The Fibroid Center at Cleveland Clinic Florida

offers a unique, multispecialty approach to treating

patients with fibroids. What does this mean

for you, the patient? Everything you need for

comprehensive management of fibroids is in one

convenient location, including our board-certified

physicians who work together to determine and

carryout your individual treatment plan.

What are fibroids?Fibroids are growths in the muscle wall of the uterus (myometrium) and are the most common benign tumors in women of childbearing age. They range in size from as small as a pea to as large as a watermelon, and the symptoms they cause are a function of their size and exact location in the uterus. Fibroids are rarely cancerous and do not become cancerous. A family history of fibroids is a common risk factor and they tend to regress spontaneously after menopause.

Fibroid Treatment Guide

Appointments: 866.237.9504 | Fibroid Treatment Guide

Who is likely To develop Fibroids and WhaT are The risk FaCTors?

Most fibroids occur in women of reproductive age, occurring in up to 60% of women. Women with darker skin color are 2-3 times more likely to have fibroids than lighter-skinned women, for unknown reasons. Risk factors for fibroids include family history, not having children, early onset of menstruation and late age of menopause. Being overweight or obese, defined as more than 20% over ideal body weight, is an increasingly common risk factor for fibroids.

WhaT sympToms do Fibroids Cause?

In many cases, fibroids do not cause any symptoms and as a result do not require treatment. Routine imaging studies are not necessary, only regular monitoring by a doctor. Some women with fibroids may experience the following symptoms:

Keep in mind that these symptoms can also be caused by other disease processes, not only fibroids.

are There diFFerenT Types oF Fibroids?

After obtaining a thorough medical history and completing a physical exam, the exact location, type and size of the fibroids need to be determined in order for the physician to offer the most appropriate, least invasive and effective treatment. Fibroids can be located in three parts of the uterine wall:

submucosal: located along the inner uterine lining or endometrium, fibroids in this location will typically cause abnormal uterine bleeding. This can occur in the form of very heavy periods with gushing and passage of blood clots, and menses lasting longer than 7 days. These can also cause cramping. Fibroids in this location tend to be relatively small, however they can cause significant bleeding issues or cramping. These fibroids will decrease a woman’s ability to get pregnant, and increase the risk of miscarriage.

intramural: these fibroids in the muscular part of the uterine wall will typically become larger before causing symptoms. Symptoms here can include cramping with menses, abnormal bleeding or pelvic fullness or pressure. If these become large enough they can push on the bladder or rectum creating bladder or bowel issues as well.

• Excessive bleeding with menstruation

• Large blood clots with menstrual flow

• Painful periods

• Bleeding between periods

• Fullness/bloating in the lower abdomen

• Low back pain

• Constipation

• Chronic vaginal discharge

• Urinary urgency or incontinence

• Inability to urinate

• Pain during intercourse

• Infertility

• Pregnancy loss

Appointments: 866.237.9504 | Fibroid Treatment Guide

Subserosal fibroid

Submucosal fibroidIntramural fibroids

subserosal: located on the outer uterine lining or serosa, these fibroids will typically become the largest of all three types before they cause symptoms and are identified. Generally these do not affect menstrual bleeding or fertility, however these will press on adjacent organs and create bladder or bowel issues, as well as pelvic and abdominal cramping, discomfort or fullness.

hoW are Fibroids evaluaTed?

The first step in evaluation of fibroids is a complete physical exam and thorough medical history. One of the following imaging techniques will likely be required to determine the exact location and size of the fibroids.

ultrasound: An ultrasound, or sonogram, is typically the first type of imaging test done for fibroids. In most cases this is done with a vaginal probe, however for large fibroids an abdominal scan may be required. This is painless, does not involve radiation and at Cleveland Clinic Florida is frequently performed by a gynecologic surgeon. The advantage of having this diagnostic test performed by a surgeon is that the appropriate treatment options, including nonsurgical treatments, will be immediately discussed. In addition to fibroids, the ovaries, uterine size, uterine lining and fallopian tubes can be evaluated.

saline infusion sonogram (sis): This type of transvaginal ultrasound, performed by either a gynecologist or radiologist, involves placing a thin catheter through the cervix into the uterus. A small amount of salt water is infused, enabling the sonographer to clearly view the uterine cavity and surrounding uterine muscle. This is very useful in determining the exact type and location of the fibroids.

mri (magnetic resonance imaging): A powerful magnet, combined with radio signals and a computer allow intricate images of the uterus and surrounding organs to be obtained.

Appointments: 866.237.9504 | Fibroid Treatment Guide

mediCal managemenT

• Hormones such as low dose birth control pills

• Intrauterine devices

• Over-the-counter medications

TreaTmenT proCedures

• Uterine fibroid embolization (UFE)

surgiCal TreaTmenTs

• Hysteroscopic myomectomy

• Laparoscopic and single, port myomectomy

• Robotic myomectomy

• Mini-laparotomy

• Vaginal hysterectomy

• Laparoscopic hysterectomy

• Robotic hysterectomy

• Traditional or abdominal hysterectomy

ConClusion

Over the years, we have found that many women are hesitant to discuss their fibroid symptoms with their gynecologist out of fear of ending up with a hysterectomy. Our Section of Minimally Invasive Gynecology, Interven-tional Radiology and multi-specialty academic practice are proud to work collaboratively as a team to offer a wide spectrum of medical, surgical and minimally invasive procedures. As a specialized, high volume center, we focus on providing only the most effective, safest, state-of-the-art treatments, in a manner which is least disruptive to your lifestyle.

What treatment options are available for fibroids? After completing a thorough history, physical exam and evaluation of fibroids, treatment options can now be addressed. With all the proper information, the most effective, safe, and least invasive options will be discussed, while taking into consideration the patient’s preferences and desires.

Appointments: 866.237.9504 | Fibroid Treatment Guide

stephen Zimberg, mdDirector, Section of Minimally Invasive Gynecology

Meet Our Staff

viviane Connor, md Gynecologist Medical Director, Cleveland Clinic Florida – West Palm Beach

rodolfo blandon, md Chair, Division of Radiology Head, Section of Interventional Radiology

michael sprague, md Gynecologist

mark berman, md Interventional Radiologist

kevin stadtlander, mdInterventional Radiologist

Chieh-lin Fu, md Hematologist