Patient Education

Uterine Fibroids

There are several different growths that can occur inside the uterus. One of the types is uterine fibroids, a benign (not cancerous) growth that is common among women; occurring in as high as 50-75% of all women. Many women who have uterine fibroids are not aware of them because they can remain small and asymptomatic. However, some can cause problems because of their size, location, and number. This page covers the basics about uterine fibroids and what to expect if you have them. 

WHAT ARE UTERINE FIBROIDS?

Uterine fibroids, also known as leiomyomas or myomas, are benign, non-cancerous growths that can grow anywhere on a woman’s uterus. They are the most common type of growth found in a woman’s pelvis. Uterine fibroids are made up of the cells that make up the muscle of the uterus, and can grow outside, against, or even inside the uterine lining. The size, shape, number, and location of uterine fibroids vary greatly depending on the woman and her specific case. They can be as small as a pea, to as large as an orange, and 6-7 inches around, causing the uterine wall to distort and change. They can even grow large enough to completely fill the pelvis or the abdomen. Sometimes, women can only have one fibroid, or many; the number that will grow is oftentimes unpredictable. They can grow rapidly or very slowly, or simply stay small. They are often hard to treat because their growth rate is very unpredictable. Uterine fibroids can be asymptomatic (cause no symptoms), or they can cause many severe symptoms in a woman. 

WHAT CAUSES UTERINE FIBROIDS?

Although fibroids are extremely common, there is not much known about what causes them. However, it is known that the female hormone estrogen can increase their growth, depending on the natural rise and fall of the hormone. Uterine fibroids are most common among women around the ages of 40-50, although they can occur at any age. They are also more common in black women. 

WHAT ARE THE SYMPTOMS OF UTERINE FIBROIDS?

When uterine fibroids do produce symptoms in a woman, they oftentimes include: 

  • Pain
    • During sex 
    • In the abdomen or lower back (dull, heavy aching) 
  • Changes in menstruation
    • Longer or more frequent periods 
    • Heavier bleeding 
    • More painful cramps 
    • Anemia from blood loss 
    • Vaginal bleeding at times other than menstruation 
  • Miscarriages and infertility, rather uncommon
  • Pressure
    • Abdominal cramps 
    • Difficulty urinating or frequent urination, somewhat uncommon
    •  Constipation, rectal pain, or difficulty passing bowel movements, in rare cases

These symptoms are also very general and could be indicative of other problems. If you have any of these symptoms, you should still see your doctor to determine the cause. 

CAN FIBROIDS CAUSE ANY SERIOUS COMPLICATIONS OR DISEASES?

Usually, fibroids do not cause any serious illnesses. However, some larger fibroids may cause complications. Large fibroids may fill up the abdominal cavity and become swollen, which makes pelvic exams difficult to perform. Any fibroids that are attached by a stem can twist, which causes severe pain, fever, or nausea. Some fibroids in certain places may cause infertility in women, but when removed allow the woman to get pregnant. Sometimes, very rapid, quick periods of growth of the fibroid can be a symptom of cancer. 

HOW ARE WOMEN DIAGNOSED WITH UTERINE FIBROIDS?

The first signs of uterine fibroids can be found during pelvic exams performed by your gynecologist. If he or she finds signs of fibroids, your doctor may perform one or more of these tests: 

  • Ultrasound- sound waves are used to create a clear picture of the pelvic organs, including the uterus 
  • Hysteroscopy- a thin, telescope-like device with an attached camera is inserted into the cervix to provide the doctor of an inside view of your uterus 
  • Hysterosalpingography (HSG)- special fluid is inserted into your uterus and mapped with a certain x-ray machine to take pictures of any changes in size or shape of the uterus. 
  • Laparoscopy- a slender, camera instrument is inserted into the abdomen (which is inflated with gas) to see any fibroids that may have grown on the outside of the uterus. A laparoscopy may also be used to treat or remove the fibroids. 

HOW ARE UTERINE FIBROIDS TREATED?

If the uterine fibroids are small and asymptomatic, they do not need to be treated. However, those that create the following symptoms oftentimes merit treatment: 

  • Bleeding between periods 
  • Heavy, painful menstrual periods 
  • Uncertainty whether the growth is a fibroid or a tumor 
  • Pelvic pain 
  • Infertility 
  • Rapid increase in growth of the fibroid 

If you have been diagnosed in the past with uterine fibroids, you will need to have regular checkups with your doctor to monitor their growth and to make sure you are healthy. If you experience any of these symptoms, see your doctor immediately. 

Fibroids can be treated through surgery. Medications like gonadotropin-releasing hormone (GnRH) agonists may be used to temporarily shrink the fibroids before surgery to remove them. The fibroids are usually removed in one of two ways: 

  • Myomectomy: This procedure is the surgical removal of fibroids while leaving the uterus in place so the woman may still have children in the future. Women who become pregnant after having a myomectomy usually need to have a cesarean birth. However, myomectomies sometimes leave permanent scarring that makes it impossible for a woman to have a baby. Myomectomies can be performed in a number of ways-
    • Laparotomy- an incision is made in the abdomen and the fibroids are removed through the incision. 
    • Laparoscopy- fibroids can be removed through the laparoscope that is used to see inside the abdomen 
    • Hysteroscopy- fibroids inside the uterus are removed through the vagina 

Sometimes, even after a myomectomy, fibroids redevelop, which usually calls for another surgery. 

  • Hysterectomy: This procedure is the removal of the uterus along with the fibroids. The ovaries and fallopian tubes may or may not be removed as well. Hysterectomy may be the best choice if-
    • Fibroids are very large/invasive 
    • Other treatments are not possible or have failed 
    • The woman has completed her family 
    • Pain or abnormal bleeding persists 

Since a hysterectomy is a major surgery and should only be used as a last resort, your doctor will rule out other treatments before deciding on this choice. 

HOW CAN UTERINE FIBROIDS AFFECT PREGNANCY?

Sometimes, pregnant women develop uterine fibroids, but usually they do not cause problems for your pregnancy. During pregnancy, the fibroids may increase in size, due to increased amounts of blood flowing into the uterus. Uterine fibroids during pregnancy can cause pain, feelings of discomfort or pressure. Usually, after pregnancy, the fibroids will decrease in size. However, fibroids during pregnancy can increase the risk of miscarriage before 20 weeks, preterm birth, or a breech baby (the baby is in a position other than the head facing downwards). In very rare cases, a large fibroid can block the uterine opening and keep the baby from passing into the birth canal.  In these cases, a cesarean birth is oftentimes necessary. If you have fibroids during pregnancy, usually no treatment is needed. 

IN CONCLUSION

Uterine fibroids are a benign condition that is very common in most women. Oftentimes, fibroids cause no symptoms and do not need treatment. If you are diagnosed with uterine fibroids, it is important to go see your doctor for regular checkups and pelvic exams. If you have any serious symptoms that may be evident of uterine fibroids, it is important to see your doctor to make sure you are well.