Dr. Heegaard voted one of Top Doctors for Women 2009

The Minnesota Monthly 2009 "Top Doctors for Women" has included Dr. Heegaard as one of the Top OB-GYN's for women.

Basic Information about Fibroids and Female Anatomy

Female Pelvic Anatomy.

The female reproductive system consists of the vagina, cervix, uterus, fallopian tubes and the ovaries. These organs are all contained within the female pelvis.

The uterus (womb) is a pear shaped organ located between the bladder and the rectum. The uterus is made up fibro muscular, smooth muscle walls and a glandular lining. The fertilized egg implants into this lining when pregnancy occurs. This lining also sheds off during the menstrual period if pregnancy does not occur. The muscular walls are able to expand enormously during pregnancy to accommodate the growing fetus.

The cervix, often described separately, is actually part of the uterus. It is the lowermost part of the uterus and has a narrow passage through which menstrual blood passes during a woman’s period. The cervix protrudes into the upper vagina and serves as an entryway into the uterus and also serves to hold the uterus closed during pregnancy.

The fallopian tubes are small muscular tubes, which are located on either side of the upper uterus. It is through these tubes that the egg will pass following ovulation into the uterus. Fertilization usually occurs in the fallopian tube.

The ovaries are tethered to the upper aspect of the uterus, in close proximity to the ends of the fallopian tubes. The ovaries release one egg during every cycle. They also make the two main female hormones, estrogen and progesterone.

What are fibroids?

Fibroids, also known as myomas, fibromyomas or leiomyofibromas are the most common pelvic tumor in women. They are generally round firm growths that develop within the uterus. They are almost always benign (non cancerous) and can range in size from microscopic to as large as a melon.

What causes fibroids?

Scientists are not sure what cause fibroids to grow. It is thought that they develop from a normal myometrial (uterine muscle) cell, which mutates due to the influence of estrogen and progesterone and other local growth factors. Fibroids may grow during pregnancy due to the high levels of hormones. Conversely, after menopause, fibroids often shrink due to decreased hormone levels.

Who is affected by fibroids?

Fibroids are very common. It is estimated that anywhere from 20-50% of all women have these benign growths. They are also more likely to effect women in their 30s and 40s. Some ethnic variability exists as well, with as many as 50% of African American women having fibroids in their reproductive years versus 25% in Caucasian women. It is not known why fibroids develop in some women and not in others. Fibroids are the most common indication for hysterectomy in the United States.

What happens to fibroids over time?

Some fibroids continue to grow steadily over the reproductive years while others may stay the same size. Fibroids generally stop growing after menopause when hormone levels diminish. Fibroids that continue to grow after menopause should be evaluated.

When should I consider treatment?

Most fibroids, even large ones, do not produce significant symptoms. If a woman is not bothered by her fibroids, she probably does not need to have treatment. If however, symptoms develop, she should be evaluated by her gynecologist.

Fibroids and Pregancy

Here is an article I wrote for the OB-GYN West patient newletter last year.

Fibroids and Pregnancy

Fibroid tumors-also known as uterine myomas or leiomyomas-are extremely common in reproductive age women. A fibroid tumor is a benign mass of compacted muscle tissue that grows on or in the uterine wall. It’s estimated that approximately 30-50% of women between 25 and 45 years old have at least one fibroid tumor and they tend to be more common in the African American population than in other ethnic groups. The actual incidence, however, among pregnant women is probably about 10%. These tumors can be as small as a pea and occasionally can grow to the size of a grapefruit.

Fibroids usually develop prior to pregnancy and most women do not even know they have them unless they produce symptoms. The most common complaints are abdominal pain, heavy menstrual bleeding, pelvic pressure, urinary frequency and, occasionally, infertility and recurrent miscarriage. Fibroids can occasionally be diagnosed by physical exam but are often found incidentally at the time of an obstetrical ultrasound.

The diagnosis of a uterine fibroid during pregnancy can create a lot of anxiety. The reality, however, is that the vast majority of women with fibroids have uneventful pregnancies and deliveries. It was once thought that pregnancy induced rapid growth of most fibroids but studies have shown that almost 70% of fibroids do not grow in size and a small percentage actually shrink. Of those that grow during pregnancy, most recede after delivery.

Rarely, however, fibroids can complicate pregnancy. The most likely complication is abdominal pain related to rapid growth and degeneration of a fibroid. This may require treatment with pain medication and bedrest but is rarely dangerous to the pregnancy. There is also slightly increased risk of preterm labor, premature separation of the placenta (placental abruption), breech presentation and cesarean section.

Once the diagnosis is made, your obstetrician will work with you to decide on the best course of treatment and monitoring. Very likely she or he will monitor your pregnancy with periodic ultrasound examinations to monitor the growth of the baby. Your doctor may also decide to see you more frequently than normal and will ask you to call if you develop contractions or bleeding. By working closely with your obstetrician you can expect a normal pregnancy and a great outcome.

Eric G. Heegaard M.D. FACOG