Fibroids and Polyps

Fibroids and polyps are benign (non-cancerous) growths of the uterus. Fibroid growths are made of smooth muscle that should only grow inside the uterine walls. Fibroids cause severe cramping, heavy bleeding, pelvic pressure, bowel problems, and bladder dysfunction. Depending on the growth rate, size, and location, fibroids can interfere with pregnancy and conception.

Polyps are smaller growths of endometrial tissue, which lines the uterus. Both fibroids and polyps can cause infertility. Uterine polyps are more likely to affect women age 40 to 50 years. These growths can occur after menopause, but are rare in women under 20 years of age. Risk factors for uterine polyps include increased weight, high blood pressure, and taking tamoxifen (drug used for breast cancer).

 

What are the symptoms of polyps and fibroids?

The most common symptom of a uterine polyp is unpredictable or irregular menstrual periods. Women with uterine growths also have irregular menses, heavy menstrual flow, spotting between periods, infertility, and postmenopausal bleeding.

 

How are fibroids and polyps diagnosed?

A variety of methods are used to diagnose fibroids and polyps. These include:

  • Pelvic examination – Large growths can be palpated (felt) during a routine pelvic examination.

 

  • Pelvic ultrasound – To view inside the uterus, an ultrasound is used. The doctor inserts a slim probe (transducer) into the vagina to evaluate the uterine lining and cavity. This test is performed right before ovulation, because this is when the endometrium (uterus lining) is thickest.

 

  • Hysterosonogram ultrasound – This test involves injecting sterile salt water (saline) into the uterine cavity to enlarge the uterus. This test is best to visualize submucous fibroids within the uterine cavity.

 

  • Hysteroscopy – This procedure involves placing a lighted instrument (called a hysteroscope) into the uterine cervix to check for growths in the uterine cavity.

 

  • Magnetic resonance imaging – Using a powerful magnetic field, this test uses radio frequency pulses and a computer to produce detailed pictures of the soft tissues and reproductive tract. This test helps distinguish adenomyosis from fibroids.

 

How are uterine growths treated?

The myomectomy is a surgical procedure where fibroids are removed without affecting the ovaries or uterus. Depending on the size of the growth, various methods are used, such as:

  • Myomectomy with laparotomy – This is the best approach for multiple fibroids or large growths within the muscle wall of the uterus. This procedure involves making an incision through the abdominal wall. A hospital stay of 2-3 days is required, and recovery can take around 4-6 weeks.

 

  • Myomectomy with a hysteroscope – A fibroid within the uterine cavity can be accessed using a hysteroscope (thin tube with camera). The hysterscope is inserted through the vagina and into the uterus. This procedure is done on an outpatient basis, there are no incisions, and recovery is 5-7 days.

 

  • Myomectomy with laparoscope – After a few small incisions are made around the abdomen, the laparoscope is inserted to view the structures. Small instruments can be inserted to remove the growths.

 

  • Uterine artery embolization – This procedure involves blocking the blood supply to the growth by injecting small beads into the arteries. When blood cannot reach the fibroid, it shrinks and is absorbed.

 

  • Medications – For abnormal bleeding, certain medications are used, such as a hormone-releasing IUD, hormone injections, and birth control pills. The type of medication depends on the severity of the bleeding, your age, and the cause.