A uterine fibroid is an abnormal growth of cells in the muscular wall (myometrium) of the uterus. Fibroids are composed of abnormal muscle cells. Uterine fibroids are common and almost always benign (not cancerous). Fibroids range in size from very tiny to the size of a cantaloupe or even larger.
Fibroids are categorized according to location which can include subserous which appear on the outside of the uterus; intramural which are confined to the wall of the uterus; submucous which appear inside the uterus; pedunculated myomas which are attached to the uterus by a stalk. Rarely, fibroids can involve the cervix.
Frequent signs and symptoms
- No symptoms (most common).
- Menstruation can be more frequent and heavy at times; occasionally with large clots and discomfort
- Bleeding between periods
- Feelings of pressure on bladder or rectum
- Anemia (weakness, fatigue and paleness)
- Pain with intercourse or bleeding after intercourse (rare)
Exact cause is unknown. Estrogen is required for their stimulation and growth.
- Risk factors
- Genetic factors. Fibroid tumors are 3 to 5 times more common in African American women than in Caucasian women.
- Family history of fibroids
- Diet high in fat and/or obesity may be a risk.
What to expect
- If there are no symptoms from the fibroids, or with mild, well tolerated symptoms, usually no treatment is needed.
- Fibroid tumors usually decrease in size without treatment after menopause
- Fibroids can be removed surgically when they cause excessive bleeding or pain, produce symptoms that interfere with conception or pregnancy. Several surgical options are available and your physician will discuss these with you.
- Heavy bleeding causing anemia leading to fatigue
- Complications can occur in pregnancy such as spontaneous abortion (usually associated with the submucous fibroid type), premature labor (usually associated with large fibroids), and placental separation (abruption). With a large fibroid, fetal growth may be at risk because blood flow is diverted from the fetus to the fibroid.
- Fibroids may return following surgery to remove them.
- Large fibroids may cause difficulty with urinating, having bowel movements or even interfere with intercourse.
- Fibroids can cause pelvic pain if they outgrow their blood supply
- A rapidly enlarging fibroid requires further evaluation, a malignant change can occur in less 0.5% of patients.
Diagnosis and treatment
- Diagnostic tests may include laboratory blood studies; ultrasound; or CT Scan. A hysteroscopy (looking in the uterus) or hysterosalpingogram (special ultrasound) can sometimes be used to aid in the diagnosis.
- Treatment will be individualized depending on symptoms and diagnostic tests, location and size of the fibroids, we will also factor in your general health and your desire for future pregnancies.
- For minimal symptoms, no treatment may be needed and you will be re-examined at 3-12 month intervals. Keep a record of dates of bleeding and number of pads used each day this will help your physician evaluate your symptoms.
- Hormonal therapy is often the first step in treatment
- Surgery may be recommended for certain situations and several different surgical procedures are possible. Your physician will discuss these in detail with you.
- Hysterectomy is surgery to remove the uterus; a myomectomy removes the fibroids.
- Uterine Artery Embolization (UAE), is a nonsurgical procedure that treats all fibroids in the uterus by cutting off the blood supply). This procedure is not recommended if you are planning on having children.
- Blood transfusions may be necessary to correct anemia.
- A combination of nonsteroidal anti-inflammatory drugs, birth control pills, or cyclic progestins may be prescribed.
- Iron supplements are recommended if you are anemic.
- A gonadotropin-releasing hormone may be prescribed. This hormone will mimic a menopause state that should stop the bleeding and reduce the size of the fibroid. In general, this therapy is not used for longer than 3 months.
More information from The American College of Obstetricians and Gynecologists>
Last Updated: 1/7/2014