Fibroids, also known as Leiomyomata
The uterus is made of muscle. A fibroid tumor is a growth of the uterus or cervix that is not cancer – also called “benign“. The fibroid continues to grow until a “knot” forms. This usually happens in many locations in the uterus and can cause multiple fibroids.
The reason that fibroids occur is not completely known, but the growth is related to the presence of estrogen in the body. Commonly, fibroids will grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medicine is used. They also stop growing or shrink once a woman reaches menopause.
- What should you know about fibroids?
- What makes a woman more likely to have fibroids?
- What are the symptoms?
- How can I know for sure that I have fibroids?
- How big are fibroids?
- How are fibroids treated?
- What medications are used to treat fibroids?
- What procedures are used to treat fibroids?
- How do fibroids affect getting pregnant, pregnancy and having a baby?
- Can fibroids turn into cancer?
- Fibroids affect more than 1 in every 5 women under age 50.
- They are the cause for 3 out of every 10 hysterectomies.
- Fibroids are most common in women in their 40s and early 50s.
- Most women who have fibroids have no symptoms and do not need any therapy.
- Fibroids stop growing, often shrink in size and cause no symptoms in women that are in menopause.
Age – Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink. Although estrogen contributes to the growth of fibroids, the levels used in hormone replacement therapy – or “HRT“- are unlikely to cause growth of existing fibroids.
Family history – Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
Ethnic origin – African-American women are more likely to develop fibroids than white women are.
Obesity – Overweight women are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
Eating habits – Eating a lot of red meat – for example, beef – and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Women who have symptoms often find fibroids hard to live with. Symptoms may include:
- heavy menstrual bleeding
- irregular bleeding in between normal periods
- iron deficiency, also called “anemia”
- in the uterus
- during intercourse
- greater menstrual pain, cramping or blood clots
- on the bladder, causing frequent urination
- on the rectum, causing rectal pressure
- Enlarged stomach area, making a woman look pregnant, if the fibroids get very large.
Pelvic exam – A doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam. It is usually a painless lump on the uterus.
Imaging tests – Your doctor can do imaging tests to confirm that you have fibroids. These tests create a “picture” of the inside of your body without surgery. These tests might include:
- Ultrasound – Ultrasound uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen, or it can be placed inside the vagina to make the picture.
- MRI, which stands for magnetic resonance imaging – MRI uses magnets and radio waves to produce the picture
- X-rays – X-rays use a form of radiation to see into the body and produce the picture
- CT or Cat scan – CT scans take many X-ray pictures of the body from different angles for a more complete image
- HSG, which stands for hysterosalpingogram – An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures.
- SHG, which stands for sonohysterogram – An SHG, involves injecting water into the uterus and making ultrasound pictures.
Surgery – You may need surgery to know for sure if you have fibroids. There are two types of surgery to do this:
- Laparoscopy – The doctor inserts a long, thin scope into a tiny incision made in or near your navel. The scope has a bright light and a camera. This allows the doctor to view your uterus and other organs on a monitor during the procedure. Pictures also can be made.
- Hysteroscopy – The doctor passes a long, thin scope with a light through the vagina and cervix into your uterus. No cutting or “incision” – is needed. The doctor can look inside your uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.
Your doctor can use a pelvic exam or ultrasound to determine the size of the fibroids. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or volleyball.
There are some important things to thing about when deciding how to treat fibroids including:
- how severe your symptoms are from the fibroids
- if you might want to get pregnant in the future
- the size of the fibroids
- the location of the fibroids
- your age and how close to menopause you might be.
- Removal of the uterus, also known as a “hysterectomy”. This is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used if:
- a woman’s fibroids are large
- she has heavy bleeding
- she is either near or past menopause
she does not want children.
- Removal of the lining of the uterus, also known as “endometrial ablation”. This is done to control very heavy bleeding. It can be done with:
- wire loops
- boiling water
- electric current
It is considered as a minor surgery and can be done on an outpatient basis or even in a doctor’s office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding.
It is important to consider that a woman cannot have children after this surgery.
Heating or freezing them off, also known as “myolysis”. A needle is inserted into the fibroids, usually guided by laparoscopy. Electric current or freezing is used to destroy the fibroids.
- Cutting off the blood supply, also known as “Uterine Fibroid Embolization” or “Uterine Artery Embolization”. A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels, blocking the blood supply to the fibroid, causing it to shrink. This can be an outpatient or inpatient procedure. Complications, including early menopause, are not common but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed.
- Removing the fibroids, also known as “myomectomy”. This surgery often makes a woman lose more blood than with hysterectomy and usually requires surgery again because the fibroids return. That is why myomectomy is best reserved for women who wish to maintain their fertility or who have certain medical conditions.
Pain control medications. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain.
Iron supplements. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
Birth control. Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections such as Depo-Provera®. An IUD – or “intrauterine device” – called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.
Hormones – Other drugs used to treat fibroids are “gonadotropin releasing hormone agonists” or “GnRHa”. The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove.
Side effects of GnRHas can include:
- hot flashes
- not being able to sleep
- decreased sex drive
- joint pain.
Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count.
GnRHas can cause bone thinning, so their use is generally limited to 6 months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.
Fibroids may cause:
- not being able to have a baby
- losing a baby
- early labor during pregnancy.
Even though fibroids tend to grow very slowly, the location or size of a fibroid might make it more difficult to carry a baby to term. The extra hormones a woman’s body makes during pregnancy can cause a fibroid to grow and take up space in the uterus that the baby needs. The baby could end up being born early or be miscarried. Fibroids near the cervix may not allow the baby to pass through the birth canal and require a Cesarean section for delivery.
Fibroids are almost never cancerous. Less than 1 person in 1,000 has a fibroid that becomes cancer. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman’s chances of getting other forms of cancer in the uterus.
- Uterine Fibroids Fact Sheet – Women’s Health.gov
- Uterine Fibroids – New York State Department of Health
- Fibroids and Fertility – The American Soceity for Reproductive Medicine
For more information:
Go to the Pregnancy health topic.