UNC Fibroid Care Clinic
What is the UNC Hospital Fibroid Care Clinic?
The University of North Carolina Fibroid Care Clinic is a new treatment model designed to provide up-to-date, comprehensive medical information and care for the treatment of women with uterine fibroids. We offer the full range of diagnostic test and treatments including minimally-invasive treatments such as laparoscopic (and robotic) myomectomy and hysterectomy, hysteroscopic myomectomy, and uterine artery embolization. The Fibroid Care Clinic also offers the benefit of close collaboration between gynecology, reproductive endocrinology, and radiology to help coordinate your care. By streamlining the process of diagnosis and treatment, the Fibroid Care Clinic hopes to reduce the strain you experience associated with having fibroids and getting them treated. Our Fibroid Care Clinic staff is dedicated to answering your questions and providing you with the highest quality medical care. We look forward to serving you. Click here to download a helpful patient information booklet.
What are uterine fibroids:
Uterine fibroids are benign (non-cancerous) tumors that grow in or around the wall of the uterus. Fibroids are the most common non-cancerous tumors in women. Fibroids are also known as myomas or leiomyomas. The size of a fibroid can vary from the size of a pea to larger than a cantaloupe. Fibroids are very responsive to the hormones estrogen and progesterone. For instance, the increase of hormones during pregnancy tends to make fibroids grow, and the decrease in hormones during menopause tends to shrink fibroids. Fibroids vary in size, shape and location and often change the shape of the uterus.
The location of a fibroid can be defined as intramural (within the muscle wall of the uterus), submucosal (underlying the lining of the uterine cavity), or subserosal (just beneath the outer covering layer of the uterus). Sometimes a fibroid grows on a stalk (pedunculated) inside or outside the uterus. Fibroids can occur on any part of the uterus, including the lower part or cervix.
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What are possible signs and symptoms of fibroids?
One quarter to one half of women with fibroids have symptoms from them. The most common symptoms include:
What causes fibroids?
To date, we do not know what causes fibroids to develop. It is thought that each fibroid arises from a single muscle cell in the uterus that experiences a mutation allowing uncontrolled growth. Studies have shown that tumor growth is encouraged by growth signals and hormones such as estrogen and progesterone. During the childbearing years, a woman’s ovaries are producing more estrogen and progesterone, and fibroids tend to grow. After menopause, fibroids tend to shrink. Current research is looking at links between fibroid development and genetic abnormalities. The exact triggers of these abnormalities are unknown. Most likely, many different factors interact to make fibroids develop and grow.
How common are fibroids and who is at risk for developing them?
Fibroids are very common and are found in more than one third of women who are child bearing age. They may effect up to 80% of all women, but are less likely to be symptomatic or diagnosed in menopausal women. African-American women are 2-3 times more likely to develop fibroids than Caucasian women. Up to one half of all hysterectomies are performed for symptoms related to fibroids.
Factors that may be associated with fibroids include:
How are fibroids diagnosed?
Fibroids are usually first found on pelvic exam or suspected based on symptoms. More definitive ways to diagnose fibroids include the following:
Endometrial biopsy is a test used to look for abnormal gland cells in the lining of the uterus (the endometrium). The biopsy is done in clinic and requires a thin flexible tube that is passed through the cervix to collect a small piece of endometrium. Endometrial biopsy may be helpful in diagnosing causes of abnormal vaginal bleeding. Mild spotting or cramping may occur during or after the biopsy.
What are available treatments for fibroids?
Because the vast majority of fibroids are benign, “watchful waiting” is an option for many women who do not have symptoms or pressure on nearby organs. Fibroid growth may be monitored periodically by ultrasound. For women with symptoms who require treatment, there are many options to consider. The most common treatment options for fibroids include: medical management of symptoms, Uterine Artery Embolization (UAE), and surgical treatment. Additional treatments are being researched or are newly available.
of fibroid symptoms may include:
*The role of other medical treatments, such as anti-progestins (mifepristone), selective estrogen-receptor modulators (SERMs) (raloxifene), and androgens (male hormones) such as danacrine (Danazol®), for fibroids is still being investigated. There is currently insufficient scientific data to support the effectiveness of herbal remedies, acupuncture, and other complementary medicine for the treatment of fibroids
Uterine artery embolization (UAE) is a radiology-guided procedure that blocks the blood supply to uterine fibroids. This causes fibroids to shrink and reduces symptoms of bleeding and pain or pressure in 60-90% of patients. Fibroids usually decrease by approximately 35-60% in volume. As an example, a treated fibroid that is 10 cm in diameter, after maximum shrinkage, may be expected to be no smaller than 7.4 cm in diameter.
UAE is usually performed under sedation and takes about 1.5 to 2 hours. A radiologist inserts a catheter through a small incision (1⁄4 inch) in the groin area. Using fluoroscopic (x-ray) guidance, the catheter is threaded into the uterine artery. Tiny round particles, the size of grains of sand, are injected into the blood vessels feeding the fibroid. Hospital stay is usually one night and time to full recovery is about 2-3 weeks.
