Uterine Fibroids

Overview

What are uterine fibroids?

Fibroids are benign growths (not cancer) in the muscular wall of the uterus. These growths can be very tiny or as large as a cantaloupe.

Fibroids are very common. At least 20% of women 35 years of age or older have fibroids. Many women have them without knowing it. Black women are at a higher risk of having fibroids than women in other racial groups.

Once a fibroid is formed, it tends to grow larger until menopause, after which fibroids tend to shrink, due to the effects of estrogen.

Symptoms

Do fibroids cause problems?

Many women who have fibroids don’t have symptoms. In other women, fibroids can cause heavy bleeding during the menstrual period. Periods may last much longer than usual.

Fibroids may also cause pain or a feeling of pressure or heaviness in the lower pelvic area (the area between the hip bones), the back or the legs. Some women have pain during sexual intercourse. Others have a constant feeling that they need to urinate. There may also be a feeling of pressure in the bowel. Some women have constipation or bloating.

Treatment

How are fibroids treated?

There are many treatment options for women who have fibroids. Fibroids that don’t cause any symptoms may not need treatment. For fibroids that do cause symptoms, treatment options include medicine, noninvasive or minimally invasive procedures, or traditional surgery. Your doctor will help you figure out the best treatment option for your fibroid.

How is medicine used to treat fibroids?

Medicines don’t get rid of fibroids, but they can help control symptoms and make fibroids smaller.

What procedures are used to treat fibroids?

Your doctor may recommend a noninvasive or minimally invasive procedure to remove or destroy the fibroid.

A noninvasive procedure means that your doctor does not have to make an incision (cut your skin) in order to destroy or remove the fibroid. MRI-guided focused ultrasound therapy is a new, noninvasive way of treating fibroids. During this procedure, you lie in a magnetic resonance imaging (MRI) scanner while it takes pictures of your uterus. The scanner shows your doctor exactly where the fibroid is. Your doctor then points ultrasound (sound waves) at the fibroid. The ultrasound waves heat up and destroy the fibroid.

A minimally invasive procedure means that your doctor makes only a very small incision (cut) in your skin in order to destroy or remove the fibroid. Minimally invasive procedures include the following:

  • Uterine fibroid embolization (also called uterine artery embolization): Fibroids will shrink or go away completely if their blood supply is stopped. During uterine fibroid embolization, the doctor injects tiny particles into the arteries that supply blood to the fibroids. These particles stop the blood flow to the fibroid. Over time, the fibroid will shrink. The procedure works even if you have several fibroids.
  • Myomectomy: During this procedure, your doctor surgically removes the fibroids from your uterus. The surgical tools are inserted in the body either through very small cuts in the abdomen, or through the vagina and cervix.

What about traditional surgery?

If you have a number of fibroids or fibroids that are very large, your doctor may need to remove the fibroids by making a large incision (cut) in the abdomen. Your doctor may also recommend a hysterectomy. During a hysterectomy, your doctor removes the entire uterus from your body. A hysterectomy can be done through an abdominal incision (cut) or through a vaginal incision.

Questions to Ask Your Doctor

  • What could have caused my uterine fibroid(s)?
  • How large is/are my uterine fibroid(s)?
  • Does my uterine fibroid require treatment?
  • Could I choose not to have the fibroid removed?
  • I’d like to spare my uterus. Is uterine fibroid embolization a good treatment option for me?
  • Do uterine fibroids put me at risk for any other health conditions?
  • Is it safe for me to exercise like normal? What about sexual activity?

Citations

  • Uterine Fibroid Embolization by SJ Smith, MD( 06/15/00, http://www.aafp.org/afp/20000615/3601.html)