What to Know About Uterine Fibroids
Uterine fibroids are so common that up to 70% percent of women in the U.S. over the age of 35 will develop them.
These non-cancerous growths within the uterus (womb) can be as small as a grape or grow to the size of a watermelon, causing the abdomen to appear pregnant falsely. For most women, fibroids don’t cause symptoms. But, if you’re a woman dealing with heavy menstrual bleeding, pelvic or back pain, bloating, or painful sexual intercourse, uterine fibroids may be causing or worsening your symptoms — and treatment is highly effective.
What are uterine fibroids?
Also called leiomyoma, leiomyomata, myoma and fibromyoma, uterine fibroids are benign tumors that can develop on the outer wall of the uterus, within the muscle or inside the cavity.
Intramural fibroids are the most common type and develop within the muscle of the uterus, making it feel larger than normal during a gynecologic internal exam. They can cause heavier menstrual bleeding, enlarged abdomen, pelvic pain/pressure, back pain, leg pain, pain during sexual intercourse, frequent urge to urinate/urinary incontinence, constipation and bloating.
Subserosal fibroids typically develop on the outer uterine wall, putting pressure on the surrounding organs. This type of fibroid normally doesn’t affect a woman’s menstrual flow but can cause pelvic pain, back pain and generalized pressure.
Submucosal fibroids are the least common type and grow just under the lining of the uterus in the cavity. They typically cause heavy bleeding and prolonged periods and sometimes enlarge the uterus cavity and block the fallopian tubes.
Who gets fibroids?
- Approximately 20 to 40% of all women 35 years and older have fibroids.
- They can develop in women as young as 20.
- They are more common among Black women. Some statistics indicate that up to 80% of African-American women develop uterine fibroids.
How are fibroids diagnosed?
Discuss your symptoms with your gynecologist if you are experiencing any symptoms or complications fibroids can cause. If your symptoms are mild and not bothering you, tell your women’s health care provider about them anyway, just to rule out other more serious potential causes.
During your routine pelvic exam (which may happen during your well-woman exam, even when you’re not due for a pap smear), your gynecologist might feel that your uterus is misshapen. This is one sign of uterine fibroids that you can have investigated further with the following tests.
Pelvic ultrasound: Your gynecologist can use this noninvasive, radio waves exam to view your uterus and cervix for fibroids.
Blood tests: Blood tests can check for anemia and some causes of abnormal bleeding.
Magnetic resonance imaging (MRI): This radiation-free test can better characterize the location and size of uterine fibroids.
Hysterosonography: To make it easier to see if fibroids are growing into the uterine cavity, your gynecologist can insert a saline solution into your uterus during an ultrasound.
Hysteroscopy: During this procedure, your doctor inserts a lighted camera into your uterus to look for fibroids in the uterine cavity.
Do fibroids need to be removed?
If they are not growing rapidly nor causing pain or excessive bleeding, fibroids may not need to be treated, as they don’t typically pose a risk to the woman’s health. Only 10 to 20% of women who have fibroids require treatment.
Because fibroid tumors can be small, multiply and spread out in the uterus, there are usually more fibroids than those seen during imaging scans. When considering treatment options, a woman with only one visible uterine fibroid should consider that she may already have multiple fibroids.
How are uterine fibroids treated?
If your uterine fibroid isn’t causing any symptoms, monitoring it for growth or changes may be the only necessary treatment. Your doctor can tell you how often you should get an ultrasound or MRI to keep an eye on it.
Are uterine fibroids are causing you bothersome symptoms or complications?
Ask your doctor about the following treatment options, along with their potential side effects and risks, to determine which approach is right for you.
Hormonal treatments are medications for uterine fibroids that target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them.
An intrauterine device (IUD) can help stop the symptoms of uterine fibroids, though they do not shrink the tumors.
Endometrial ablation is a noninvasive procedure that destroys the lining of the uterus with the goal of reducing or stopping your menstrual flow. This treatment can be used to treat submucosal fibroids less than one inch in diameter.
Hysterectomy is the removal of the uterus and is considered major abdominal surgery. Uterine fibroids are the most common reason premenopausal women get hysterectomies.
Hysteroscopic myomectomy is an outpatient procedure that removes uterine fibroids through the cervix and vagina. Not all types of fibroids can be removed this way.
Laparoscopic or robotic myomectomy is a procedure that removes uterine fibroids through a few small incisions in your abdomen.
Myolysis is a minimally invasive procedure that uses radio-wave energy, electricity or cold to destroy fibroids and the blood vessels that feed them, causing the fibroids to shrink and die.
Uterine fibroid embolization or uterine artery embolization is a minimally invasive procedure that inserts special particles into the blood vessels around the fibroids. These particles block blood flow to the fibroids so they shrink and die.
Do fibroids affect a woman’s fertility?
Many women diagnosed with uterine fibroids are of childbearing age. The presence of most uterine fibroids does not affect a woman’s ability to get pregnant and carry pregnancies to term. But, if your fibroids are causing irregular and unpredictable periods, it can be challenging to monitor your cycle to determine when you’re most likely to conceive.
In addition, submucosal fibroids can not only block the fallopian tubes, but they can also prevent implantation of the embryo or interrupt pregnancy. Removal of these fibroids may be recommended to improve your chances of conception and carrying a pregnancy to term.
Maintaining or even improving your ability to have children can play a role in the uterine fibroid treatment you choose. If you may want to have children in the future, discuss your concerns with your gynecologist. If you’re considering an embolization procedure, speak candidly with your interventional radiologist. These experts may have information and guidance specific to your fertility that impacts which fibroid treatment you choose.
While hysterectomy makes fertility impossible without in-vitro fertilization, myomectomy and uterine fibroid embolization procedures usually leave the uterus intact. Many women maintain the ability to have children after fibroid embolization, but your doctor cannot guarantee it.
Women’s health care in South Florida
At the University of Miami Health System’s Comprehensive Women’s Health Alliance, a nurse coordinator can coordinate your care for the diagnosis and treatment of uterine fibroids, in addition to other health and wellness concerns affecting women of all ages.
UHealth’s obstetrics and gynecology experts provide research-backed care that’s tailored specifically for each woman. The Department of Interventional Radiology uses the latest research and the least invasive procedures to offer you the safest and most effective treatment for fibroids. UHealth is also home to some of the world’s most experienced robotic surgeons who perform gynecologic laparoscopy and robotic-assisted surgery.
To make an appointment, call 855-3-4-WOMEN (855-349-6636) or request an appointment.
Dana Kantrowitz is a contributing writer for UHealth’s news service. Medically reviewed by Jacqueline Mercedes Sanchez, M.D., an obstetrician and gynecologist with the University of Miami Health System.
Tags: Comprehensive Women's Health Alliance, Dr. Jacqueline Sanchez, uterine fibroid, uterine pain
