Uterine Fibroid

What is a uterine fibroid?

A uterine fibroid (also called a fibromyoma, leiomyoma, or myoma) is a noncancerous growth of the uterus. It grows slowly in or from the wall of the uterus and it may grow in the cervix. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. The cervix is the lower part of the uterus that opens into the vagina.

A uterine fibroid may be as small as a pea or as large as a grapefruit. As the fibroid grows, it may change the shape of the uterus or move it out of place. If this happens, it may cause symptoms in your bladder or intestines. In rare cases, a rapidly growing fibroid may become cancerous.

The cause of uterine fibroids is not known. Estrogen and other hormones produced by the ovaries may play a role. Fibroids are common in women between the ages of 20 and 50. When a woman goes through menopause, the fibroids usually shrink. Your risk for fibroids may be greater if other women in your family have had them.

What can I expect in the hospital?

You may need to stay in the hospital for treatment of your uterine fibroids because your symptoms are severe or medical treatment outside the hospital has not been effective. Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.

Testing

Testing may include:

• Blood tests to check for infections or blood loss.
• Pelvic exam: Your healthcare provider will gently put a small tool called a speculum into your vagina to hold the vaginal walls open during the exam. Your provider will then put 1 or 2 lubricated, gloved fingers in your vagina and a hand on your abdomen to feel and check the size and shape of the uterus and ovaries.
• Ultrasound scan: Sound waves and their echoes are passed through your body from a small device that is held against your skin or put inside the vagina to create pictures of the uterus
• Sonohysterogram: This is an ultrasound scan where fluid is put into the uterus before sound waves and their echoes are passed through the body from a transducer. The transducer is held against your skin or put inside the vagina to create pictures of the uterus.
• Hysteroscopy: Your healthcare provider inserts a thin, flexible, lighted tube with a camera into the uterus through the vagina to look at the inside of the uterus. Fibroids may also be treated during this procedure.
• Hysterosalpingogram: Your provider puts contrast dye into the uterus to create pictures of the inside of the uterus and tubes.
• Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the uterus.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin sections of the uterus.

Treatment

The treatment for uterine fibroids depends on how many fibroids you have, how large they are, and how severe your symptoms are.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You will be given medicines to prevent pain during your surgery. These may include:
  • Local anesthesia, which numbs the cervix and uterus.
  • Regional anesthesia, which numbs a larger area of your body. Depending on the medicine, you may be awake or asleep during the procedure.
  • General anesthesia, which relaxes your muscles and puts you into a deep sleep. It also keeps you from remembering the operation. While you are asleep, you will have a tube in your throat to help you breath and to make sure you are getting enough oxygen. The tube may be removed before you wake up after the surgery.
• Treatments for uterine fibroids may include:
  • Uterine artery embolization (UAE): A procedure in which a thin, flexible tube (catheter) is put into a blood vessel in your groin and guided up to the uterine artery. Arteries providing blood to the fibroid are then blocked using plastic, metal, or other small materials. This may help to shrink the fibroids and can help stop heavy bleeding.
  • Dilatation and curettage (D&C): A procedure in which your provider widens the cervix and scrapes or suctions tissue from the lining of the uterus to reduce bleeding caused by the fibroid. This procedure does not remove the fibroid and the abnormal bleeding may come back.
  • Myomectomy: Surgery to remove the fibroids without removing the uterus. There are several ways a myomectomy may be done:
    • Hysteroscopy: A procedure in which your healthcare provider inserts a slim, flexible, lighted tube with a camera into the uterus through the vagina to look at the inside of the uterus and remove the fibroid. Your provider may insert a small balloon catheter in your uterus after the procedure. It may need to stay in the uterus for a while to help prevent scar tissue from forming inside your uterus.
    • Laparoscopic myomectomy: A surgical procedure that uses a small lighted tube put into the abdomen through a small cut to look at the organs and pelvic cavity. This allows your provider to see and remove the fibroid.
    • Abdominal myomectomy: Surgery to remove the fibroids through one larger cut in your lower abdomen
  • Hysterectomy: Surgery to remove the cervix and uterus. Tissue on the sides of the cervix may also be removed. In some cases, the fallopian tubes and ovaries are also removed. If your uterus is removed, you will not be able to get pregnant.
• Your provider may prescribe medicine to:
  • Treat pain
  • Treat or prevent an infection
  • Treat or prevent side effects, such as nausea or constipation, from other treatments
  • Soften your bowel movements to reduce straining
  • Reduce symptoms from fibroids or to treat symptoms of menopause if your ovaries were removed with your uterus
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• To care for your surgical wound:
  • Keep your surgery wound clean.
  • If you are told to change the dressing on your surgical wound, wash your hands before changing the dressing and after disposing of the dressing.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Dizziness or lightheadedness
  • Shortness of breath
  • Belly pain
  • Change in bowel habits, such as pain, mucus, diarrhea, constipation
  • Heavy vaginal bleeding
  • Trouble emptying the bladder
  • Vaginal discharge with a bad odor or itching
  • Redness, swelling, pain, warmth, or drainage from your surgical wound
  • Fever, chills, or muscle aches
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, why you are in the hospital, and the treatment you need. Talk with your provider about how long your stay may be.