Fibroids

What are fibroids?
Fibroids or leiomyoma are benign tumors of the uterus made of muscle. These growths can occur in different parts of the uterus, including inside the cavity of the uterus, on the outside of the uterus or within the wall of the uterus. Fibroids can range in size from less than a centimeter to larger than a grapefruit.

How common are fibroids? What causes them?
Fibroids are very common and occur in 25-80% (NIH statistic) of women. It is unknown what specifically causes fibroids.

Fibroids are thought to grow in response to the female hormone, estrogen. Therefore, they are most frequently seen in women of reproductive age. Some women who have fibroids report that other women in their families also have this condition. There is, indeed, thought to be a hereditary component. Also, African American women are more likely than Caucasion women to have uterine fibroids.

How do I know if I have fibroids?
Most commonly, fibroids do not cause any symptoms or health problems. Sometimes they are discovered incidentally during a woman’s annual GYN exam. If fibroids arise in particular parts of the uterus or grow to a larger size, they can cause problems including abnormal or heavy periods, anemia, difficulty becoming pregnant, back pain, painful intercourse, bloating or fullness in the belly or difficulty urinating.

How are fibroids treated?
If fibroids are diagnosed in a woman who has no symptoms, they usually do not require treatment. However, if a women is suffering from any of the symptoms listed above, she may require treatment.

The approach to treating symptomatic fibroids depends on what the woman’s symptoms are and where/how large her fibroids are.

Many doctors start with less invasive therapies first. Painful periods related to fibroids can sometimes be treated with anti-inflammatory medications like ibuprofen or naproxen. Also, some doctors may prescribe a birth control pill or a medication called lupron to decrease hormone levels and thereby decrease growth of the fibroids and bleeding.

For other women, surgery may be the best option. In women who have pain or heavy periods related to fibroids and want to potentially become pregnant in the future, a myomectomy, or removal of the fibroids with preservation of the uterus, can be an option. A myomectomy is a major surgery. It is possible to do a myomectomy using small incisions and laparoscopy or robotic surgery. In younger women who have myomectomies, fibroids may grow back in the future.

If the fibroids are located within the uterine cavity, a myomectomy can be performed through a tiny scope inserted into the cervix and uterus. This is called a ‘hysteroscopic’ myomectomy.

Another procedure, called uterine fibroid embolization (or UFE), is sometimes recommended for women who have heavy periods due to their fibroids and wish to avoid surgery. This type of procedure is performed by a special doctor called an Interventional Radiologist. It involves injecting a material into the blood vessels that supply the fibroids, thereby decreasing blood flow. Women who desire pregnancy in the future are not candidates for this procedure.

Finally, hysterectomy is an option for treatment of fibroids. A hysterectomy is a major surgery during which the uterus is removed. Depending on the size of a woman’s fibroids, hysterectomy can be performed through small incisions (laparoscopically), through the vagina and in rare cases, must be performed using a large incision if the fibroids are very big.