Uterine fibroids are tumors, usually benign, that grow into the uterus from the muscle tissue that surrounds it. They are also known as leiomyomas or myoma of the uterus. Uterine fibroids can grow within or on the uterine wall, push the uterus to one side, or force it to grow abnormally. They can be as large as a basketball or as small as a pea.
Complications from uterine fibroids occur when larger fibroids put pressure on the intestines or bladder, resulting in constipation, frequent urination, heavy menstrual bleeding, and pelvic pain. This abnormal growth can lead to backache, an uncomfortable pressure or feeling of fullness in the lower abdomen, and trouble conceiving. Uterine fibroids can cause complications in pregnancy when large fibroids block the opening to the uterus, necessitating a c-section delivery.
Twenty-five percent of women of childbearing age have fibroids, most commonly, the age group including 30 to 50 year olds. African American women are three times as likely to develop uterine fibroids as white American women. Those at lower risk include athletic women and women who have had two or more children vaginally.
Nobody knows the exact cause of uterine fibroids. Fluctuations in estrogen levels affect the growth of fibroids; high levels, such as during pregnancy, promote fibroid growth. During and after menopause, when estrogen levels are significantly lower, fibroids shrink or nearly disappear.
During regular pelvic exams, the doctor feels the uterus for abnormal size and growth. The presence of uterine fibroids can make the uterus feel lumpy. An ultrasound is usually performed to rule out cysts or malignant tumors.
Treatment of uterine fibroids depends on the severity of the symptoms. Most uterine fibroids are left untreated if they do not have a large impact on a woman’s life. When deciding on treatment, a doctor takes into account blood loss and pain during menstruation, the woman’s age, and how quickly the fibroids are growing. Besides estrogen lowering medications, which may help shrink the fibroids, but bring on menopausal like symptoms, there are two main surgical options.
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.
Uterine fibroid symptoms and problems include:
Abnormal menstrual bleeding. Up to 30% of women with fibroids have menstrual period changes, such as:
Heavier, prolonged periods that can cause anemia.
Painful periods.
Spotting before or after periods.
Bleeding between periods.
Pelvic pain and pressure, such as:
Pain in the abdomen, pelvis, or low back.
Pain during marital relations.
Bloating and feelings of abdominal pressure.
Urinary problems, such as:
Frequent urination.
Leakage of urine (urinary incontinence).
Kidney blockage following ureter blockage (rare).
Other symptoms, such as:
Difficulty or pain with bowel movements.
Infertility. Sometimes, fibroids make it difficult to become pregnant.
Problems with pregnancy, such as placental abruption and premature labor.
Miscarriage.
There's no single best approach to uterine fibroid treatment. Many treatment options exist.
Many women with uterine fibroids experience no signs or symptoms. If that's the case for you, watchful waiting (expectant management) could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause when levels of reproductive hormones drop.
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there's a risk of fibroid recurrence.
Myomectomy options include:
Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
Laparoscopic or robotic myomectomy. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a remote monitor via a small camera attached to one of the instruments. Use of a surgical robot now allows for removal of more fibroids or larger fibroids.
Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus. This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off-again fashion, sometimes spanning several hours.
Because it's a newer technology, researchers are learning more about the long-term safety and effectiveness of FUS. Research continues, but so far data collected show that FUS for uterine fibroids is safe and very effective.
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
Myolysis. In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.
Uterine artery embolization. Small particles (embolic agents) injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique, performed by an interventional radiologist, is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include no incision and a shorter recovery time. Complications may occur if the blood supply to your ovaries or other organs is compromised.