Indications for Surgery: Fibroids

Indications for Surgery: Fibroids

As a patient, it is very difficult to understand when surgery is needed – or not. Often patients go online to find out information about their condition, and all too often they become confused and even misled as to whether or not surgery is something they need. Here we discuss the top three indications for surgery for patients with GYN conditions: Endometriosis, Fibroids, and Adenomyosis. Please review each individual article in this series for each of the three conditions.


Fibroids are smooth muscle growths in the uterus that are exceptionally common. Symptoms from fibroids depend on where they are located and how large they are. Fibroids that are near the uterine lining – the endometrial lining – will cause patients bleeding. So will fibroids in the cavity of the uterus. Fibroids that are in the muscle or on the outside of the uterus can cause “compression” symptoms, meaning that as they become larger they will press on the bladder causing frequent urination, or cause bloating and distension, pelvic pressure, and back pain if they press on the spine. The Diagnosis of fibroids is best made by ultrasound, which is an inexpensive and accurate method for evaluating the size, number, and location of fibroids. MRI can be used but is not necessary. CT scan is not helpful for diagnosing fibroids, so if your primary care or OBGYN physician wants to schedule a CT scan, ask for an ultrasound instead. The Cause of fibroids is from smooth muscle in the uterus that overgrows, and is stimulated by estrogen. This means that estrogen causes the growth of fibroids, just like it causes the growth of endometriosis and adenomyosis.

Once fibroids are diagnosed by ultrasound, treatment will depend on whether or not the fibroids are causing symptoms. The size of the fibroids, the potential for their growth, and the fertility desires of the patient will determine if treatment is needed. Patients should avoid the “watch and wait” method used by OBGYN’s in the management of fibroids. “Watch and wait” is flawed if the fibroids are increasing in size, are causing significant symptoms, or fertility is a factor. In these situations, watch and wait can cause serious harm to the patient and the uterus for pregnancy. Heavy blood loss during the menstrual period can cause anemia, fatigue, the need for blood transfusion, depression and anxiety. Compression symptoms can alter bowel function significantly, can affect bladder function, can seriously increase pain, and cause general misery. Fibroids in or near the cavity can prevent pregnancy, and even those fibroids in the muscle that are larger can cause problems for patients who are trying to get pregnant, or to maintain a pregnancy.

Larger fibroids will have to be treated, and any form of treatment – surgical or not – can compromise the ability to become pregnant.

There are many methods to treat fibroids, depending on the size and location, and fertility. Those patients who are considering pregnancy should NEVER undergo embolization procedures, also known as uterine fibroid embolization. Radiologists perform these procedures, and they will clearly let the patient know that it is unknown how embolization can affect the ability to become pregnant. Embolization ‘kills” fibroids – it does not remove them – so the fibroids are still in the uterus and will still cause symptoms until they decrease in size.

The recovery with embolization is NOT better than advanced techniques of fibroid removal, such as the LAAM procedure. LAAM is a revolutionary method of removing fibroids that provides for a recovery in 7 – 14 days, removes all the fibroids with immediate relief of symptoms, can be used even for the largest of fibroids, and will not compromise fertility by increasing miscarriage rates or affecting the ovaries, which can happen with embolization. For more information on embolization and LAAM and the treatment of fibroids, please review the Top Five Number 3 – Treatment Options