Fibroids
Benign muscular growths in the uterus. We treat large and complex fibroids, including those that other centers decline.
Fibroids range from incidental to life-limiting. Size is not the whole story. Position matters more, and a small fibroid in the wrong place can cause more trouble than a large one elsewhere.
How common they are
Fibroids are very common, and a good deal more common than most people are told. On the best ultrasound-based figures, by the age of fifty around seventy percent of white women and more than eighty percent of Black women will have had them.
So an enormous number of people are walking around with fibroids. Some have symptoms and some have none at all. Some need help and some do not. Having fibroids is not in itself a reason to remove them, and it is not a reason to have a hysterectomy.
Position matters more than size
Where a fibroid sits does more to determine how much trouble it causes than how big it is. Size matters too, but not in a straightforward way.
Fibroids on the inside of the uterus stop it squeezing down, and they bring extra blood supply with them, so they tend to cause heavy bleeding. Fibroids within the wall can distort the uterus enough that it cannot squeeze down and stop the bleeding either, so it simply carries on. Those can be large or small. What decides the effect is what they do to the structure of the uterus.
Some people have a single fibroid. Others have dozens.
Fibroids on the outside of the uterus may do very little. They can also press on other things: the bowel, the bladder, or a muscle or nerve trapped against the bone of the pelvis, which causes severe pain or stops something working properly.
Fibroids and pregnancy
The ones inside the uterus, and the ones distorting its shape, are also the ones most likely to affect fertility. That is genuinely hard to predict in any individual.
We see people with large fibroids who go through pregnancy without difficulty. We also see people with relatively small ones in the middle of the uterus where a pregnancy cannot grow, and that ends in miscarriage.
Working out whether the fibroids are the problem
The first step is a conversation about your history and your symptoms. That gets put together with imaging, usually an ultrasound or an MRI, to build an accurate picture of where the fibroids are and what they are doing.
Sometimes that process shows the fibroids are present but innocent, and the symptoms are coming from something else entirely. It is worth the time it takes to find that out. Otherwise we could remove every fibroid and leave you with exactly the symptoms you came in with.
If you have been told yours are too large or too complex
Usually that describes the operation rather than your body. Complex fibroid surgery is not part of every gynecologic practice, and a surgeon who does not take it on is making a reasonable decision about the limits of their own work.
Some positions are genuinely difficult, particularly fibroids sitting behind the uterus, which are hard to reach, hard to see properly, hard to remove cleanly, and hard to close well afterwards. Difficult is not the same as impossible.
The other version is many small fibroids rather than one large one. The real work there is that once they are out, the uterus has to be rebuilt into a uterus again: each one separated out, and every space closed correctly. That takes time more than anything else.
There are patients whose uterus is large enough that a traditional open myomectomy makes more sense, and for them it is the right answer. We do not need to do that often. Most of this work can be done laparoscopically, which means no large incision and a faster return to normal life.
Whether the uterus can stay
For the large majority of people, fibroids can be removed and the uterus kept.
If you do not want to use your uterus for a pregnancy in future, a hysterectomy may genuinely be the better operation. Recovery is often faster and more comfortable, because after a myomectomy the uterus has to heal in every place a fibroid was taken from. Which of those is right depends on you and on what you need from your life.
Whether fibroids grow back is a fair question and the answer varies. Someone who had one fibroid removed may never have another. Someone who had hundreds, most of which are now out, may find the small ones left behind cause trouble later. That is a conversation to have individually, about what you should expect.
When they come with endometriosis or adenomyosis
Fibroids frequently turn up alongside endometriosis and adenomyosis. When all three are present, the work is to understand how much each one is contributing to your symptoms now, and what each is likely to mean for you later.
That is what decides the order of treatment, and it is why the conversation comes before the plan.