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Uterine Fibroids
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Uterine Fibroids

(Fibroids; Leiomyoma; Myoma; Fibromyoma)

En Español (Spanish Version)More InDepth Information on This Condition

Definition

Fibroids are benign (noncancerous) growths in the wall of the uterus. The uterus is the reproductive organ where a fetus grows. Fibroids often grow into the uterine cavity. In rare cases, they may protrude from the uterus toward nearby organs. Fibroids may be very small or may grow to eight or more inches in diameter. Usually more than one fibroid is present. About 20%-30% of women of childbearing age, and as many as half of all women, have fibroids. Many do not realize it. Most do not have symptoms until their late 30s or 40s.

Uterine Fibroid

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Causes

The cause of fibroids is unknown. Genes and changes in substances that control blood vessel growth may make some women prone to fibroids. Female reproductive hormones stimulate fibroid growth. Fibroids grow larger during pregnancy then shrink after childbirth. Fibroids become less of a problem after menopause . However, symptoms may return with hormone replacement therapy .

Risk Factors

These risk factors increase your chance of developing fibroids:

  • Sex: female
  • Age: 13-50 years old (childbearing age)
  • Race: Black

Symptoms

Symptoms range from none at all to mild or severe. This all depends on the size and location of the growths.

If you have any of these symptoms do not assume it is due to fibroids. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Pelvic pain
  • Feeling of pelvic pressure
  • Heavy menstrual bleeding
  • Clots in menstrual flow
  • Long periods
  • Bleeding between periods
  • Increased cramping during periods
  • Pain during sex
  • Frequent need to urinate
  • Constipation
  • Bloating
  • Enlarged uterus, giving the appearance of pregnancy
  • Low back or leg pain
  • Infertility by blocking the fallopian tubes
  • Miscarriage

Iron-deficiency anemia may develop if bleeding is heavy.

Diagnosis

Doctors find most fibroids during routine pelvic exams. An abdominal ultrasound confirms the diagnosis. A transvaginal ultrasound may be done to obtain clearer images. A CT scan or magnetic resonance imaging (MRI) may be ordered in complex cases. Hysteroscopy allows the doctor to see inside the uterus. She inserts a thin, lighted tool into your vagina and passes it through your cervix. During the procedure, the doctor may be able to remove small fibroids or reduce the size of larger growths.

Treatment

Most women with fibroids have no symptoms and do not need treatment. Your doctor may recommend "watchful waiting." This is done to monitor the size and growth of the fibroids at regular intervals using ultrasound.

Treatments include:

Pain Medication

Over-the-counter pain pills ease mild symptoms. Prescription pain relievers may be needed. Nonsteroidal anti-inflammatory drugs reduce inflammation and help relieve cramping.

Hormonal Therapy

Hormone medications, which decrease estrogen levels, are an option if you are not trying to become pregnant. Synthetic hormones create an artificial menopause. The drugs shrink fibroids. The drugs also lessen the pain by decreasing the supply of estrogen to the uterus. However, fibroids can return once you stop taking the drugs. These drugs are often used to reduce fibroid size prior to surgery.

Surgery

Surgery is considered if:

  • The uterus becomes extremely large.
  • The fibroids are interfering with fertility.
  • Symptoms are severe.

Surgical procedures include:

Myomectomy

Myomectomy is the removal of the fibroids only and leaving the uterus intact. This can be done by:

  • Open surgery that involves a single large abdominal incision
  • Laparoscopy —using a lighted fiberoptic tube and requiring only a few small incisions
  • Hysteroscopy—which involves the insertion of a hysteroscope through the cervix into the uterine cavity

Because it preserves the uterus, myomectomy is commonly performed on younger women who may want to have children. However, conceiving may still be hard. The surgery is less successful if there are many fibroids, because some may grow back.

Uterine Fibroid Ablation

An alternative to surgical removal, uterine fibroid ablation (also called myolysis) uses heat to disrupt the blood supply to the fibroid. This causes the fibroid to shrink.

Total Hysterectomy

Total hysterectomy is the removal of the entire uterus. This may be done through a vaginal or abdominal incision. Hysterectomy is the definitive treatment for fibroids. But you will be unable to have children if you have this surgery.

Nonsurgical Options

Uterine Fibroid Embolization

Fibroids need a good supply of blood to grow. Without blood, the tumors shrink. Doctors can perform a uterine fibroid embolization (also called uterine artery embolization) to stop the blood flow. The doctor makes small cuts in your groin. She threads a catheter into your arteries that supply your uterus with blood. Tiny particles of plastic or gelatin are passed through the catheter. The particles make their way to the fibroids and block blood from reaching the tumors.

Focused Ultrasound Therapy

Focused ultrasound therapy is a noninvasive treatment using an MRI. This procedure may not be ideal for patients who are very overweight, have very large fibroids, or have extensive scars from prior abdominal surgeries.

Prevention

There are no guidelines for preventing fibroids because the cause is unknown.

RESOURCES:

The American College of Obstetricians and Gynecologists
http://www.acog.org /

The International Council on Infertility Information Dissemination
http://www.inciid.org /

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Cotran RS, Kumar V, Collins T, et al. Robbins Pathologic Basis of Disease . 6th ed. Philadelphia, PA: WB Saunders; 1999.

Hindely J, Gedroyc WM, Regan L, et al. MRI guidance of focused ultrasound therapy of uterine fibroid: early results. Am J Roentgenol . 2004;183:1713-1719. Reviewed in: OBG Management . 2005;17:34-37.

Minimally invasive treatments for women provided by interventional radiologists. Society of Cardiovascular and Interventional Radiology website. Available at: http://www.sirweb.org/patients/womens-health/ . Accessed July 19, 2008.

National Institute of Child Health and Human Development. National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ . Accessed October 13, 2005.

Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Uterine fibroid embolization: an alternative to surgery. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20010815/tips/4.html . Published August 15, 2001. Accessed July 19, 2008.



Last reviewed January 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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