids. However, it is major surgery and recovery time can be up to 4-6 weeks, depending on the technique used. If you are told you need a hysterectomy, you should get a second opinion (usually required for insurance coverage, anyway). There are many surgical options as well as varying degrees of invasiveness.
Endometrial ablation is a treatment which uses electrical energy or heat from a fluid-filled balloon or other techniques to cauterize the fibroids and treat heavy bleeding.
Do uterine fibroids lead to cancer?

Uterine fibroids are not cancerous. Fibroids rarely develop into cancer (in less than 0.1 percent of cases.) Having fibroids does not increase your risk for uterine cancer.

Do uterine fibroids ever go away?

For the most part, fibroids stop growing or shrink once a woman passes menopause. However, this is not the case for all women

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