How are Fibroids Diagnosed & Treated?

Excerpted from
Blessed Health: The African-American Woman's Guide to Physical and Spiritual Well-being
By Melody T. McCloud, M.D., Angela Ebron

There are two major components to diagnosing fibroid tumors: a pelvic exam and an ultrasound. If you have fibroids, they will usually be detected during a pelvic exam by your gynecologist, his or her physician's assistant, or a nurse practitioner. A trained examiner who does pelvic exams daily is well trained to feel the "lumps and bumps" these tumors cause in or on the uterus, or to recognize one protruding from the cervix.

If the tumors are very large, they may be readily apparent even to you, because they can distort the abdominal wall, often giving the appearance of a pregnancy.

A pelvic ultrasound or sonogram is often in order, as well. This test, which employs sound waves and emits no radiation, takes a picture of the growths, though very tiny tumors (smaller than a green pea) may not be detected. The objective picture of the ultrasound allows your doctor to check the relative size, location, and number of tumors present. All of these factors can be very important when deciding the best course of treatment and whether a woman needs surgery.

The treatment you receive for fibroids is largely determined by your symptoms, physical findings on exam and ultrasound, and your plans for future childbearing. Options can include observation and periodic monitoring, hormone therapy, or surgery.

If the tumors are small and are not causing any symptoms, your doctor may simply have you come in for exams periodically so that he can monitor the fibroids. He will check them to make sure they haven't grown and ask whether you have experienced any fibroid-related problems.

If the tumors are large, your doctor may utilize a treatment known as hormonal manipulation. With this treatment, specific drugs, such as Lupron, Synarel, and others, are prescribed in an attempt to shrink the tumors in preparation for surgery, or to relieve the symptoms (though temporarily) if the patient is not a surgical candidate because of medical reasons.

Here's how hormonal manipulation works: Because it is widely believed that the hormone estrogen plays a key role in the development and growth of fibroid tumors, doctors now prescribe medications that counteract estrogen's effects. These medications, which-as a group-your doctor classifies as gonadotrophin - releasing hormone (CnRH) agents, act to decrease and ultimately eliminate estrogen production for the time period in which the drug is used. Without estrogen, the fibroids lose their source of nutrition, so to speak, and end up diminishing in size. Such a reduction is often desired when the woman has tumors large enough to cause problems, but wishes to maintain her childbearing capabilities.

The medication is usually given in the form of an injection once a month for three to six months (typically three). Once the tumors shrink, surgery is performed to remove them.

Some may ask, why not just continue taking the medication and avoid surgery altogether? GnRH agents are powerful drugs whose primary action is to stop estrogen production. As a result, women using the drugs experience the same symptoms as women going through menopause: hot flashes, decreased sex drive, occasional mood swings, and the possible onset of osteoporosis (loss of bone density, which leaves bones brittle and easily fractured). What's more, drug treatment is not a panacea. Once the medication is stopped, the tumors will grow back. Because of these factors, the standard recommendation is to administer the drugs for three months, reevaluate the fibroids, and, in all likelihood, proceed with the myomectomy (a surgical procedure that removes the tumors and leaves the uterus in place).

If certain drugs can shrink fibroids, why can't they get rid of them for good? you may wonder. Why do they grow back? Think about what happens when you go on a diet. You diligently cut back or eliminate the foods that go right to your hips. Three months without them, and the pounds have melted off. What would happen if you suddenly began constantly eating all of those foods again? That's right-you'd regain the weight. The same thing happens with fibroids. When the drug treatment stops, your body begins producing estrogen again, thus feeding the shrunken tumors and causing them to grow. With a diet, you are able to exercise self-control, but your hormones occur naturally and spontaneously. That makes it tough for you to control their effects.