What are uterine fibroids?
Uterine fibroids – also known as leiomyomas or myomas – are benign (not cancer) growths that develop from the muscle part of the uterus. The size, shape, and location of fibroids can vary greatly. They may be inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure called a peduncle. Some women may have only one fibroid and others may have many in various sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.
Who is most likely to have fibroids?
Fibroids can occur at any age, but they are most common in women aged 30–40 years old. They occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.
What are symptoms of fibroids?
Fibroids may cause no symptoms at all. They may be found incidentally during a routine pelvic exam or during a pelvic ultrasound for other problems or pregnancy.
Fibroids may also have the following symptoms:
- Changes in menstruation
- Longer, more frequent, or heavy menstrual periods
- Menstrual pain (cramps)
- Vaginal bleeding at times other than menstruation
- Anemia (from blood loss)
- In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
- During sex
- Difficulty urinating or frequent urination
- Constipation, rectal pain, or difficult bowel movements
- Abdominal cramps
- Enlarged uterus and abdomen on exam
What complications can occur with fibroids?
Fibroids that are attached to the uterus by a stem may twist and can cause pain, nausea, or fever. Fibroids that grow rapidly, or those that start breaking down, also may cause pain. Very rarely, they can be associated with cancer. A very large fibroid may cause swelling of the abdomen. This swelling can make it hard for your doctor to do a thorough pelvic exam.
Fibroids also may 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 fibroids are thought to be a cause, many women are able to become pregnant after they are treated.
How are fibroids diagnosed?
Fibroids are often diagnosed during a pelvic exam in the office. A number of other tests may show more information about fibroids:
- Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
- Hysteroscopy uses a slender camera (the hysteroscope) to see the inside of the uterus. It is inserted through the vagina and cervix and lets your doctor see fibroids inside the uterine cavity.
- Hysterosalpingography is a special X-ray test done at a Radiology office and it may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
- Sonohysterography is an office test using ultrasonography. Fluid is put into the uterus through the cervix using a small catheter and ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
- Laparoscopy uses a slender camera (the laparoscope) to help your doctor see the inside of the abdomen. It is inserted through a small cut just below or through the belly button. Fibroids on the outside of the uterus can be seen with the laparoscope.
Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography scans (CT scans), may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.
When is treatment necessary for fibroids?
Fibroids often do not require treatment. If they are not causing symptoms, are small in size, or occur near menopause then you likely will not need treatment.
Certain signs and symptoms may indicate the need for treatment:
- Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
- Bleeding between periods
- Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
- Rapid increase in growth of the fibroid
- Pelvic pain
Can medication be used to treat fibroids?
Medications may reduce heavy bleeding and pain that fibroids sometimes cause, however they may not prevent their growth over time. Surgery is sometimes necessary to remove fibroids in some women.
Here are a few examples of medications that can be used to help treat symptoms related to fibroids:
- Birth control pills and other types of hormonal birth control methods—These drugs often are used to control heavy bleeding and painful periods.
- Gonadotropin-releasing hormone (GnRH) agonists—These drugs stop the menstrual cycle and can shrink fibroids. They are sometimes used before surgery to reduce the risk of bleeding.
- Progestin–releasing intrauterine device (IUD)—This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
- Tranexamic Acid (Lysteda)—This medication can be used only during a menstrual cycle to help control heavy bleeding.
What types of surgery may be done to treat fibroids?
Myomectomy is the surgical removal of fibroids and leaves the uterus in place. Fibroids usually do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.
Hysterectomy is the removal of the uterus. The ovaries may or may not be removed at the same time as the uterus. Hysterectomy is usually done when other treatments have not worked or are not possible, when the fibroids are very large, or if a woman is no longer interested in having children.
Are there other treatments besides medication and surgery?
Other treatment options are as follows:
- Hysteroscopy—This technique is used to remove fibroids that protrude into the cavity of the uterus by cutting away or resecting it. Although it cannot remove fibroids deep in the walls of the uterus, it is an option to help control bleeding that can occur from fibroids in the cavity. This is done as an outpatient procedure.
- Uterine artery embolization (UAE)—In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure and is done with an Interventional Radiologist.
- Magnetic resonance imaging-guided ultrasound surgery—In this new approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging. Ongoing research is underway to see if this approach provides long-term relief.
Do you have fibroids or do you have symptoms that might be attributed to fibroids?
Call Bloom Ob/Gyn at 202-449-9570 to make an appointment with one of our health care providers! Through a simple office exam and ultrasound we can help counsel you about your options.