Definition

Fibroids are benign growths in the wall of the uterus, the reproductive organ where a fetus develops. The tumors often grow into the uterine cavity. In rare cases, fibroids may protrude from the uterus toward nearby organs. Fibroids vary in size from very small to eight or more inches in diameter. Usually more than one fibroid is present. About 20% to 30% of women of childbearing age, and as many as half of all women, have fibroids. Many do not realize it. Most do not develop symptoms until their late 30s or 40s.

Uterine Fibroid

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Causes

The cause of fibroids is unknown. Genes and abnormalities in substances that regulate blood vessel development may make some women prone to fibroids. Female reproductive hormones stimulate fibroid growth. Fibroids increase in size during pregnancy then decrease after childbirth. Fibroids become less of a problem after menopause . However, symptoms may return with hormone replacement therapy.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

  • Sex: female
  • Age: approximately 13 to 50 years old (childbearing age)
  • Race: Black

Symptoms

Symptoms range from none at all to mild or severe, depending on the size and location of the growths.

Symptoms include:

  • Pelvic pain
  • Feeling of pelvic pressure
  • Heavy menstrual bleeding
  • Clots in menstrual flow
  • Long periods
  • Bleeding between periods
  • Increased cramping during periods
  • Pain during sex
  • Frequent need to urinate
  • Constipation
  • Bloating
  • Enlarged uterus, giving the appearance of pregnancy
  • Low back or leg pain
  • Infertility by blocking the fallopian tubes
  • Miscarriage

Iron-deficiency anemia may develop if bleeding is heavy. Symptoms include:

  • Weakness
  • Fatigue
  • Pale skin
  • Light-headedness

Diagnosis

Doctors find most fibroids during routine pelvic exams. An abdominal ultrasound confirms the diagnosis. A transvaginal ultrasound may be done to obtain clearer images. A CT scan or magnetic resonance imaging (MRI) may be ordered in complex cases. Hysteroscopy allows the doctor to see inside the uterus using a thin, lighted tool inserted in the vagina and passed through the cervix. During the procedure, the doctor may be able to remove small fibroids or reduce the size of larger growths.

Treatment

Most women with fibroids have no symptoms and do not need treatment. The doctor may recommend "watchful waiting," monitoring the size and growth of the fibroids at regular intervals using ultrasound.

Treatments include:

Pain Medication

Over-the-counter pain pills ease mild symptoms. Prescription pain relievers may be needed. Nonsteroidal anti-inflammatory drugs reduce inflammation and help with cramping.

Hormonal Therapy

Hormone medications, which decrease estrogen levels, are an option if you are not trying to become pregnant. Synthetic hormones create an artificial menopause. The drugs shrink fibroids and diminish the pain by decreasing the supply of estrogen to the uterus. However, fibroids can return once you stop taking the medication. These drugs are often used to reduce fibroid size prior to surgery.

Because hormone medications are harmful to a developing fetus, you must use a barrier method of birth control while taking them.

Surgery

Surgery is considered if:

  • The uterus becomes extremely large.
  • The fibroids are interfering with fertility.
  • Symptoms are severe.

Surgical procedures include:

Myomectomy

Myomectomy is the removal of the fibroids only and leaving the uterus intact. This can be done by:

  • Open surgery that involves a single large abdominal incision
  • Laparoscopy—using a lighted fiberoptic tube and requiring only a few small incisions
  • Hysteroscopy—which involves the insertion of a hysteroscope through the cervix into the uterine cavity

Because it preserves the uterus, myomectomy is commonly performed on younger women who may want to have children. However, conceiving may remain difficult. The surgery is less successful if there are many fibroids, because some may grow back.

Uterine Fibroid Ablation

An alternative to surgical removal, uterine fibroid ablation (also called myolysis) uses heat to disrupt the blood supply to the fibroid, causing it to shrink. This is a relatively new procedure and not available in all medical facilities.

Total Hysterectomy

Total hysterectomy is the removal of the entire uterus. This may be done through a vaginal or abdominal incision. Hysterectomy is the definitive treatment for fibroids, but it eliminates the possibility of having children.

Nonsurgical Options

Uterine Fibroid Embolization

Fibroids need an adequate supply of blood to grow. Without blood, the tumors shrink. Doctors can perform a uterine fibroid embolization (also called uterine artery embolization) to stop the blood flow. A specially trained doctor makes small cuts in the groin and threads a catheter into the arteries that supply the uterus with blood. Tiny particles of plastic or gelatin are passed through the catheter. The particles make their way to the fibroids and block blood from reaching the tumors.

Focused Ultrasound Therapy

Focused ultrasound therapy is a new, noninvasive treatment done under magnetic resonance imaging (MRI) guidance, which recently completed successful clinical trials. This procedure is available in a limited number of academic medical centers and may not be appropriate for patients who are significantly overweight, have very large fibroids, or extensive scars from prior abdominal surgeries.

Prevention

There are no guidelines for preventing fibroids because the cause is unknown.