Your Guide to Uterine Fibroids

Uterine fibroids are benign tumors that are made up of the muscle and connective tissue from the wall of the uterus -- a woman's womb. Fibroids may grow as a single nodule or in clusters and may range in size from 1 mm to more than 20 cm (8 inches) in diameter. They may grow within the wall of the uterus or they may project into the interior cavity or toward the outer surface of the uterus. In rare cases, they may grow on stems projecting from the surface of the uterus.

What Causes Uterine Fibroids?

The causes of uterine fibroids are not known. Most fibroids occur in women of reproductive age, and according to some estimates, they are diagnosed in black women two to three times more frequently than in white women. They seldom are seen in young women who have not begun to menstruate, and they usually stabilize or shrink in women after menopause.

According to the U.S. National Institutes of Health (NIH), at least 25% of women suffer from uterine fibroids. Women can also have fibroids and not know it since they have no symptoms.

Are Uterine Fibroids Cancer?

No. Uterine fibroids are not associated with cancer. They are benign tumors that almost never develop into cancer.

Who Is at Risk for Uterine Fibroids?

No risk factors have been found for uterine fibroids other than being a female of reproductive age. However, some studies suggest obese women are at increased risk of having fibroids. A person is considered obese if he or she is more than 20% over his or her ideal body weight.

What Are the Symptoms of Uterine Fibroids?

Most uterine fibroids do not cause any symptoms and do not require treatment other than regular observation by a doctor. Fibroids may be discovered during a routine gynecologic exam or during prenatal care. Some women who have uterine fibroids may experience the following symptoms:

• Excessive or painful bleeding during menstruation
• Bleeding between periods
• A feeling of fullness in the lower abdomen
• Frequent urination resulting from a fibroid that compresses the bladder
• Pain during sexual intercourse
• Low back pain

How Are Uterine Fibroids Treated?

More and more, doctors are beginning to realize that uterine fibroids may not require any intervention or, at most, limited treatment. For a woman with uterine fibroids that are not causing symptoms, the best therapy may be watchful waiting. Some women never exhibit any symptoms nor have any problems associated with fibroids, in which case no treatment is necessary.

If a woman is experiencing anemia caused by heavy, prolonged menstrual bleeding, moderate to severe pain, infertility, or urinary tract or bowel problems, she will require therapy. Treatment options for uterine fibroids include:

• Medications. For women who experience occasional pelvic pain or discomfort, a mild, over-the counter anti-inflammatory or pain-killing drug such as Aleve or Motrin, often will be effective. More bothersome cases may require stronger drugs available by prescription.
  Some fibroids are treated with hormones that reduce the amounts of the hormone estrogen. Doctors believe that fibroids grow when there are high levels of the female hormone estrogen.
  Birth control pills can be used to treat the bleeding symptoms of uterine fibroids because they decrease the production of female hormones and prevent ovulation. Birth control pills (oral contraceptives) do not reduce the size of uterine fibroids and may in fact increase their size. For more on oral contraceptives, see the article on the pill.
• Surgery. Fortunately, a woman now has a number of surgical options that are less invasive for treatment of uterine fibroids that can control symptoms, preserve the uterus, and preserve fertility. In the past, the primary option for a woman with growing uterine fibroids was a hysterectomy (the surgical removal of the uterus). At that time, it was impossible to differentiate growing fibroids from cancer. Performing hysterectomy in a woman of reproductive age means that she will no longer be able to have children. Hysterectomy also may have other effects, both physical and psychological. Today, many women and their doctors are considering other treatment options and the main focus is to treat symptoms. 
  If a fibroid is particularly troublesome, the surgeon often can remove only the tumor, leaving the uterus intact. This procedure is called myomectomy. This is done when a woman wants to be able to have children.
  There are a number of techniques that can be used to perform a myomectomy:
  • Laparoscopic myomectomy involves the use a thin, telescope-like instrument attached to a small video camera called a laparoscope inserted through a tiny incision at the belly button. The surgeon uses specialized surgical instruments inserted through this incision and two or three additional small incisions in the abdomen to remove the fibroids.
  • Hysteroscopic myomectomy is a procedure where some fibroids are removed through the vagina using a surgical instrument called a hysteroscope -- a thin, telescope-like instrument inserted through the cervix and into the uterus.
  • Laparotomy involves an abdominal incision to remove all fibroids, no matter what size or location of the tumors.
• Fibroid embolization. This treatment works by decreasing the blood supply to the fibroids, causing them to shrink. It is a minimally invasive procedure performed by an interventional radiologist. Patients are typically able to return home the same day of the procedure.
• MRI-guided ultrasound. This is the newest technique available to remove fibroids. The treatment uses MRI images to plan and guide focused ultrasound waves that destroy fibroid tissue.