can someone tell me about subserosal fibroids? and the treatment to have them removed?
Wednesday, August 26th, 2009 at
11:49 pm
I was told that i have 2 subserosal fiborids and they hurt i want them removed but i want to know really can i still have children after the trement?
Filed under: Fibroids Treatment
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Fibroids, also known as leiomyomas or just plain myomas, are benign, smooth muscle tumors that usually grow in the uterus (womb). They are the most common pelvic tumors in females. They can range in size anywhere from a few millimeters (the size of a sesame seed) to several centimeters (about an inch). Fibroids can occur in different locations in and on the uterus but very rarely on organs outside of the uterus.
Subserosal fibroids are located under the outer “skin” of the uterus (serosa) and do not grow into the muscular wall of the uterus (myometrium).
What are the Available Treatment Options?
Medication
Medical management of fibroids is fairly limited and often used only to reduce symptoms until surgery is necessary. Currently two medical agents are used for the management of fibroids:
* Depo-Provera, an intramuscular injection of long-acting progesterone (a commonly used birth control agent) has been used for the management of fibroids that cause heavy vaginal bleeding. Used over time, Depo-Provera stops menstruation (amenorrhea). This reduces the vaginal bleeding, but there are troublesome side-effects associated with this process including: weight gain, hair thinning, and irregular vaginal spotting. This medication is of little or no use in treating symptoms of fibroids other than those related to vaginal bleeding.
* Depo-Lupron (Lupron) has also been used in the medical management of fibroids. It is given by injection. Lupron essentially creates a “medical menopause” by decreasing the amount of estrogen circulating in the bloodstream and causing the fibroids to shrink. Like Depo-Provera, Lupron also causes amenorrhea. When used for a short time (from 3 to 6 months), Lupron has proven beneficial in reducing fibroid size making them surgically more manageable. It also helps to reverse the anemia (low red blood cell count) caused by increased vaginal bleeding. However, Lupron cannot be used for more than 6 months, as over-usage leads to bone loss (osteoporosis) and significant increases in triglyceride (a fat molecule) and cholesterol levels.
Surgery
Surgery is needed when your symptoms cannot be managed using medication. The surgical procedures that are used are described below. The one that is right for you depends on multiple factors including your age, the symptoms and types of fibroids you have, and your desire for future child bearing.
* Abdominal Myomectomy involves the removal of fibroids (pedunculated, subserosal or intramural) from the uterine surface or wall through an incision made in the abdomen. This procedure is indicated if you have symptomatic fibroids and plan to have children in the future. The risks of an abdominal myomectomy include significant blood loss, post-operative infection, accumulation of scar tissue (with possible detrimental effects on fertility), possible need for cesarean section with subsequent pregnancies, and possible growth of new fibroids.
* Hysteroscopy and Submucus Resection is performed through the vagina for the treatment of symptomatic submucosal fibroids. The cervix is dilated and a small camera (hysteroscope) is passed through the cervix into the endometrial cavity. This camera allows the physician to see a submucosal fibroid directly. A small wire with a weak electrical current is then used to shave the fibroid from the endometrial cavity. The risks of this procedure include infection, uterine perforation, and possible growth of new fibroids with recurrence of symptoms.
* Laparoscopic Removal of Fibroids and Myolysis involve placing a small telescope (laparoscope) through the naval to visualize subserosal and pedunculated fibroids. A laser or electrical wire is then used to remove or dissolve the fibroid. There are very few indications for this procedure. If your fibroids are small enough to be treated this way, then you should discuss with your physician whether your fibroids actually need to be treated at all.
* Hysterectomy is the removal of the uterus with or without the removal of the cervix. Hysterectomy is the only definitive treatment for fibroids and can be used for all types. It can be performed in several ways. An abdominal hysterectomy involves removing the uterus through a surgical incision in the abdomen, while a vaginal hysterectomy is done by making an incision in the vagina. In a laparoscopic-assisted vaginal hysterectomy, a laparoscope, inserted through the navel, is used to aid in the removal of the uterus through the vagina. A hysterectomy is indicated if you have symptomatic fibroids that cannot be managed by other means and you are done with child bearing. The type of hysterectomy that should be done depends upon the size and location of your fibroids. The complications of a hysterectomy include bleeding and infection.
Uterine artery embolization
An alternative to medical management or surgical treatment of fibroids is uterine artery embolization. Embolizations are performed by cardiovascular interventional radiologists. Your gynecologist should be able to refer you to one. In this specialized test, a small tube (catheter) is placed into the blood vessels going to your uterus. These vessels are then blocked so that the blood flow to the fibroids is greatly decreased. This blocking causes the fibroids to shrink, improving your symptoms. This procedure is indicated if you have symptomatic fibroids and would like to preserve fertility. The complications of this procedure are rare but include internal swelling from ruptured blood vessels (hematomas) and infection.
Uterine fibroids can sometimes interfere with a healthy pregnancy. During pregnancy, uterine fibroids tend to grow to large sizes as they are triggered by your body�s increase in hormones. This can compromise the shape of your uterus and limit the amount of space that your baby has to grow. As a result, miscarriage or fetal malpresentations may occur. Uterine fibroids can also increase the chance of:
* postpartum hemorrhaging
* obstructed labor
* stalled labor
* cesarean section
It depends on the treatment you get. There are procedures that simply remove the fibroids (myomectomy, uterine fibroid embolization, e.g.) and those types of procedures shouldn’t prevent you from having children later. Hormonal therapy (i.e. birth control pills) may also help the fibroids shrink, which might reduce the pain you are experiencing from them.
Subserosal fibroids are a benign growth (made out of smooth muscle) that lie on the outer part of the uterus, just under the covering of the outside of the uterus (the serosa).