Uterine fibroids are benign lumps that grow on the uterus. Sometimes, these tumors become quite large and cause severe abdominal pain, heavy periods, cramping, painful sex, and an urge to urinate. In other cases, they cause no signs or symptoms at all. The growths are typically benign (noncancerous). The cause of fibroids is unknown.Treatment options include hysterectomy, embolization, and hormone therapy.
Different fibroids develop in different locations in and on the uterus.
Intramural Fibroids:
Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.
Subserosal Fibroids:
Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.
Pedunculated Fibroids:
When subserosal tumors develop a stem (a slender base that supports the tumor), they become pedunculated fibroids.
Submucosal Fibroids:
These types of tumors develop in the middle muscle layer (myometrium) of your uterus. Submucosal tumors are not as common as other types, but when they do develop, they may cause heavy menstrual bleeding and trouble conceiving.
Causes:
The exact cause of uterine fibroids is not known. Fibroids begin when cells overgrow in the muscular wall of the uterus.
Hormones:
The hormones estrogen and progesterone appear to influence its growth. A woman's body produces the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decline, fibroids usually shrink or disappear.
Family History:
Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.
Pregnancy:
Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you are pregnant.
Symptoms:
Uterine fibroid symptoms can develop slowly over several years or rapidly over several months. Most women with uterine fibroids have mild symptoms or none at all and never need treatment.
For some women, uterine fibroid symptoms become a problem. Pain and heavy menstrual bleeding are the most common symptoms. In some cases, difficulty becoming pregnant is the first sign of fibroids. Your symptoms will depend on the location and size of the tumor(s) and how many tumors you have. If your tumor is very small, or if you are going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause.
Uterine fibroid symptoms and problems include:
• Abnormal menstrual bleeding, such as:
o Heavier, prolonged periods that can cause anemia.
o Painful periods.
o Spotting before or after periods.
o Bleeding between periods.
• Pelvic pain and pressure, such as:
o Pain in the abdomen, pelvis, or low back.
o Pain during sexual intercourse.
o Bloating and feelings of abdominal pressure.
• Urinary problems, such as:
o Frequent urination.
o Leakage of urine (urinary incontinence).
o Kidney blockage following ureter blockage (rare).
• Other symptoms, such as:
o Difficulty or pain with bowel movements.
o Infertility. Sometimes, fibroids make it difficult to become pregnant.
o Problems with pregnancy, such as placental abruption and premature labor.
What increases your risk factor?
Women are at greater risk for developing fibroids if they have one or more of the following risk factors:
• Age. Fibroids become more common as women age, especially from the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Family history. Having a family member with fibroids increases your risk.
• Ethnic origin. Black women are more likely to develop fibroids than white women.
• Obesity.
Diagnosis:
You will need to see a gynecologist to get a pelvic exam. This exam is used to check the condition, size, and shape of your uterus. You may also need other tests, which include:
Ultrasound:
An ultrasound uses high frequency sound waves to produce images of your uterus on a screen. This will allow your doctor to see its internal structures and any fibroids present. A transvaginal ultrasound, in which the ultrasound wand (transducer) is inserted into the vagina, may provide clearer pictures since it is closer to the uterus during this procedure.
Pelvic MRI:
This in-depth imaging testing produces pictures of your uterus, ovaries, and other pelvic organs.
Additional testing:
If you have severe pain, bleeding, or pelvic pressure or have had repeat miscarriages or trouble becoming pregnant, you will probably have other tests to look for other possible causes of your symptoms. Two examples of possible causes are endometriosis and pelvic inflammatory disease (PID).
And tests for specific symptoms, such as urinary or bowel problems, may be needed to diagnose the problem or to help build a treatment plan.
Treatment:
Most uterine fibroids are harmless, do not cause symptoms, and shrink with menopause. But some fibroids are painful, press on other internal organs, bleed and cause anemia, or cause pregnancy problems. If you have a fibroid problem, there are several treatments to consider. Fibroids can be surgically removed, the blood supply to fibroids can be cut off, the entire uterus can be removed, or medicine can temporarily shrink fibroids or manage symptoms. Your choice will depend on whether you have severe symptoms and whether you want to preserve your fertility.
A treatment plan based on your age, the size of your fibroid(s), and your overall health. You may receive a combination of treatments.
Medications
Medications to regulate your hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.
Other options that can help control bleeding and pain, but will not shrink or eliminate fibroids, include:
• an intrauterine device (IUD) that releases the hormone progestin
• over-the-counter anti-inflammatory pain relievers, such as ibuprofen
• birth control pills
Surgery:
Surgery to remove very large or multiple growths (myomectomy) may be performed. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted.
Your physician may perform a hysterectomy (removal of your uterus) if your condition worsens, or if no other treatments work. However, this means that you will not be able to bear children in the future.
Minimally Invasive Procedures
A newer and completely noninvasive surgical procedure is forced ultrasound surgery (FUS). You will lie down inside a special MRI machine that allows doctors to visualize the inside of your uterus. High-energy, high-frequency sound waves will be directed at the fibroids to destroy (ablate) them.
Similarly, myolysis shrinks fibroids using an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, hot water, or microwaves.
Prevention:
There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.
Preventing fibroids from coming back after treatment
It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to think about. For more information, see the topic Hysterectomy.
