FIBROIDS AND PREGNANCY MISCARRIAGES:
Do fibroids cause recurrent miscarriages? While there is no consensus among experts, the preponderance of evidence does suggest that fibroids can cause women to experience multiple pregnancy miscarriages. The reasons are not entirely clear, but most believe fibroids can exert this negative effect by several means. First, fibroids can distort the shape of the uterus or otherwise obstruct the proper growth of a pregnancy simply as a result of their physical presence. Second, the blood supply of the pregnancy can be diverted to a growing fibroid. In all of these cases, pregnancies can miscarry. The benefits of surgically removing fibroids seem to reflect these hypotheses. For example, the medical literature shows that pregnancy rates have been reported as high as 60% after myomectomy, regardless of which type of myomectomy is performed.
If you’ve been experiencing recurrent miscarriages or are otherwise experiencing fertility issues, it’s worth it to seek out medical care as soon as possible.
SURGICAL OPTIONS FOR FIBROIDS:
Many women are under the impression that minimally invasive surgical options are only available in limited cases. As mentioned, however, in the hands of experienced minimally invasive surgeons, this is absolutely not true. Advanced surgeons like Dr. Nezhat are able to remove even the largest fibroids minimally invasively without compromising the function of your uterus or resorting to a hysterectomy. The surgery to remove fibroids is called a myomectomy. This is an organ-sparing surgery in which just the fibroids are removed from the uterine tissue, while leaving the uterus intact. Prior to the advent of videolaparoscopy, myomectomies were performed using large incisions through the abdomen (i.e., laparotomy).
Today, however, the following minimally invasive choices are now available:
- Hysteroscopic myomectomy A camera with an electric loop attachment is placed inside the cavity of the uterus through the vagina and the fibroids are visualized and removed by shaving them off the wall of the uterus. This can only be done for submucosal fibroids that are protruding into the cavity of the uterus. This is an outpatient surgical procedure and patients can go home the same day of surgery with minimal side effects.
- Abdominal myomectomy A large incision is made on the abdomen to gain access to the uterus. The fibroids are removed by cutting into the uterus and taken out through the abdominal incision. The uterus is then sewn back together. Fibroids that are on the outside or in the wall of the uterus can be removed this way. Because of the large abdominal incision, patients are hospitalized for 2-4 days after surgery. Recovery can take up to six weeks.
- Video-assisted laparoscopic myomectomy A small camera is placed through the navel, 2-3 small 0.5-1.0cm incisions are made in the lower abdomen and the surgery is performed through these small incisions. Fibroids on the outside and in the walls of the uterus can be removed this way. They are cut into small pieces and pulled out through the small laparoscopic incisions. For larger fibroids (around 30-40 weeks gestational size), one of the small incisions is extended and the fibroid is pulled out in pieces through this extended incision. Patients typically go home the day of or day after their surgery. The American Congress of Obstetricians and Gynecologists stated in their 2009 Practice Bulletin that laparoscopic myomectomy minimizes the size of the abdominal incision, resulting in a quicker postoperative recovery (compared to abdominal myomectomy). Because of the complex nature of laparoscopic dissection and suturing, special surgical expertise typically is required.
- Robotic-assisted laparoscopic myomectomy The incisions are similar to that of a video-assisted laparoscopic myomectomy, but instead of the surgeon standing over the patient operating the instruments, robotic arms are placed through the incisions and the surgeon sits at a consul operating the arms remotely. It aids the surgeon by allowing better visualization and handling of the fibroids. It also has similar recovery as a laparoscopic myomectomy and requires special surgical expertise.
- Uterine artery embolization (UAE) – Another minimally invasive option is uterine artery embolization (UAE). This is an outpatient procedure performed by an interventional radiologist. A catheter is placed through the groin into the uterine artery. Small coils or pellets are used to block the uterine artery, which gives its blood supply to the uterus and fibroids. Without adequate blood supply, the fibroids shrink and symptoms of pressure and heavy bleeding can also reside.
- However, UAE is recommended for only a select group of patients; specifically, for those who are premenopausal with symptomatic fibroids within the uterine wall and where future fertility is not a primary concern. UAE is also helpful for patients for whom surgery is too risky. Although it is a relatively safe procedure, there are some severe side effects, including fever, pain, infection, death (necrosis) to uterine tissue and vulva, premature ovarian failure, infertility, necrosis of buttock and thigh muscle, and increase risk of hospital readmission compared to minimally invasive myomectomy procedures.
FIBROIDS CO-EXISTING WITH ENDOMETRIOSIS?
If you have uterine fibroids, there’s a chance that you may have endometriosis as well. At least that’s what Dr. Nezhat’s many years of research suggest, findings which he first reported back in 2009. Far from an incidental footnote, this research actually has tremendous implications. To begin with, the apparent strong relationship between fibroids and endometriosis may mean that endometriosis is far more prevalent than previously suggested.
This inference can be drawn when one considers reported prevalence rates of fibroids, which countless studies have observed to be between 30% to 50% in the female population. If endometriosis commonly co-exists with fibroids, then this means that it too may occur in a similar percentage of women as fibroids.
To test this hypothesis, Dr. Nezhat looked at 131 women undergoing surgical intervention for symptomatic fibroids and found that 113 also had pathology-confirmed endometriosis, representing an 86% correlation between the two disorders.
Extrapolating from these findings led to some very surprising potential correlations. For example, with a world population of approximately 3.5 billion females, a fibroid prevalence rate of 30% to 50% would means that an estimated 1.05 to 1.75 billion women either have had, will have, or currently do have fibroids. Given Dr. Nezhat’s hypothesis that at least an 86% coexistence of endometriosis and fibroids exists, this would therefore suggest that there are 900 million to 1.5 billion females who also either have had, will have, or currently do have endometriosis. This is a far higher estimate than the 5% to 15% prevalence rates generally cited for endometriosis.
What this means is that, if you’ve been diagnosed with fibroids, it’s a good idea to ask your doctor to check for signs of endometriosis as well.
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Reference: Huang JQ, Lathi RB, Lemyre M, Rodriguez HE, Nezhat CH, Nezhat C. Coexistence of endometriosis in women with symptomatic leiomyomas. Fertil Steril. Jul 2010;94(2):720-723.
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Drs. Nezhat have pioneered many of these techniques and instrumentations and are among the most, if not the most, experienced surgeons in treating fibroids.