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Fibroids: Diagnosis and Treatment
Diagnosis
- History and physical examination, including pelvic exam, generally
make the diagnosis. The uterus is usually enlarged, moveable, and
asymmetric. Extremely large fibroids may be felt in the abdomen.
- Definitive testing may include ultrasound, MRI, or hysteroscopy.
Treatment
Most uterine fibroids cause no symptoms and need not be treated.
Intervention depends on a number of factors, including age (women
approaching menopause may not require therapy as fibroids typically
fade away spontaneously), desire for fertility, and the location
and size of the fibroids.
- Surgery is usually the most effective treatment. A procedure
to remove the fibroid while preserving the uterus may be possible.
In patients who do not wish to become pregnant, hysterectomy is
usually advised. Hysterectomy results in improvement in 90 percent
of cases. The remaining cases with incomplete resolution of symptoms
may be due to an inaccurate diagnosis or complications of the surgery.
- Aside from surgery, various drug therapies can be tried.
Oral contraceptive pills are the simplest treatments for abnormal
bleeding associated with fibroids. These treatments can be continued
until menopause in women who are not interested in pregnancy. Although
these appear to be protective in most women, one study showed an
increased risk of developing fibroids in girls who used oral contraceptive
pills at ages 13 to 16.
Several medications, including gonadotropin releasing hormone antagonists
(e.g., leuprolide), mifepristone, asoprisnil, and androgens are
under investigation for future use in treating fibroids.
Pain can be treated with nonsteroidal anti–inflammatory drugs (e.g.,
ibuprofen). COX–2 inhibitors (e.g., Celebrex) appear to benefit
postmenopausal women, but further trials are needed to establish
their effect for younger women.
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