On an annual basis, thousands of women are treated for uterine fibroids. It is estimated that up to 30% of women in the 35- to 50-year-old age group develop these growths. Prior to the year 2000, hysterectomy was a primary treatment for this condition. Today, we have much more conservative measures that may be taken to improve a woman’s health and well-being.
What Are Fibroids?
Uterine fibroids are benign growths that may also be referred to as myomas or leiomyomas. They may develop in various numbers, sizes, shapes, and locations of the muscular uterine tissue, including on the outside of this structure. Fibroids are attached to the uterus by a “stem.” The growth of a fibroid may stagnate while it is still small, or it may progress into a large growth.
I Have Heavy Periods. Does That Mean I Have Fibroids?
There are several symptoms that may develop for women who have uterine fibroids. Menstrual changes such as longer duration or heavier flow is just one of several indicators of abnormal tissue growth. Additional symptoms of uterine fibroids include:
- Bleeding in between periods
- Anemia due to heavy menstrual bleeding
- Painful intercourse
- Chronic abdominal or low back pain
- Abdominal cramping
- Rectal pain and/or constipation
- Frequent urination or difficulty urinating
- Enlarged abdomen
- Miscarriage or infertility
It is also possible to have no symptoms.
Are Fibroids Serious?
Fibroids do not indicate uterine cancer, nor are they thought to increase the risk of that disease. The primary complication of uterine fibroids is physical discomfort. If a fibroid stem twists, a woman may experience pain, as well as fever or nausea. Large fibroids can present an obstacle to the routine pelvic exam. Although fibroids can be cited in some cases of infertility, this is rare.
How Do I Know If I Have Fibroids?
Your healthcare provider may perform diagnostic testing to accurately diagnose fibroids if this condition is suspected. There are several tests that may be recommended based on appropriateness for your circumstances.
- Ultrasound may be performed to observe the pelvic organs, including the uterus.
- Sonohysterography involves the insertion of fluid into the uterus (via the cervix pathway) prior to ultrasound examination. The presence of fluid increases visual clarity.
- Hysterosalpingography is x-ray imaging that observes the uterus as well as the fallopian tubes.
- Hysteroscopy may be performed to observe the inside of the uterus. This small scope is inserted vaginally, through the cervix, and into the uterus.
- Laparoscopy is a minor surgical procedure conducted through a small abdominal incision. This diagnostic procedure enables your physician to observe fibroids that have formed along the outside wall of the uterus.
In addition to initial diagnosis, these imaging tests may also be performed periodically to monitor the condition or growth of fibroids.
Do Fibroids Need to Be Treated?
If no symptoms result from the presence of uterine fibroids, the recommendation for treatment may be limited to monitoring. Symptoms that may warrant treatment include:
- Persistent pelvic pain
- Rapid fibroid growth
- Bleeding in between periods
- Menstrual flow is disruptive to a woman’s lifestyle or well-being (anemia)
Removal may be recommended, as well, if diagnostic tests cannot confirm that the growth is a fibroid rather than a tumor.
How Are Fibroids Treated?
There are several approaches to fibroid treatment.
Medications that may be used to treat fibroids include:
- Oral contraceptives, which can control menstrual flow and pain.
- Gonadotropin-releasing hormone agonists. This type of medication is generally reserved for use before fibroid surgery as a way to reduce bleeding risk. These drugs are not intended for long-term use.
- Intrauterine device, IUD that releases progestin may be used in cases where no uterine distortion has occurred. This method does not treat the fibroids themselves; rather, it is used to control menstrual symptoms.
Therapeutic Treatments May Include:
- MRI-guided ultrasound surgery breaks up fibroids with ultrasound waves, guided by magnetic resonance imaging.
- Hysteroscopy destroys fibroids with laser energy or electricity via a small instrument called a hysteroscope.
- Endometrial ablation removes the lining of the uterus to which fibroids are attached. There are several ablation techniques used today.
- Uterine artery embolization cuts off the blood supply to uterine fibroids by introducing tiny particulates into the vessels the feed them.
Surgical Treatment for Fibroids May Involve:
- Myomectomy, or the direct removal of fibroids, leaving the uterus intact. This procedure enables a woman to maintain her reproductive possibilities, but it does not prevent the future growth of new fibroids.
- Hysterectomy is the removal of the uterus and the fibroids, in some cases, will also remove the ovaries. A definitive treatment for many of the symptoms associated with having fibroids, especially abnormal periods. Your provider and you will discuss your options as your needs arise.