Uterine fibroids are non-cancerous growths that develop in or on the uterus. Composed of muscle and connective tissue, these growths can vary significantly in size, from microscopic to as large as a melon, and may appear as a single growth or multiple growths. While many individuals with fibroids experience no noticeable symptoms, others face issues such as heavy menstrual bleeding, pelvic pressure, or pain. The presence of fibroids can significantly impact quality of life for those who are symptomatic. This article explores how fibroids can naturally regress, shrink with treatment, or be surgically removed.
Natural Regression and Expulsion
Uterine fibroids are influenced by hormones, particularly estrogen and progesterone, which contribute to their growth during reproductive years. Following menopause, when estrogen levels naturally decline, fibroids often shrink considerably or may even disappear entirely.
While natural shrinkage is common post-menopause, the spontaneous expulsion of a fibroid is rare. This typically involves a pedunculated submucosal fibroid, which grows just beneath the uterine lining and is attached by a stalk.
If the stalk twists or the fibroid degenerates, the uterus may attempt to expel it through the cervix and into the vagina, causing severe pain, heavy bleeding, and labor-like contractions.
Minimally Invasive Shrinkage
Some medical interventions aim to shrink fibroids within the body rather than physically removing them. A prominent example is Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE).
This procedure works by intentionally blocking the blood supply to the fibroids, causing them to degenerate and shrink. A small catheter is inserted into an artery, typically in the groin or wrist, and guided to the uterine arteries that supply blood to the fibroids.
Tiny particles are then injected through the catheter to block these arteries. By cutting off the blood flow, the fibroid cells are deprived of oxygen and nutrients, leading to necrosis.
Over several weeks to months, the fibroids harden, shrink significantly, and become inactive. This method allows individuals to retain their uterus and avoid surgical incisions.
Surgical Excision of Fibroids
When fibroids cause significant symptoms and require physical removal while preserving the uterus, various surgical procedures known as myomectomies are employed. The approach chosen depends on the fibroid’s size, location, and number. Hysteroscopic myomectomy is used for submucosal fibroids that protrude into the uterine cavity. During this procedure, a thin, lighted telescope called a hysteroscope is inserted through the vagina and cervix into the uterus, and specialized instruments are used to resect and remove the fibroid tissue.
For fibroids located on the outer surface of the uterus (subserosal) or within the uterine wall (intramural), laparoscopic myomectomy offers a minimally invasive option. Small incisions are made in the abdomen, through which a laparoscope and surgical tools are inserted. The fibroids are carefully cut out from the uterine wall and then removed through one of the small incisions, sometimes after being morcellated (cut into smaller pieces). This approach generally results in less pain and a quicker recovery compared to traditional open surgery.
Open abdominal myomectomy, also known as a laparotomy, is a traditional surgical method reserved for larger or numerous fibroids, or in complex cases. This procedure involves a larger incision in the lower abdomen, providing the surgeon direct access to the uterus. The fibroids are enucleated, meaning they are carefully peeled or shelled out from the surrounding uterine muscle. After removal, the uterine wall is repaired, ensuring its integrity. This method allows for the removal of very large or deeply embedded fibroids that might be difficult to access with less invasive techniques.
Hysterectomy
Hysterectomy represents a definitive method for addressing fibroids, as it involves the surgical removal of the entire uterus. This procedure is typically considered when other treatment options have been exhausted, are not suitable, or when an individual no longer desires to preserve their uterus, often after childbearing is complete.
Hysterectomy can be performed through various approaches, including abdominal, vaginal, laparoscopic, or robot-assisted techniques. An abdominal hysterectomy involves an incision in the abdomen to remove the uterus.
Vaginal hysterectomy removes the uterus through the vagina without an external abdominal incision. Laparoscopic and robot-assisted hysterectomies utilize small incisions and specialized instruments or robotic arms, offering minimally invasive benefits similar to laparoscopic myomectomy. The entire uterus and its fibroids are removed, providing a permanent solution to fibroid-related symptoms.