Authors: Spies JB, Bradley LD, Guido R, Maxwell GL, Levine BA, Coyne K.

Study from: Georgetown University Hospital Department of Radiology, Washington, DC

Problem: Despite the very common occurrence of fibroids, very few studies have evaluated the severity of symptoms caused by uterine fibroids, their effect on health-related quality-of-life, or the changes in symptoms after treatment compared with women who do not have fibroids.

Study: Groups of women with fibroids who were scheduled for hysterectomy, myomectomy, or uterine artery embolization, as well as women without fibroids were assessed using questionnaires designed to measure quality of life and symptoms, including physical functioning, pain, sexual function, vitality, energy/mood, social functioning and mental health. Questionnaires were completed before treatment and again at 6 and 12 months after treatment.

Results: A total of 375 women Participated in the study: 101 without fibroids, 107 who had embolization, 61 who had a myomectomy, and 106 who had a hysterectomy. Before treatment women with fibroids had more severe symptoms than women without fibroids. At both 6 and 12 months after treatment, women having treatment for their fibroids had as few symptoms as women who did not have fibroids. One year after treatment, the women who had a hysterectomy reported less symptoms and better health-related quality of life than women who had embolization or myomectomies. However, the majority of the benefit of hysterectomy was attributed to the absence of menstrual periods.

Authors’ Conclusions: At 12 months after treatment, all three leiomyoma therapies resulted in substantial symptom relief, to near normal levels, with the greatest improvement after hysterectomy due to the absence of menstrual periods.

Dr. Parker’s Comments: Since myomectomy, embolization and hysterectomy all reduce symptoms to the levels seen with women without fibroids, all three treatments should be very effective for women who have bothersome symptoms related to fibroids. Therefore, a woman’s choice for treatment should depend on other individual factors including the desire for fertility, the desire to preserve her uterus, willingness to undergo surgery and anesthesia, willingness to undergo embolization, etc. The other point here is that the women choosing to have treatment had significant symptoms; most women with minor symptoms will often choose watchful waiting and wait for menopause when fibroids shrink and bleeding stops.

Authors: Davis BJ, Haneke KE, Miner K, Kowalik A, Barrett JC, Peddada S, Baird DD. J
Journal: Women’s Health (Larchmt). 2009 May;18(5):725-32.
Study performed by: National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA. Barbara.Davis@MPI.com

Problem: A common question in my office is “if these fibroids grow, won’t I just need treatment in the future?” Despite years of studies about fibroids, no one has ever documented if there is a size at which women will always want treatment.
Study: MRIs were done on 116 premenopausal women, ranging in age from 20 to 54 years; 48% were black women, 41% were white women, 10% were women of other racial backgrounds

Conclusions: Neither the number of fibroids a woman had nor the over-all size of her uterus was related to which women chose treatment. The women who asked for treatment had more symptoms, including more bleeding and pain, compared with the women who chose not to have any treatment. The authors suggested that aggressive treatment of pain and bleeding might reduce the need for surgery.

Dr. Parker’s Comment: The size of a woman’s fibroid does not always correspond with the degree of her symptoms. For instance, a small fibroid (even 2-3 cm = 1 inch) inside the uterine cavity can cause severe bleeding and anemia. But, a large fibroid, say 7 cm (3 in), outside the uterine wall will cause no extra bleeding. A 7 cm fibroid sitting directly over the bladder can cause urinary frequency and the need to get up in the middle of the night to urinate, very bothersome symptoms to some women. But, a 7 cm fibroid at the top of the uterus may cause a little bloating, but not enough for the woman to seek treatment. So, sizes, number and position of the fibroids are all important factors in determining which women might have bothersome symptoms.

See: http://www.fibroidsecondopinion.com/fibroid-symptoms/