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Uterine Fibroids

Uterine fibroids are benign (not cancerous) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.

Symptoms

  • Changes in menstruation
  • Pain during sex or in the abdomen or lower back
  • Pressure, difficulty urinating or frequent urination
  • Constipation, rectal pain, or difficult bowel movements
  • Enlarged uterus and abdomen
  • Miscarriages
  • Infertility

Fibroids also may cause no symptoms at all.

Diagnosis

The first signs of fibroids may be detected during a routine pelvic exam. A number of tests may show more information about fibroids:

  • Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
  • Hysteroscopy uses a slender device to see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This permits us to see fibroids inside the uterine cavity.
  • Hysterosalpingography is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
  • Sonohysterography is a test in which fluid is put into the uterus through the cervix. Ultrasonography is then used to show the inside of the uterus. The fluid provides a clear picture of the uterine lining.
  • Laparoscopy uses a slender device to help us see the inside of the abdomen. It is inserted through a small cut just below or through the navel. We can see fibroids on the outside of the uterus with the laparoscope.

Treatment

Fibroids that do not cause symptoms, are small or occur in a woman who is nearing menopause often do not require treatment. Certain signs and symptoms may signal the need for treatment:

  • Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
  • Bleeding between periods
  • Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
  • Rapid increase in growth of the fibroid
  • Infertility
  • Pelvic pain

Drug therapy is an option for some women with fibroids. Medications may reduce the heavy bleeding and painful periods that fibroids sometimes cause, but may not prevent the growth of fibroids. Surgery often is needed later. Drug treatment for fibroids includes hormonal birth control, gonadotropin-releasing hormone (GnRH) agonists, and a progestin–releasing intrauterine device.

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed. Hysterectomy, the removal of the uterus and possibly the ovaries, is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

Other treatment options include:

  • Hysteroscopy
  • Endometrial ablation
  • Uterine artery embolization (UAE)
  • Magnetic resonance imaging-guided ultrasound surgery

Source: American College of Obstetricians and Gynecologists.