Most women feel some pain and cramping following a UAE. Other symptoms such as nausea, fever, and muscle aches can occur, a condition known as “post-embolization syndrome”. Less common complications include passage of the embolized fibroid through the vagina, vaginal discharge, loss of ovarian function, or severe infection.
UAE offers the advantages of preserving the uterus, a short hospital stay, minimal blood loss, and a fast return to work. UAE does not completely eliminate the fibroid(s) and is appropriate only for certain patients with certain fibroid characteristics. Approximately 5% of patients who have a UAE will sometime later require additional surgical treatment for new or recurrent symptoms. Additional research is required before UAE can be recommended for women who still hope to become pregnant.
To discuss the option of UAE at UNC Hospitals, you can make an appointment with Interventional Radiology at (919) 966-4645.
Myomectomy is the surgical removal of uterine fibroids without the removal of the uterus. There are several techniques that may be used, and the choice of the technique depends on the location and size of the fibroids as well as the characteristics of the woman. It is sometimes impossible to remove all the fibroids, and new fibroids may grow after a myomectomy. Though myomectomy is the only accepted procedure for fibroids in a woman who wants to maintain fertility, a myomectomy may lead to scarring that can negatively affect future fertility. Following a myomectomy, cesarean delivery is frequently recommended to prevent the myomectomy scar from breaking open during labor. Types of myomectomies include:
Hysterectomy is a surgery to remove the uterus. It prevents future pregnancy and eliminates fibroid-related bleeding and pressure symptoms. A hysterectomy is the surgical treatment of choice for women with symptomatic fibroids who have completed childbearing.
There are two categories of hysterectomy:
Possible complications of hysterectomy include: bleeding, infection, injury to surrounding organs, blood vessels, and nerves. After laparoscopic surgery, pain may be felt in the shoulders which is often due to irritation from the gas used to inflate the abdomen prior to surgery.
Depending on factors such as a uterus size, previous surgery or scarring, and obesity, a hysterectomy can be performed by one of the following techniques:
What effects do fibroids have on pregnancy?
Most women with fibroids have uncomplicated pregnancies. However, some women may have trouble conceiving or may experience early pregnancy loss, vaginal bleeding, preterm delivery, breech birth (baby emerges buttocks or feet first), or other complications of pregnancy. These complications generally occur in the setting of submucosal fibroids or those fibroids that change the shape of the uterine cavity. Large fibroids may block the opening of the uterus enough to prevent a baby from delivering head-first, leading to a cesarean delivery. Additionally, during pregnancy estrogen and progesterone hormones increase, which causes some fibroids to grow quickly. Other fibroids shrink or stay the same size. Some fibroids may outgrow their blood supply and degenerate (deteriorate), which can cause pain. Surgery for fibroids is rarely performed during pregnancy.
What effects do fibroids have on fertility?
Couples who are experiencing infertility in the setting of a woman’s fibroids may need additional workup to determine whether there are other causes of infertility besides the fibroid. This evaluation may include:
If all other factors are favorable, removal of some fibroids (myomectomy) can help improve the chances of pregnancy and may be recommended. During a myomectomy, incisions are made in the wall of the uterus. These healed incisions may rupture under the stress of labor, and a cesarean delivery is often recommended for future pregnancies. Additionally, healing of the uterus after a myomectomy may result in scarring between the uterus, ovaries, fallopian tubes, and bowel. This scarring may decrease chances for pregnancy or make future surgery difficult.
Many available treatments used to manage the symptoms of fibroids, either delay pregnancy or are not recommended if a woman desires future pregnancy. Some of these medications or treatments include:
Could my fibroid be a cancer?
Fibroids are rarely malignant (cancer). In fact, over 99% of uterine tumors that appear to be fibroids on imaging (ultrasound or MRI) are benign (not cancer). If a fibroid has a worrisome appearance on imaging, the woman may be recommended to have a hysterectomy instead of a myomectomy. Other worrisome findings include a fibroid that grows very rapidly, particularly in a woman who has experienced menopause.
What other treatments for fibroids are available or may be available in the future?
A number of other treatments have been explored for fibroids. One of the newest treatments to be approved is ultrasound ablation of fibroids (Magnetic Resonance-guided Ultrasound Surgery for Fibroids (MRgFUS), ExAblate 2000®, InSightec.) This technique uses ultrasound waves to heat and destroy fibroid cells (a process called thermoablation). The procedure is performed under MRI-guidance while the woman is awake but sedated and generally takes several hours. Large studies are not yet available on this technique. In those women studied, more than half have experienced a decrease in symptoms, and complications have been few. MRgFUS is currently available only in certain states. More information can be found at www.uterine-fibroids.org.
Other treatments for fibroids exist and are supported by small studies. These treatments include myolysis (destruction of fibroid tissue using heat or cold) and laparoscopic uterine artery ligation (tying off the main blood supply to the uterus to shrink the fibroid). These treatments are not widely performed and it is best to speak directly with a doctor about the details of their availability and safety.
Other websites for additional information: