Uterine Fibroids

Uterine fibroids are benign (not cancerous) growths in the uterus.

Also known as leiomyomas, fibroids affect most women at some point in their lives. They generally cause no symptoms or health problems and seldom require treatment.

When fibroids do cause problems because of their size, number, or location, treatment is necessary.

The cause of fibroids is not known. Most fibroids occur in women of reproductive age. The hormones estrogen and progesterone appear to play a role in their growth.

You are more likely to develop uterine fibroids if you:

• Are of reproductive age
• Are African American
• Have a family history of fibroids
• Are obese

Most fibroids do not cause symptoms. Women who do have symptoms may experience:

• Heavy or prolonged menstrual bleeding
• Anemia
• Bleeding between periods
• Severe menstrual cramps
• A feeling of fullness in the lower abdomen
• Frequent urination or difficulty urinating
• Pain during intercourse
• Low back pain or abdominal pain
• Constipation
• Chronic vaginal discharge
• Infertility or miscarriages

Fibroids are often found during routine pelvic exams. Additional tests to confirm or gain more information about the fibroids include:

Blood tests.

Ultrasound. To confirm diagnosis and obtain images and measurements of fibroids in the uterus.

Hysterosonography. An ultrasound using sterile saline to expand the uterine cavity for easier imaging.

Hysterosalpingography. This special x-ray test uses dye to help detect abnormal changes in the size and shape of the uterus and fallopian tubes.

Hysteroscopy. An office procedure that uses a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to examine areas of concern inside the uterus.

Laparoscopy. A thin, lighted tube with a camera on the end (laparoscope) is inserted into the abdomen through a small incision, allowing the surgeon to see inside the abdomen and view fibroids on the outside of the uterus.

Imaging tests. Magnetic resonance imaging (MRI) and computed tomography (CT) scans.

Treatment will depend on the number, size, and location of the fibroids, the symptoms they are causing, and the individual patient. Treatment options include:

Watchful waiting. For fibroids that aren't causing symptoms or problems.

Medications. To relieve symptoms, including menstrual cramps and bleeding.

Myomectomy. Surgical removal of fibroids while leaving the uterus intact. The procedure can be performed:

• By laparoscopy and robotic surgery, removing the fibroids through tiny incisions in the abdomen
• By hysteroscopy, viewing and removing the fibroids through a small scope passed through the vagina
• By laparotomy, removing fibroids through open abdominal surgery

Endometrial ablation. Destroys the lining of the uterus using some form of energy, such as heat.

Uterine artery embolization. Decreases the blood supply to the fibroids, causing them to shrink.

Hysterectomy. Surgical removal of the uterus.

MRI-guided ultrasound surgery. Uses ultrasound waves to destroy fibroids.