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What are Uterine Fibroids?
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Fibroids are a buildup of muscular tissue within the uterus–typically small, benign, and go without being noticed. Also called leiomyomas, they can be as small as a pebble to as large as a tennis ball–and in some rarer cases, larger still. They can grow in several locations–from being within the uterine cavity, within the wall of the uterus itself, or even outside of the uterus. Uterine fibroids are common in most women, though they can vary in severity, with about 10% of women in the US being clinically diagnosed and a higher rate of prevalence in African American / black women. Despite the fact that for most women they are not problematic, for others they can be painful and cause heavy bleeding. Because of this, uterine fibroids are the most common cause for hysterectomy in the United States.
Between 20 – 80% of women will get uterine fibroids at some point in their life, more commonly during childbearing years, and for many of these women, the fibroids will diminish naturally as they age into menopause and hormone levels reduce. However, for those few who do experience symptoms, they tend to be very difficult to bear; and depending on the size and location, the fibroids may affect a woman’s ability to become pregnant.
Uterine Fibroid Causes
The direct cause of uterine fibroids is actually unknown, for now. What is currently known is that there are two likely players in the arena: hormones (both estrogen and progesterone), and genetics. However, there are several known risk factors associated with the likelihood of fibroid development:
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Uterine Fibroid Symptoms
There are also certain complications that can arise with fibroids, including anemia from the heavy blood loss during menstruation, and difficulties with conception (or potential loss of a pregnancy).
Uterine Fibroid Diagnosis
Fibroids can be found during routine pelvic exams, though there are ways of imaging the inside of the uterus to further confirm the presence and size of the growths. Your doctor may request an ultrasound either on the abdomen or inside the vagina, using sound waves to visualize the internal cavity. Magnetic resonance imaging (MRI) does the same using magnets and radio waves, while C-T scans take multiple x-rays from different angles to produce a full picture. There are also ways of visualizing inside of the uterus using a scope, either through the vagina (hysteroscopy) or through a very small incision near the naval (laparoscopy). Once the presence and size of fibroids have been confirmed, treatment options can be explored.
Uterine Fibroid Treatment
Treatment for uterine fibroids depends on the location, size, and severity of symptoms. For some women who experience minimal symptoms–or none at all–there may be no treatment necessary, other than waiting to see if the situation worsens or goes away with age.
In other cases, women may be put on medication to control mild symptoms. If the symptoms are very mild, then over-the-counter drugs (like ibuprofen for pain management, or iron supplements to counteract anemia) may suffice. In situations where the pain and excessive bleeding is more severe, birth control options are used as a form of hormonal control. Low-dose pills, progesterone-like injections, and hormonal IUDs can pause fibroid growth and reduce bleeding. There is also the option of taking a gonadotropin-releasing-hormone agonist (GnRHa), which can shrink fibroids. Unfortunately, these drugs come at a cost–both literally, and metaphorically. In addition to being expensive, GnRHa use is typically limited to six months, given that they may cause bone thinning with prolonged exposure. Although GnRHas have been proven to reduce fibroids while being taken, fibroids grow back quickly once the drug is stopped.
In more severe cases where symptom management is limited, women suffering from their uterine fibroids have the option of surgery:
- Myomectomy is the surgical removal of fibroids whilst leaving the uterus intact. With myomectomy, getting pregnant is still possible–though, depending on the location of the fibroids and how deeply embedded into the uterus they were, vaginal birth may not always be an option. Although myomectomies remove current growths, it is still possible for new fibroids to appear.
- Hysterectomy is the complete removal of the uterus. Many women with severe uterine fibroids are told that this is their only option–which, for those who may want to have children (or maintain their uterus for other reasons, or simply do not want to undergo an invasive procedure) this can be devastating news. It is important to speak with your doctor about all possible options when it comes to treating your uterine fibroids, and selecting the option that is best for you. Although hysterectomies do cure uterine fibroids, the cost can be very large for some women–including sterility, early menopause, and weeks of recovery. If you are suffering from uterine fibroids and have only been given hysterectomy as an option, we strongly urge you to seek a second opinion.
- Endometrial ablation uses different techniques to remove the lining of the uterus. By doing so, it reduces (or in most cases, stops entirely) menstrual bleeding. It is considered a minor surgery, and recovery time is short. The uterus is left intact, but women who have undergone this procedure cannot have children.
- Myolysis is a minimally invasive procedure in which a laparoscopic-guided needle is used to either freeze or conduct electric current into the fibroids. This removes selected fibroids while leaving the uterus intact, but does not stop new ones from forming.
- Uterine fibroid embolization (UFE, or uterine artery embolization, UAE) is a new, minimally invasive outpatient procedure where tiny particles are introduced into the arteries that supply blood to the uterus, blocking blood flow to the fibroids. Without oxygen, the fibroids reduce and typically do not grow back (though UFE studies are still somewhat early and more long-term research is still being done), while the uterus is still intact. Complications like early menopause can occur, but it is very rare.