What are uterine fibroids?
Uterine fibroids are tumors or growths, made up of muscle cells and other tissues that grow within the wall of the uterus (or womb). Although fibroids are sometimes called tumors, they are almost always benign (not cancerous). The medical term for fibroids is uterine leiomyomata (pronounced you-ter-in lie-oh-my-oh-mah-tah). Fibroids can grow as a single growth or in clusters (or groups). Their size can vary from small, like an apple seed (or less than one inch), to even larger than a grapefruit, or eight inches across or more.
Background
Why should women know about fibroids?
Uterine fibroids are the most common benign tumors in women of childbearing age, but no one knows exactly what causes them. They can be frustrating to live with because there are limited treatment options, and they are the cause of many hysterectomies (surgery to remove the uterus).
Where can fibroids grow?
Fibroids are placed into three groups based on where they grow, such as just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus, or into the cavity of the uterus.
What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
- Heavy bleeding or painful periods
- Bleeding between periods
- Feeling of fullness in the pelvic area (lower abdomen)
- Urinating often
- Pain during sex
- Lower back pain
- Reproductive problems - such as infertility, having more than one miscarriage, or having early onset of labor during pregnancy
What causes fibroids?
No one knows for sure what causes fibroids. Researchers have some theories, but most likely, fibroids are the result of many factors interacting with each other. These factors could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. But, this is not true for all women with fibroids.
Can fibroids turn into cancer?
Fibroids are almost always benign, or not cancerous, and they rarely turn into cancer (less than 0.1 percent of cases). Having fibroids does not increase a woman's chances of getting cancer of the uterus.
Who gets fibroids?
Most of the time, fibroids grow in women of childbearing age. While no one knows for sure what will increase a woman's chances of getting fibroids, researchers have found that African American women are 2 to 3 times more likely to get them than women of other racial groups are. African American women also tend to get fibroids at a younger age than do other women with fibroids. Women who are overweight or obese also are at a slightly higher risk for fibroids than women who are not overweight. Women who have given birth appear to be at a lower risk for fibroids. Research is now being done to figure out who is at risk for fibroids.
Uterine Fibroids: Diagnosis
How do I know for sure that I have fibroids?
Your Minnesota Women's Care provider may find that you have fibroids when you have your regular pelvic exam (to check your uterus, ovaries, and vagina). Often, a health care provider will describe how small or 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 8 weeks pregnant.
We can perform imaging tests, or tests that create a "picture" of the inside of your body without surgery, in order to confirm that you have fibroids. These tests might include:
- Ultrasound (which uses sounds waves to produce the picture)
- Magnetic Resonance Imaging (often called MRI) which uses magnets and radio waves to produce the picture
- X-rays (which use a form of radiation to see into the body and produce the picture)
- Cat scan or (CT scan) - which makes many pictures of the body from different angles to provide a more complete image.
Our Treatment Options
Treatment for Uterine Fibroids at Minnesota Women's Care
Surgical and Non-Surgical Options
There are many surgical and non-surgical treatment options for fibroids. The best treatment approach depends on many factors including what symptoms you are experiencing, the size number and location of the fibroids, and whether you are interested in pregnancy or not, among others. Your doctor will work with you to tailor the best treatment plan for you. Some treatment options are as follows:
Hormonal and non-hormonal medical therapies
The most common hormonal medications used include oral contraceptive pills and progestins, including the progesterone IUD. These regulate your menstrual cycle; they do not eliminate the fibroids, but control the bleeding and cramping associated with them.
Another class of medications include gonadotropin-releasing hormone agonists or antagonists (GnRH modulators). GnRH modulators treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. In turn, fibroids shrink and anemia improves, making these a good short term option to optimize a patient before surgery.
Nonhormonal options are also available, including NSAIDs and tranexamic acid, a medication taken during your menstrual period to reduce bleeding.
Hysteroscopic procedures
Hysteroscopic procedures are performed to help diagnose and remove fibroids that are located inside the uterine cavity. During hysteroscopy, the surgeon will insert a hysteroscope (a thin tube with a light and camera) into the vagina and cervix to get a clear picture of any fibroids located along the internal uterine lining and remove them. No incision is made during hysteroscopic procedures, which means that there are very few risks associated with it, and a very fast recovery.
Laparoscopic or robotic myomectomy
A myomectomy is a surgical procedure to remove fibroids while preserving healthy uterine tissue. This is best for women who intend on future childbearing. A laparoscopic or robotic myomectomy means the procedure is done through small incisions on the abdomen. This approach causes less pain and blood loss, fewer adhesions (scar tissue), and a quicker recovery than a traditional, “open” abdominal myomectomy
Laparoscopic or robotic hysterectomy
A hysterectomy is the surgical removal of the uterus. This treatment option is for patients who have completed childbearing and are seeking a definitive, permanent solution to their fibroid related symptoms. When feasible, a minimally invasive approach to a hysterectomy (i.e. laparoscopic, robotic, or vaginal) is favored, as this minimizes risks and recovery time. More information on hysterectomy can be found here.
Uterine fibroid embolization
This option preserves the uterus and avoids surgery. This is an outpatient procedure where an interventional radiologist uses image-guided techniques to block the blood supply to the fibroids. This causes them to shrink over time and reduces bleeding.
Uterine fibroid radiofrequency ablation
Radiofrequency ablation is a minimally invasive procedure that uses heat to target fibroids one by one, reducing their size. By shrinking the fibroids, patients enjoy less severe symptoms and a better quality of life. This procedure is best for patients who have completed childbearing, have fibroids that are not too large, and wish to avoid major surgery.
