What are uterine fibroids?
Uterine fibroids are
noncancerous growths in the
uterus. Fibroids can grow on the
inside of the uterus ,
within the muscle wall of the uterus , or on the
outer surface of the uterus . Fibroids can change the shape of the uterus as
they grow. This can make it difficult to become pregnant or can cause problems
during a pregnancy. Over time, the size, shape, location, and symptoms of
fibroids may change.
The cause of uterine fibroids is not known.
But after fibroids develop, the hormones
progesterone appear to influence their growth. A
woman's body produces the highest levels of these hormones during her
childbearing years. After menopause, when hormone levels decline, fibroids
often shrink or disappear.
Fibroids are also called myomas,
leiomyomas, and fibromas.
What are the symptoms of uterine fibroids?
women age, they are more likely to have uterine fibroids, especially from their
30s and 40s until menopause. About 80% of women have uterine fibroids by the
time they reach age 50. Most have mild or no symptoms.3 But fibroids can cause serious problems that need treatment.
Uterine fibroids usually need treatment when they cause:
heavy fibroid bleeding.
- Ongoing low back pain or a feeling of
pressure in the lower abdomen (pelvic pressure).
Infertility, when a fibroid changes the shape of the
uterus or the location of the
- Complications during
pregnancy, such as
miscarriage or premature labor.
- Blockage of the urinary tract or bowels.
if the tissue of a large fibroid dies (necrotic fibroid).
What is a myomectomy?
Myomectomy is the surgical
removal of fibroids from the uterus. The uterus is repaired and left in place.
For some women, this makes pregnancy possible. Myomectomy may improve your
chances of having a healthy pregnancy after fibroid treatment.
Effectiveness. Myomectomy decreases menstrual
bleeding and pelvic pain from fibroids. Myomectomy is the only fibroid
treatment that may improve your chances of having a baby.2 Some studies suggest that myomectomy may also lower the risk
of miscarriages among women with fibroids. But more study is needed to know for
Fibroid recurrence. With all fibroid treatments except hysterectomy, fibroids
tend to grow back. New fibroids can also grow. After myomectomy, fibroids grow
back in up to 50% of women. Larger and more numerous fibroids are most likely
to recur.4 Talk to your doctor about whether your
type of fibroid is likely to grow back.
Risks. When incisions have been made into the uterine wall to remove fibroids,
future pregnancy may be affected. Sometimes, problems develop when the
placenta grows during pregnancy, such as
placenta abruptio or
placenta accreta. During labor, the uterus may not
function normally, which can make a
cesarean delivery necessary.5
If you are hoping for a future pregnancy,
an abdominal myomectomy may be safer than a laparoscopic myomectomy. There is
limited research about pregnancy safety after laparoscopic myomectomy and
isolated reports of the uterus rupturing during pregnancy after a laparoscopic
What is a hysterectomy?
Hysterectomy is surgery to
remove your uterus. The
ovaries and fallopian tubes may also be removed at the
same time. Hysterectomy is the one known cure for fibroids, but it usually is
used as a last resort because it is a major surgery. It ends your childbearing
ability and can cause long-term problems (see Risks below). But most women
report improvement in physical symptoms (including pelvic pain, abdominal
bloating, and physical and social functioning) after a hysterectomy.6
If you are considering a hysterectomy and are
not close to menopausal age (about age 50), talk to your health professional
about the question of ovary removal (oophorectomy). When comparing women who
do and don't have their ovaries, experts estimate that women live longer when
they keep their ovaries until at least age 65. This may be because women who
have their ovaries have fewer hip fractures (stronger bones) and are less
likely to develop
After early oophorectomy,
estrogen replacement therapy (ERT) is recommended to
prevent bone-thinning. For more information, see the topic Hysterectomy.
Fibroid recurrence. Fibroids do not grow back
Hysterectomy for uterine fibroids:
- Is the only fibroid treatment that prevents
regrowth of fibroids.
- Relieves ongoing pain caused by fibroids.
- Corrects anemia from prolonged, heavy, and irregular vaginal
- Usually corrects problems caused by scar tissue (adhesions).
- May correct leakage of urine
(urinary incontinence) if it has been caused by fibroid pressure on internal
Risks. Most women do not have
complications after hysterectomy. But possible long-term effects of
- The formation of scar tissue in the pelvic area. Scar tissue
can bind organs and cause pelvic pain.
- Early menopause caused by a
slow, yet early decline of the ovaries (premature ovarian failure).8
- Weakness of the pelvic muscles and ligaments that
support the vagina, bladder, and rectum. The weakness can cause bladder or
bowel problems, such as
urinary incontinence (most common in women older than
60).9Kegel exercises may help strengthen the pelvic muscles
and ligaments. But some women need other treatments, including additional
- Difficulty urinating. This is more common after removal of
lymph nodes, ovaries, and structures that support the
uterus (radical hysterectomy, which is not normally done for fibroid
- Pelvic pain that was present before surgery may not be
relieved by hysterectomy.
What are the general risks of surgery?
do not have complications after myomectomy or hysterectomy for uterine
fibroids. But complications that may occur include:
- Fever. A slight fever is common after any
- Rare complications. These include:
- Blood clots in the
legs (thrombophlebitis) or lungs (pulmonary embolus).
- The formation
of scar tissue (adhesions).
- Injury to other organs, such as the
bladder or bowel.
- A collection of blood at the surgical site
heavy bleeding. Some vaginal bleeding within 4 to 6
weeks after a hysterectomy is expected. But call your health professional if
bleeding continues to be heavy.
- Severe blood loss that requires
- Heart problems.
- Breathing problems.
For more information, see the topic