Uterine Fibroids

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• 0:04What fibroids are
• 0:50Bleeding symptoms
• 1:33Where fibroids grow
• 3:23Pressure symptoms
• 4:08How fibroids are diagnosed

Full transcript

1. 0:04What fibroids are

   Hi, I'm Dr. Taz Varkey. Today I'd like to talk to you about a common condition in women called uterine fibroids. Uterine fibroids are just benign overgrowth of the smooth muscle of the uterus. They're rarely cancerous. The estimates are about 1 in 350 to 1 in 2,000 in terms of the chances of cancer. And the reason that number varies so much is it depends on the study that was done asking that question and the type of women, the population of women, that were in that study.

2. 0:28

   But basically it's a very uncommon thing for a fibroid to be cancerous. So what are the symptoms of fibroids? People commonly ask me that. So the most common symptom of uterine fibroids is heavy vaginal bleeding.

3. 0:50Bleeding symptoms

   Patients will often come to me complaining of heavy periods, prolonged periods, maybe they're lasting more than the usual seven days, they last two weeks or even the whole month. Or maybe they just bleed for three to five days during their period, but then a week later, if they start bleeding in between their period. Fibroids can show up in lots of different ways in terms of your menstrual or period flow.

4. 1:14

   Other symptoms that might be caused by fibroids include trouble getting pregnant, miscarriage, complications in pregnancy, and pressure symptoms. So let me explain that with a diagram.

5. 1:33Where fibroids grow

   Okay, so if this was the uterus here, this is the vagina, here's your tubes and ovaries. Okay, so this is all underneath, this whole part is underneath the abdomen, and this is the vagina where we see the cervix.

6. 1:56

   This is all muscle, uterine muscle, and this is the cavity where the blood is made every month and then for the baby would be, and it all comes out through the vaginal canal there, right? So fibroids are smooth muscle overgrowths, as I said. So imagine that this is a fibroid.

7. 2:17

   And they can be located in the wall, that's called intramural. They can be located out here on the edge of the uterus, and that's called subserosal. So they can be intracavitary, that's in the cavity, and they can be submucosal, and that's half in the muscle and half in the uterine cavity.

8. 2:38

   So these two, the submucosal and the intracavitary, those are pushing on that lining, the uterine lining called the endometrium, and therefore they can cause a patient to have heavier bleeding because it's stimulating that lining and it's drawing more blood to that area.

9. 3:01

   So fibroids that are out in the wall or out on the outer edge of the uterus usually don't cause heavy bleeding, but the ones that are in the cavity do. And these are the ones to worry about in terms of heavy bleeding. If a patient is trying to get pregnant, these will also be an issue because this will impede, this can keep the embryo that's normally formed up here in the tube, and then it travels in and tries to implant in the cavity.

10. 3:23Pressure symptoms

    Well, if there's a fibroid pushing on that cavity, the embryo may have difficulty implanting, or the patient will get pregnant and she could miscarry. So that's another reason we'd have to deal with these type of fibroids. Lastly, if patients have really big fibroids like this, regardless of where they're located, they can make the uterus so much bigger.

11. 3:45

    So patients can have sometimes pain, but maybe just pressure symptoms, pelvic pressure that pushes on the bladder, which is right here and in the front of the uterus. So if you've got a big fibroid pushing out at the front of the uterus onto the bladder in front of it, that can cause urinary frequency. The patient has to go pee all the time, or if it's on the back of the uterus pushing on the rectum, it can make patients feel constipated.

12. 4:08How fibroids are diagnosed

    So those are all other common symptoms, and again, they all depend on the location of the fibroids. Lastly, I want to talk a little bit about diagnosis. How do we detect the fibroids?

13. 4:30

    So basically there's four ways that we can find fibroids. One is through physical exam, so that means you go into the gynecologist and she or he will do a pelvic exam.

14. 4:52

    They'll put two fingers into the vagina and one hand on the abdomen, and that's where they're feeling the uterus and the ovaries. And that's sometimes how I pick them up. A patient has no heavy bleeding or no symptoms, but I'll feel the fibroids that way. The second way is through ultrasound, and this is a procedure using sound waves, not radiation.

15. 5:16

    And often the gynecologist will use a wand. It's like a probe, and it actually goes into the vagina. It looks very big, but it's actually only the very end of it goes in, and the sound waves come out at the tip of it, and that gives us the best picture of the uterus and ovaries. So that's one, another way we can detect them. The third way is through a procedure called hysteroscopy.

16. 5:40

    And hysteroscopy is a procedure that's often done in the office. Some doctors don't have the equipment in their office, so they may have to take you in the operating room or a procedure center, but they put the camera through the cervix into the uterus and they look at the uterine cavity, and they can see fibroids that are pushing into the cavity, which as I explained a minute ago are the ones that are the most important.

17. 6:03

    And the fourth way is through MRI, and MRI stands for magnetic resonance imaging. So it's important to understand there's no radiation with this method, there's just magnetic waves, and through this process we can get an image of the uterus and the fibroids, but most importantly we get a very specific image of how many there are and where they're located.

18. 6:25

    So we usually only order these MRIs when we're trying to plan a complicated surgical procedure so that we can map out the fibroids and plan the surgery accordingly. We hesitate in ordering it casually because it can be very expensive, cost several thousand dollars.

19. 6:48

    And even if a patient just has a 10% copay, that can still be several hundred dollars for a patient. So we really reserve that test for specific reasons only. So that's it, that's the overview of fibroids today. I hope this was helpful. As always, I want to remind you I can't cover everything in these videos.

20. 7:11

    So if you have more questions, please feel free to come in to see me if you're my patient or to see your doctor. Otherwise, thank you so much for tuning in, and please don't forget to subscribe.