What is the difference between fibroids and cysts? What to do if you have them? How they can be treated/prevented? How will this affect your spouse and your sex life? Should you increase or decrease hormones? Should you get surgery? What are the risks? Will this affect your ability to get pregnant?
Women always come into the office confused stating that their primary doctor or an emergency room doctor told them they have cysts in their uterus or possibly in their ovaries. Here, we help to clarify the two different conditions.
Ovarian cysts are very common in reproductive age women. Most of them are called functional or physiologic cysts that are a result of our monthly ovulation. Each month when you begin your period a hormone is released from the pituitary gland that stimulates the follicles in your ovary to grow and produce estrogen. One cyst will become the dominant follicle and stop the other follicles from growing. This follicle will rupture at ovulation and release the egg which makes its way to the fallopian tube. The remaining follicle can fill up with fluid or blood and form an ovarian cyst. This type of cyst has a very specific appearance on ultrasound. These functional cysts will usually resolve on their own after one or two menstrual cycles. They do not require surgery, just monitoring with ultrasound and occasionally anti-inflammatory medication such as Tylenol or Motrin for pain.
Other types of ovarian cysts can represent tumors of the ovary. Some are benign and others are malignant. Benign examples include endometriomas or dermoids. Malignant tumors include germ cell tumors or epithelial ovarian cancers. Each type of ovarian cyst has a specific appearance on ultrasound. Your gynecologist can get a pretty good idea of what type of tumor it is based on its ultrasound appearance. Also certain blood tests can be done to tell if the cyst may be malignant.
If a cyst does have the characteristics of non-functional cysts usually some type of surgical removal is required either of the cyst or of the ovary. They are tumors and we do not yet know what stimulates tumor growth in people. Once this is discovered we would be able to eliminate cancer. Functional ovarian cysts on the other hand can often be prevented by the use of birth control pills which suppress ovulation. We do not find cysts in the uterus, however, fibroids which are smooth muscle tumors, form in the uterus.
Fibroids are very common, over 50% of women will have a fibroid at some point. They are almost always benign. They can be in any portion of the uterus, in the cavity of the uterus, in the muscle of the uterus or on the exterior surface of the uterus. They can also be attached to the uterus on a stalk. Many times fibroids are asymptomatic and are diagnosed on a pelvic ultrasound or during a routine pelvic exam. If they are small and a woman doesn’t have abnormal pain or bleeding the fibroid can be observed and followed for growth or symptoms by the gynecologist.
Symptoms from the fibroid include: heavy menstrual cycles, passing large clots during menses, pelvic pressure or pain, severe cramping with menses, urgency to urinate or difficulty having bowel movements, lower back pain. Women may also have pain with intercourse if the fibroid is located in a specific portion of the uterus. Your partner may also feel the fibroids if they are coming into the back portion of the vagina. If the fibroids are located in the cavity of the uterus where a pregnancy would implant, fibroids can cause infertility and miscarriage. Also if the fibroids are near the opening of the fallopian tubes into the uterus this can cause infertility as well. Pain with intercourse, recurrent miscarriage, infertility or any of the above mentioned symptoms would indicate the need for treatment for fibroids.
The following treatments are available for fibroids: surgical removal of the fibroids which is called a myomectomy or removal of the uterus which is called a hysterectomy. Other options include removing the fibroid transvaginally with use of a camera and operating system called a hysteroscope if the fibroid is small and is in the cavity of the uterus. If a woman isn’t planning on having more children an interventional radiographic procedure called uterine artery embolization is another means to reduce the size and bleeding from fibroids.
Fibroids typically grow in response to the release of estrogen from our ovaries. Situations that increase our hormone levels will stimulate fibroid growth such as pregnancy. Situations that decrease our hormones will cause fibroids to shrink which is what typically occurs after menopause. Some women will be treated with birth control pills to attempt to control the excess bleeding from the fibroids if the patient does not want surgical intervention.
The gynecologist should monitor the growth of the fibroids while on hormones to insure that they are not getting too big. Also there are drugs available that will temporarily induce a menopausal hormonal state to help stop bleeding from fibroids and to help them shrink. Unfortunately, this drug can only be used for short durations because it can induce osteoporosis or weak bones. It is typically given to help reduce fibroid size or help build up a woman’s blood count for surgery.
Treatment for fibroids depends on many factors such as size, degree and severity of symptoms and age of the woman. Each case is different so the management is something to be determined by the patient’s desires and her gynecologist recommendations.
Unfortunately, ovarian tumors and fibroids cannot be prevented with medication, dietary changes or herbs. We recommend women discuss treatment and prevention with their doctors and always advocate for healthy living overall to reduce risks for every kind of health ailment and disease.