Fibroids

What are uterine fibroids?

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying 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 are most common in women aged 30 – 4 0 years, but they can occur at any age. Fibroids 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 have the following symptoms:

Changes in menstruation — longer, more frequent or heavy periods; menstrual pain (cramps); vaginal bleeding at times other than menstruation; anemia (from blood loss)
Pain — in the abdomen or the lower back (often dull and heavy, but it can be sharp); during sexual intercourse
Pressure — difficulty passing urine or frequent urination; constipation, rectal pain or difficulty with bowel movements; abdominal cramps
An enlarged uterus and abdomen
Miscarriages
Infertility

Fibroids may also cause no symptoms at all. They may be found during a routine pelvic examination or during tests for other problems.

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. Rarely, they can be associated with cancer. A very large fibroid may cause swelling of the abdomen. This swelling can make it hard 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?

The first signs of fibroids may be detected during a routine pelvic examination. A number of tests can give more information about fibroids:

Ultrasound uses sound waves to create a picture of the uterus and other pelvic organs.
Hysteroscopy uses a slender device (the hysteroscope) to light up the inside of the uterus. It is inserted through the vagina and the cervix (the opening of the uterus). This allows the doctor to see fibroids that are inside the uterine cavity.
Hysterosalpingography is a special X-ray. It can detect abnormal changes in the size and shape of the uterus and fallopian tubes.
Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasound is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
Laparoscopy uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen. It is inserted through a small incision just below or through the navel. The doctor can see fibroids on the outside of the uterus with the laparoscope.

Imaging tests such as magnetic resonance imaging and computed tomography may be used, but they are rarely needed. Some of these tests may be used to monitor the growth of fibroids over time.

When is treatment necessary for fibroids?

Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal 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
Infertility
Pelvic pain

Can medication be used to treat fibroids?

Medication is an option for some women with fibroids. Medicines can reduce the heavy bleeding and painful periods that fibroids sometimes cause. However, they may not stop fibroids from growing, and surgery is often needed later. Medical treatment for fibroids includes the following options:

Birth control pills and other types of hormonal contraception — these are often used to control heavy bleeding and painful periods.
Gonadotropin-releasing hormone (GnRH) agonists — these medicines stop the menstrual cycle and can shrink fibroids. They are sometimes used before surgery to reduce the risk of bleeding. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
Progestin-releasing intrauterine device — 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.

What types of surgery may be done to treat fibroids?

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids 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. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

Are there other treatments besides medication and surgery?

Other treatment options are as follows:

Hysteroscopy — this technique is used to remove fibroids that project into the uterine cavity. A resectoscope is inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it can often control the bleeding these fibroids cause. Hysteroscopy can often be done as an outpatient procedure, so you do not need to stay overnight in hospital.
Endometrial ablation — this procedure destroys the lining of the uterus. It is used to treat women with small fibroids (less than 3 centimetres). There are several ways of performing endometrial ablation.
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 make it shrink. Uterine artery embolization can be performed as an outpatient procedure in most cases.
MRI-guided ultrasound surgery — in this newer 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. Studies show that women have improved symptoms for up to 1 year after the procedure. Whether this approach provides long-term relief is currently being studied.