Uterine Fibroids FAQ
What are uterine fibroids?
Many of you may have first heard of fibroids when you found out a friend had them. They're generally benign tumors that grow inside your uterus and can be as small as a pea or as large as a cantaloupe. Fibroids are the most common type of growth in the pelvic region; most women who have them are between the ages of 35 and 45.
Uterine fibroids contain fibrous tissue that's similar to the normal tissue of the uterus. They usually grow along the uterine wall, but sometimes they protrude into the cavity of the uterus or grow outside it altogether. The hormones progesterone and estrogen stimulate their growth, which is usually slow, but can be very rapid. Since estrogen levels decline with age, fibroids usually affect women during their reproductive years and shrink after menopause. Depending on the number, size and location of the fibroids, pregnant women may experience localized pain or more serious complications, such as miscarriage or premature delivery.
According to the Mayo Clinic, up to 75 percent of women develop uterine fibroids, but most are unaware of them because they cause no symptoms. It isn't known what causes them, although recent studies indicate that genetics may play a part: Women who have family histories of fibroid development are twice as likely to get them as those who don't. And according to the Mayo Clinic, black women's chances of having the tumors, of having larger tumors, and having them at a younger age are greater than women of other racial groups.
What are the symptoms?
You may not even know you have fibroids. But depending on how numerous they are, how large they are, and where they're located, your symptoms might include heavy menstrual bleeding and severe cramping, pelvic pain, bleeding between periods, pains in the legs, abdominal bloating, backaches, miscarriage, infertility, and pain during intercourse. If you bleed heavily during or between your periods, you might become anemic (that is, have too little iron in the blood) -- and anemia can cause fatigue. You might also be bothered by constipation and by an urgent need to urinate, signals that a large fibroid may be squeezing the organs around your uterus.
How are uterine fibroids detected?
They're usually found during a routine pelvic exam, in which your doctor feels your abdomen to see if there are any unusual growths. If your uterus seems lumpy or its shape is irregular, you may have fibroids. An ultrasound exam, which creates a visual image of the uterus, can confirm that you have fibroids and map them for you.
Are they cancerous?
Almost never. Far fewer than one percent of uterine fibroids are cancerous.
What are my treatment options?
That depends on a number of factors, including your age, the location of the growths, the mildness or severity of your symptoms, and the question of whether or not you want to have children.
If you don't have symptoms, you probably wont need any treatment. Your doctor may want to do periodic ultrasounds to monitor the size of the fibroids in order to make sure they're not getting large enough to cause serious problems.
If you do have symptoms, if your fibroids are fast-growing, or if you're concerned about your efforts to get pregnant, you can choose from a number of treatments. Some birth control pills lessen heavy menstrual bleeding, but they usually don't stop fibroid growth. You can take medication to reduce your level of estrogen, which should shrink the fibroids -- but this treatment may leave you with the same symptoms occurring in women going through menopause, including hot flashes, mood swings, and vaginal dryness. Your fibroids can also begin growing again once you stop taking the medicine. Because of these drawbacks, few doctors prescribe estrogen-reducing medication for long-term fibroid control.
A comparatively new option is uterine artery embolization (UAE). In this nonsurgical procedure, your doctor makes a tiny cut in your groin and inserts a catheter through the artery there into the uterus. Then he or she uses an injection of plastic or gelatin particles to block the vessels that supply blood to the fibroids. The procedure generally shrinks the fibroids successfully without the incision or longer recovery period surgery requires. Five-year follow up studies have shown UAE to be safe and effective. There is still some question about the effect of uterine artery embolization on fertility, but a study published in 2008 found that women who underwent UAE had similar infertility rates to those with fibroids who did not have the procedure.
Surgery is another alternative, and you should weigh it carefully. If your doctor has recommended it as a first course of action, for example, you may want to get another opinion.
A myomectomy involves surgical removal of the fibroids, leaving the uterus in place. Myomectomy can be performed with open surgery, or the less invasive techniques of hysteroscopy and laparoscopy. In a hysteroscopy, your doctor looks inside your uterus by inserting a long thin tube with a light on one end through your cervix. He or she then removes the fibroids, using a laser or another miniature instrument. In another form of microsurgery, a laparoscopy, your doctor takes the fibroids out through a small incision in your abdomen. There's a chance that they'll grow back, but the operation usually solves the problem for a considerable length of time.
Another treatment option is myolysis. Myolysis is a laparoscopic procedure that uses an electric current to destroy fibroids without having to remove them.
A far more invasive procedure, one that isn't open to you if you want to have children, is a hysterectomy. This procedure, in which the entire uterus is removed, can be done either vaginally or abdominally.
In October 2004, the Food and Drug Administration approved a new treatment called MRI-guided focused ultrasound surgery (FUS). This treatment uses highly focused sound waves to target and destroy fibroid tumors. Early results of the treatment are promising, but more studies are needed to determine if it is an effective long-term option.
Insurance coverage may vary depending on the treatment so be sure to ask your doctor first what your best options are.
Are there other things I can do to make my fibroids shrink?
Some studies suggest that cutting out caffeine and eating a vegetarian diet or one that's low in fat and in complex carbohydrates may help shrink fibroids, but these findings aren't conclusive. Since obesity is associated with the tumors (although thin women can get them too), many doctors also recommend that you exercise and try to keep your weight down.
Belenky A, Cohen M, Bachar GN. Uterine arterial embolization for the management of leiomyomas. Isr Med Assoc J 2001 Oct;3(10):719-21
Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, Willett WC, Hunter DJ. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol 1997 Dec;90(6):967-73
Benson CB, Chow JS, Chang-Lee W, Hill JA 3rd, Doubilet PM. Outcome of pregnancies in women with uterine leiomyomas identified by sonography in the first trimester. J Clin Ultrasound 2001 Jun;29(5):261-4
Stewart EA, et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003 Jul;189(1):48-54.
Mayo Clinic. Uterine Fibroids. June 2007.
Hirst, A, et al. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG : An International Journal of Obstetrics and Gynecology. 2007 Nov; 114(11):1340-51.