Uterine Fibroids

What are uterine fibroids?
Who is most likely to have fibroids?
What are symptoms of fibroids?
What complications can occur with fibroids?
How are fibroids diagnosed?
When is treatment necessary for fibroids?
Can medication be used to treat fibroids?
What types of surgery may be done to treat fibroids?
Are there other treatments besides medication and…

What are uterine fibroids?

Uterine fibroids (also called leiomyomas or myomas) are noncancerous growths that develop from the muscle tissue of the uterus.

• Uterine fibroids size, shape, and location can vary greatly.
• They can be inside the uterus, on its outer surface or within its walls, or attached to it by a stem-like structure.
• You can have only one fibroid or many of varying sizes.
• A fibroid may remain very small for a long time, then it may grow rapidly or slowly over many years.

Who is most likely to have fibroids?

• Uterine fibroids can happen at any age but are most common in women aged 30-40.
• Uterine fibroids are more common in African American women than in white women. They also occur at a younger age and grow more rapidly in African American women.

What are symptoms of fibroids?

The following may be symptoms of fibroids:

• Vaginal bleeding at times other than menstruation
• Changes in menstruation (longer, more frequent, or heavy menstrual periods or menstrual pain and cramps)
• Anemia (from blood loss)
• Pain during sex
• Dull or sharp pain in the abdomen or lower back
• Internal pressure (difficulty urinating, frequent urination, constipation, rectal pain, or difficult bowel movements)
• Abdominal cramps
• Miscarriages
• Enlarged uterus and abdomen
• Infertility
• Fibroids can also cause no symptoms at all.

Fibroids can be found during a routine pelvic exam or during tests for other problems.

What complications can occur with fibroids?

• Fibroids that grow rapidly, or those that start breaking down, may cause pain. Rarely are these associated with cancer.
• Fibroids that are attached to the uterus by a stem can twist, possibly causing pain, nausea, or fever.
• A very large fibroid can cause swelling of the abdomen, making it difficult to do a thorough pelvic exam.
• Fibroids may also cause infertility, although other causes are more common. Other factors should be explored before fibroids are considered the cause of a couple’s infertility.
• When are fibroids are thought to be the cause of infertility, many women are able to become pregnant after treatment.

How are fibroids diagnosed?

Fibroids may be detected during a routine pelvic exam. These other tests may show more information about fibroids:

• Ultrasonography — Uses sound waves to produce a picture of the uterus and other pelvic organs.
• Hysteroscopy — Uses a slender device (the hysteroscope), inserted through the vagina and cervix, to see the inside of the uterus.
• Hysterosalpingography — A special X-ray test that can detect abnormal changes in the size and shape of the uterus and fallopian tubes.
• Sonohysterography — Fluid is put into the uterus through the cervix, then ultrasonography is used to show the inside of the uterus and the uterine lining.
• Laparoscopy — Uses a slender device (the laparoscope), inserted through a small cut just below or through the navel, to look inside the abdomen and see the fibroids on the outside of the uterus.
• Imaging tests, such as MRI and CT scans.

Some of these tests may be used to track the growth of fibroids over time.

When is treatment necessary for fibroids?

• Women nearing menopause often do not need treatment.
• These signs and symptoms may signal the need for treatment:
  • Bleeding between periods
  • Heavy or painful menstrual periods that cause anemia or that disrupt normal activities
  • Rapid increase in the growth of the fibroid
  • Uncertainty whether the growth of a fibroid is a fibroid or another type of tumor
  • Infertility
  • Pelvic pain.

Can medication be used to treat fibroids?

Medication is an option to treat fibroids. Medications may reduce heavy bleeding and painful periods, but they may not prevent the fibroid growth and surgery may be needed later.

Drug treatment includes the following options:

• Birth control pills and other hormonal birth control methods (used to control heavy bleeding and painful periods)
• Gonadotropin-releasing hormone (GnRH) agonists
  • These drugs stop the menstrual cycle and can shrink fibroids. There may be side effects, so they are only used for short periods of time. Sometimes they may be used before surgery to reduce the risk of bleeding.
• Progestin-releasing intrauterine device
  • This drug option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful periods but does not treat the fibroids themselves.

What types of surgery may be done to treat fibroids?

Two surgeries can be done to treat fibroids:

• Myomectomy – the surgical removal of fibroids while leaving the uterus in place
  • This is done so the woman can keep her uterus and still be able to have children
  • Fibroids will not regrow after surgery, but new ones may still develop
  • If new fibroids form, more surgery may be needed
• Hysterectomy – the surgical removal of the uterus (ovaries may or not be removed)
  • This is done when other methods have not worked, or the fibroids are very large
  • A woman who has a hysterectomy will no longer be able to have children.

Are there other treatments beside medication and surgery?

These other methods may be done to treat fibroids:

• Hysteroscopy
  • This technique removes fibroids that protrude into the cavity of the uterus
  • A resectoscope is inserted through the hysteroscope and destroys fibroids with electricity or a laser beam
  • It cannot remove fibroids that are deep within the walls of the uterus
  • This can be done as an outpatient procedure
• Endometrial ablation
  • This procedure destroys the lining (endometrium) of the uterus and is used to treat women with small fibroids (less than 3 cm)
  • Endometrial ablation can be performed using uterine artery embolization (UAE)
  • In UAE tiny particles are injected into the blood vessels of the uterus, cutting off blood supply to the fibroid, and causing them to shrink
  • UAE can be done as an outpatient procedure
• Magnetic resonance imaging-guided ultrasound surgery
  • This is a new approach in which ultrasound waves are used to destroy fibroids
  • The ultrasound waves are directed at the fibroids through the skin with the help of magnetic resonance imaging
  • Studies show that women have improved symptoms up to 1 year after having this procedure, but long-term relief by this method is still being studied.