Fibroids: Answering 6 Essential Questions

Uterine fibroids are benign (noncancerous) tumors made of muscle and tissues that can grow in or on a woman’s uterus. Fibroids are very common and are often seen in women in their childbearing years. These tumors come in all shapes and sizes, ranging from 1 millimeter to 20 centimeters, and can be singular or form clusters. In the same way, they can also be in different locations, resulting in four main types:

• Intramural fibroids: The most common type; found inside the muscle lining of the uterus
• Pedunculated fibroids: The least common type; attach to the uterus by a stalk or stem and have a mushroom-like appearance
• Submucosal fibroids: Grow under the inner lining of the uterus
• Subserosal fibroids: Grow on the outer surface of the uterus and can extend into the pelvic cavity

Fibroids don’t always cause symptoms, which is why many women never know they have them. But when they do cause symptoms, they can range from mild to severe.

The symptoms of fibroids are often influenced by their size, type, location and amount. Common fibroid symptoms include:

• A feeling of fullness in the belly
• Constipation
• Frequent urination
• Heavy or painful bleeding between or during a menstrual cycle
• Lower back pain
• Pain during sex
• Pelvic pressure or pain
• Potential fertility issues, like miscarriage, early labor or low implantation rates, with submucosal fibroids
• Vaginal discharge

But the good news is that fibroids are highly treatable.

Just like their symptoms, fibroid treatment options depend on their size, location and the amount.

Medications

Both over-the-counter (OTC) and prescribed medications for fibroids work by targeting the specific hormones, estrogen and progesterone, that control the menstrual cycle. Medications are often used to treat heavy bleeding and pain, and may help to reduce their size.

Common medications used to treat fibroids include:

• Gonadotropin-releasing hormone (GnRH) agonists (stop the menstrual cycle and shrink fibroids)
• Gonadotropin-releasing hormone (GnRH) antagonists (treat heavy menstrual bleeding)
• Hormonal birth control pills
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Progestin-releasing intrauterine device (IUD)

Nonsurgical Procedures

If medications aren’t working, you have other options before having to consider surgery:

• Endometrial ablation: Uses heat or energy to remove the uterine lining to reduce heavy menstrual bleeding
• MRI-guided focused ultrasound (MRgFUS): Uses high-intensity ultrasound waves to heat and destroy fibroid tissue
• Transcervical radiofrequency ablation: Uses radiofrequency energy to destroy fibroids inside the uterus without the need for incisions
• Uterine fibroid embolization (UFE): Catheter inserted into the uterine arteries to block blood flow to the fibroids, shrinking them by 30 to 50%

Surgical Procedures

Several surgical procedures can treat fibroids, including:

• Hysterectomy: The surgical removal of the uterus
• Hysteroscopy: A thin, flexible scope is inserted into the uterus to cut and remove the fibroids
• Myomectomy: Fibroids are removed through one larger incision in the abdomen

Currently, there’s no known cause of fibroids. However, a few factors may play into their development, including genetics and hormones such as estrogen and progesterone.

Anyone with a uterus in childbearing years is at some risk of developing fibroids. However, several factors put you at a greater risk for developing them, including:

• African American descent
• Age
• Family history of fibroids
• Getting your period before age 10
• High blood pressure
• Not given birth
• Obesity
• Vitamin D deficiency

It’s best to talk with your doctor about your risk for developing fibroids. Together, you can come up with a personalized prevention and treatment plan, if you do develop them.

Oftentimes, health care providers find fibroids during pelvic exams. However, other tests and screenings can successfully identify them, including various lab tests, ultrasounds, MRIs, CT scans, X-rays and a saline infusion sonography.