Uterine Fibroids

Uterine fibroids at a glance

• Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), sometimes causing abnormal bleeding, pain, and infertility; the location and size of the fibroid can also lead to miscarriages.
• Treatment is not always necessary, but may include hormonal and vitamin supplements or surgical removal.

About uterine fibroids

Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female reproductive organ. They can cause abnormal bleeding and pain and depending upon their position in the uterus, they may impair infertility. Fibroids sometimes protrude directly into the uterine cavity—and sometimes are within the uterus itself. The location and size can sometimes lead to miscarriages.

Uterine fibroids are common – as many as one in five women may have fibroids during their childbearing years, and half of women have fibroids by age 50. Fibroids are rare in women under age 20, and they are more common in African Americans.

The cause of uterine fibroids is unknown. However, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. Fibroids can be so tiny that you need a microscope to see them. However, they can also grow very large. They may fill the entire uterus and may weigh several pounds.

Symptoms

Often, there are no symptoms, but more common symptoms of uterine fibroids are:

• Heavy menstrual bleeding, sometimes with the passage of blood clots
• Bleeding between periods
• Menstrual periods that may last longer than normal
• Pelvic cramping or pain with periods
• Sensation of fullness or pressure in lower abdomen
• Pain during intercourse
• Need to urinate more often

Uterine fibroids may be difficult to detect during a physical exam, especially if the woman is overweight. Commonly, physicians discover fibroids via ultrasound or occasionally by magnetic resonance imaging.

Fibroids may be located several places in the uterus, but those that affect fertility tend to be the ones that change the shape of the uterine cavity or are within the cavity itself. Removal of these fibroids may increase fertility.

Treatment of fibroids

Some women do not need treatment, instead requiring only pelvic exams or periodic ultrasounds to monitor the fibroid’s growth. Treatment for the symptoms of fibroids may include:

• Intrauterine devices (IUDs) that release the hormone progestin to help reduce heavy bleeding and pain
• Short-term hormonal therapy injections to help shrink the fibroids
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or Naprosyn for cramps or pain
• Iron supplements to prevent or treat anemia due to heavy periods
• Birth control pills (oral contraceptives) to help control heavy periods

If removal of fibroids is called for by a physician, these four surgical procedures remove fibroids:

• Women who have fibroids growing inside the uterine cavity may need an outpatient procedure using a hysteroscope to remove the fibroids.
• Embolization: This procedure cuts the blood supply to the fibroid, causing it to die and shrink. This procedure must be carefully considered if a woman wants to become pregnant later on.
• Surgery called myomectomy completely removes the fibroids. It preserves fertility, so it is a good choice for women who want to have children. Risk: More fibroids can develop after this surgery.
• Hysterectomy could be called “the death penalty for fibroids.” However, it is invasive and completely removes a woman’s entire reproductive system and should only be considered if nothing else has or will work.

Medical studies have shown that both uterine artery embolism and myomectomy may preserve or restore fertility after removal of fibroids. These two procedures are done by different specialists and have conflicting claims. Be careful and consult your physician on the best alternatives.