QuestionQUESTION: I am a 37 year old woman with a long history of fibroids. I went to the ER a few days ago with severe abdominal pain. The doctor there did a CT scan and diagnosed a ruptured ovarian cyst. I went to my gynecologist who did a sonogram and said that he didn't see any evidence of fluid (which ruled out an ovarian cyst) and suggested that my pain was a result of the fibroids. I have never experienced pain before due to fibroids and looked it up online. I read about degenerative fibroids. Could this be what is happening to me? How does one diagnose a degenerative fibroid? Should that have shown up on my sonogram?
Thank you for your attention. I'm feeling a bit lost.
ANSWER: Dear Kerry,
Uterine fibroids are nodules of smooth muscle cells and fibrous connective tissue that develop within the wall of the uterus. Medically they are called a uterine leiomyoma. The factors that initiate fibroid growth are not known. The vast majority of fibroids occur in women of reproductive age and are the most frequently diagnosed tumor of the female pelvis. It has been estimated that up to 20-30% of women of reproductive age have fibroids, though not all have been diagnosed. It is important to know that these are benign tumors. They are not associated with cancer, they virtually never develop into cancer, and they do not increase a woman's risk for uterine cancer.
As fibroids grow, they may outgrow their blood supply, resulting in necrosis (destruction of tissue), calcification, and various types of degeneration. However, unless there are chronological scans to compare changes in the appearance of the fibroids, I would think it nearly impossible to determine whether they are degenerative.
Many times fibroids cause no symptoms at all. For women who do experience symptoms, the following can occur: excessive or painful bleeding during menstruation, bleeding between periods, a feeling of fullness in the lower abdomen, frequent urination resulting from a fibroid that compresses the bladder, pain during sexual intercourse, and/or low back pain.
If the pain you experienced has resolved and you are no longer having any symptoms, a small ruptured cyst would not necessarily be out of the question. The rupture of a small cyst can cause sharp abdominal or pelvic pain for a day or two, which then subsides.
Again, if the pain has disappeared, I would not fret much over this incident. If the pain has lingered and continues, then by all means follow-up with your doctor to determine a cause. If it actually is the fibroids causing the pain, the pain will not resolve itself and treatment will be required.
I hope this has helped you and answered your question. I wish you well.
Brenda
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QUESTION: Thank you so much - your response was extremely helpful.
I have had 2 previous surgeries (myomectomies) to remove other fibroids during the last 10 years. I do get annual sonograms to check on the growth of new ones. The doctor did say that this particular fibroid has doubled in size over the last year. He didn't mention whether or not there was evidence of degeneration. Should that have been clear on the sonogram?
Thanks again,
Kerry
ANSWER: Dear Kerry,
They usually can note calcification via ultrasound and I believe they usually start changing shape if they begin the degenerative process. I'm not an expert in the area of sonography by any means, but I believe these are changes they would spot if present.
Hope that helps! Be well.
Brenda
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QUESTION: Thanks again - Your knowledge and input is extremely helpful. What do you know about the Uterine Fibroid Embolization procedure? Particularly with regard to recovery and side effects (long-term and short-term)?
Best,
Kerry
AnswerDear Kerry,
Thank you for your kind words.
Here's what I found about the Embolization procedure - a catheter is placed in each of the two uterine arteries and small particles - polyvinyl alcohol (a material resembling coarse sand), gelatin sponge (Gelfoam), or microspheres - are injected to block the arterial branches that supply blood to the fibroids. The fibroid tissue dies, the masses shrink, and in most cases symptoms are relieved. It is done under local anesthesia by a interventional radiologist (a doctor specially trained to perform procedures such as this). It usually takes 60 to 90 minutes.
Because the effects of uterine fibroid embolization (UFE) on fertility are not yet known, the ideal candidate is a premenopausal woman with symptoms from fibroid tumors who no longer wishes to become pregnant, but wants to avoid having a hysterectomy.
Most patients having UFE remain overnight in the hospital for pain control and observation. Patients typically experience pelvic cramps for several days after uterine fibroid embolization, and possibly mild nausea and low-grade fever as well. The cramps are most severe during the first 24 hours after the procedure and improve rapidly over the next several days. While in the hospital, the discomfort usually is well-controlled with a narcotic pump, which dispenses IV pain medication. Oral pain medication is provided after discharge from the hospital. Most patients will recover from the effects of the procedure within 1-2 weeks after UFE and will be able to return to their normal activities.
It usually takes 2-3 months for the fibroids to shrink enough so that bulk-related symptoms such as pain and pressure improve. It is common for heavy bleeding to improve during the first menstrual cycle following the procedure.
Although the possibility of re-growth of fibroids cannot be completely eliminated, follow-up studies lasting several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after UFE.
I hope this helps information you!
Brenda
