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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

 

Fibroids (Myomata)

Fibroids are fibrotic (scarred) muscle tumors and are also called myomata.  Fibroids can be in the muscle wall, inside of the uterine cavity, outside of the muscle wall or any combination of these. A sonogram (ultrasounds) may help determine the location.

As many as 1 in 2 women may have small fibroids.  Many do not need treatment.  However, fibroids can cause bleeding, pain, infertility miscarriages, premature labor, premature birth and delayed growth in pregnancy.  Treatment depends on the size, location, and reason for treatment.  Some of the treatment options are:

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Watch them.  You may not need treatment.

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Pain medication

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Hormonal pills, patches or shots for bleeding

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Hysteroscopy for bleeding
    D&C removes the surface of the inside lining.
    Resection (removal) of the fibroids can preserve fertility.
    Ablation
(removal) of the entire uterine lining may stop bleeding.

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Shrink the Fibroids
    Shrink fibroids using medication. (temporary)
    Shrink fibroids using myolysis.  (scope surgery)
    Shrink fibroids using embolization.  (radiology)

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Myomectomy (removing fibroids)
    Hysteroscopy (scope) if inside the cavity.
    Laparoscopy (scope) if outside the muscle.
    Laparotomy (open surgery) if inside the muscle.

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Hysterectomy (open, laparoscopic, or vaginal)
    The muscular body is removed.
    The ovaries can be saved if healthy.
    The cervix can be saved if healthy.

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Hormonal medicines such as birth control pills or shots can help control bleeding.  But these can increase growth of the fibroids. GnRH analogs such as Lupron, Synarel, or Zoladex can temporarily (6 to 18 months) shrink fibroids and control bleeding.  These have significant side effects.  Danazol can be used for a longer time but is a male-like hormone with male type side effects

If you are not going to have children, myolysis or embolization may shrink fibroids permanently.  Myolysis is a surgical procedure.  Embolization is a radiology procedure to stop blood flow to fibroids.  Pregnancy is avoided because uterine rupture could happen during pregnancy and threaten the life of both the mother and the baby.  Embolization may also result in damage to the ovary resulting in early menopause.  A tubal ligation to avoid pregnancies can be a good idea.  Common complications include pain, fever, infection, and hospitalization.  Severe complications such as ovarian failure, damage to other organs, delayed diagnosis of cancer and death are rare.

Open myomectomy for large fibroids (removing fibroid tumors) and hysterectomy (removing the fibroids and the uterine muscle that surround them) are both major surgeries.  Each requires 2 to 8 days in the hospital, 3 to 8 weeks for recovery, and 2 to 6 months for complete return of energy.  Both can have major complications including hemorrhage (bleeding), infection, allergy, damage to the tubes and ovaries, damage to the ureters, and damage to the bowel.  But, severe complications such as unplanned hysterectomy, colostomy, paralysis, and death are rare.

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Hysterectomy is often a shorter and more complete operation.  This is particularly true when there are several fibroids present.  When there are several fibrosis, hysterectomy decreases the chance of a reaction to the anesthesia.  The cost may be lower.  There is less chance of repeat surgery.  The major disadvantages are the risks and recovery from surgery and sterility (inability to have more children) The cervix (mouth of uterus) and ovaries (hormones) can sometimes be saved if they are healthy.

Myomectomy has the advantage of preserving your uterus and may increase or preserve fertility.  This is particularly useful with one or two fibroids.  However, removing fibroids can also cause adhesions, block the uterine tubes or cause scarring inside the uterus.  These problems can increase infertility and miscarriages.  In addition, at delivery of a baby, there is the worry that the incision may rupture during labor and threaten the life of the baby or mother.  C-section may be needed. Other disadvantages include increased blood loss, increased chance of transfusion, increased chance of postoperative adhesions, increased chance of postoperative bowel obstruction, increased chance of repeat operations and the possibility of needing an emergency or immediate hysterectomy. Complications increase with increased numbers of fibroids and with fibroids in delicate areas.  Limiting the number of fibroids removed can decrease the chance of transfusion and the chance of emergency hysterectomy. 

Uncommonly, adenomyomata (a combination of a fibroid and adenomyosis) may be present.  For fertility, the best thing to do is to leave this alone.  For pain, a hysterectomy may be all that will work. 

On rare occasion, endometrial, uterine or ovarian cancer may be confused as a fibroid.  Frozen section diagnosis at the time of surgery is sometimes used for decisions.  A final pathology report a few days after surgery can give a better answer in some women.

For myomectomy or hysterectomy, you should consider banking your own blood.  Medicines such as GnRH and danazol are sometimes useful before surgery. 

Dr. Dan Martin was trained in Gynecology, Reproductive Endocrinology and Reproductive Surgery in the Division of Reproductive Endocrinology at the Johns Hopkins Hospital.  His practice and research has focused on endometriosis, infertility, microsurgical tubal reversal and anastomosis techniques.

Dr. Martin's office for infertility, fertility preservation, reproductive surgery and gynecology is located at 7945 Wolf River Boulevard, Suite 320, Germantown, TN 38138. Memphis, Tennessee is convenient to Arkansas (AR), Mississippi (MS), Missouri (MO), western Kentucky (KY), and southern Illinois (IL).

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