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Uterine Fibroids

 

Uterine fibroids are among the most common tumors in women. Over 70% of women may have them in their lifetime. These benign growths of smooth muscle cells and other tissues in and around the wall of the uterus often appear during childbearing years. Uterine fibroids are also called fibromyomas, leiomyomas, or simply myomas, and they are not usually associated with an increased risk of uterine cancer. It’s possible to have a single fibroid, or many, and they can be as small as an apple seed or as large as a melon.

Many women have uterine fibroids, but because there are often no symptoms associated with this condition, most women are not aware of them. A provider may discover fibroids during a pelvic exam or prenatal ultrasound. Fibroids cause problems for about one in four women, most frequently during their 30s or 40s. After menopause, fibroids usually shrink.

The cause of uterine fibroids is unknown, but there are factors that can increase the risk of developing fibroids. These risk factors include:

  • Family history: Having a family member with fibroids increases the risk.
  • Ethnicity: Fibroids are more common in black women than white women.
  • Obesity: Women who are obese are two to three times more likely to develop fibroids.
  • Diet: Eating a lot of red meat and ham is associated with a higher risk for fibroids, while a diet including plenty of green vegetables seems to protect against fibroids.

Although women with uterine fibroids do not usually have symptoms, there are some signs and symptoms that can be related to fibroids. Those symptoms include:

  • Heavy menstrual bleeding or bleeding between periods
  • Painful periods
  • Pelvic pressure or feeling “full” in the lower abdomen
  • Pain during sexual intercourse
  • Urinary incontinence, frequent urination, or urine retention
  • Constipation
  • Lower back pain or leg pains
  • Reproductive problems, such as infertility, multiple miscarriages, or early labor
  • Abdominal distension and growing size

In rare cases, a fibroid can cause intense pain, usually when it does not receive enough blood as nourishment. In this case, the fibroid can begin to degenerate, producing byproducts that can seep into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside or outside the uterus, called a pedunculated fibroid, can sometimes trigger pain if it turns on its stalk, thereby cutting off its own blood supply.

The location and size of a fibroid influences the signs and symptoms. For example, fibroids that grow into the inner cavity of the uterus, called submucosal fibroids, can cause prolonged, heavy menstrual bleeding. Fibroids that project to the outside of the uterus, called subserosal fibroids, can press on the bladder or ureters, causing urinary symptoms. If fibroids bulge from the back of the uterus, they can press either on the rectum, causing constipation, or on the spinal nerves, causing backache.

Treatment options for fibroids include:

  • Watchful Waiting: Because fibroids are not cancerous and rarely interfere with pregnancy, a watchful waiting approach may be the best treatment. Fibroids usually grow slowly and often shrink after the onset of menopause, when hormone levels drop.
  • Medications: Medications for uterine fibroids target hormones that regulate the menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. There are several different medications available to treat fibroids. Your provider can tell you more about what options are best for you.
  • Uterine Artery Embolization: This approach, sometimes referred to as a UAE, blocks the arteries that supply blood to the fibroids, causing them to shrink. It is a minimally invasive procedure, which means that it requires only a tiny incision in the groin to access the vessels of the pelvis, and is usually performed while the patient is conscious but sedated.
  • Myomectomy: A myomectomy involves the removal of masses from the uterus using one of several procedures, including:
    • Hysteroscopic myomectomy, which is used for fibroids that are just under the lining of the uterus and that protrude into the uterine cavity.
    • Laparoscopic myomectomy, which may be used if the fibroid can be safely removed with minimally invasive surgical approaches.
    • Abdominal myomectomy, which uses a larger incision in the abdomen to access the uterus, and another incision in the uterus to remove the tumor.
  • Hysterectomy: A hysterectomy is the only proven permanent solution for uterine fibroids. Of course, hysterectomy is major surgery that renders a woman incapable of bearing children. Removal of the ovaries at the time of hysterectomy is optional and should be discussed with your provider.