Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.
What are fibroids?
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.
who is at risk of getting fibroids?
There are factors that can increase a woman's risk of developing fibroids.
• Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
• Ethnic origin. African-American women are more likely to develop fibroids than white women.
• Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
• Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:
Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated (pih-DUHN-kyoo-lay-ted) fibroids
Most fibroids do not cause any symptoms, but some women with fibroids can have:
heavy bleeding (which can be heavy enough to cause anemia) or painful periods
a feeling of fullness in the pelvic area (lower stomach area)
enlargement of the lower abdomen
pain during sex
lower back pain
complications during pregnancy and labor, including a six-time greater risk of cesarean section
reproductive problems, such as infertility or miscarria
what causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:
hormonal (affected by estrogen and progesterone levels)
genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. We do know that they are under hormonal control — both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.
can fibroids cause cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do NOT arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids does NOT increase a woman's chances of getting other forms of cancer in the uterus.
what if I become pregnant and have fibroids?
Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:
• Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
• Baby is breech. The baby is not positioned well for vaginal delivery.
• Labor fails to progress.
• Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
• Preterm delivery.
Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or volleyball.
Uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
magnetic resonance imaging (MRI)
Uses magnets and radio waves to produce the picture
Uses a form of radiation to see into the body and produce the picture
Computed tomography (CT scan)
Takes many X-ray pictures of the body from different angles for a more complete image
An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.
saline infusion sonogram (SIS
Uses a small amount of saline (salt solution) inserted into the uterus (or womb) that allows the lining of the uterus (endometrium) to be clearly seen on an ultrasound scan.
a thin stick-like device with a camera is inserted though the vagina into the uterus for a direct visual inspection of the uterine cavity. Endometrial polyps or fibroids may be identified with this visual procedure. If there is a polyp or fibroid present an option would be to have an operative hysteroscopy under anesthesia to remove it, otherwise there would be no need to undergo an operative procedure.
office-based procedure similar to hysteroscopy to vizualize inside the uterine cavirt for the presence of fibroids. This is purely diagnostic (looking only) and is not done to remove fiboids. A biopsy of the uterine cavity can be performed at the same time
this procedure is performed in an operating room under general anesthesia. A thin device (like a telescope) is inserted through a small cut just below or through the belly button. Your doctor can then view the inside of the abdomen. Diagnostic laparoscopy is simply looking at all the organs in the pelvis (as well as the upper abdomen). When procedures such as biopsies or removal of ovarian cysts and even the uterus (hysterectomy), this is referred to operative laparoscopy.
what questions should I ask my doctor if I have fibroids?
How many fibroids do I have?
What size is my fibroid(s)?
Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
Can I expect the fibroid(s) to grow larger?
How rapidly have they grown (if they were known about already)?
How will I know if the fibroid(s) is growing larger?
What problems can the fibroid(s) cause?
What tests or imaging studies are best for keeping track of the growth of my fibroids?
What are my treatment options if my fibroid(s) becomes a problem?
What are your views on treating fibroids with a hysterectomy versus other types of treatments?
A second opinion is always a good idea if your doctor has not answered your questions completely or does not seem to be meeting your needs.
Many women have fibroids but do not have any significant symtoms. Therefore, most women with fibroids are simply "observed". For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment.
Some of these things include:
whether or not you are having symptoms from the fibroids
if you might want to become pregnant in the future
the size of the fibroids
the location of the fibroids
your age and how close to menopause you might be
Once a diagnosis is made then treatment options can be discussed. Treatment falls into 3 general categories: observation, medical treatments and procedural or surgical options.
If you have fibroids but do not have any symptoms andarenot planning pregnancy, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.
During this time continue to keep a Menstrual Diary. This is also a good opportunity to track the food you are eating. Processed sugary foods will increase insulin and play havoc on the female hormones leading to bleeding irregularities. Meat and dairy from industrial raised animals are often given hormones and these external hormones may cause fibroids to grow and/or to bleed more.
Adopt a whole foods plant rich diet. Also sleep can affect our hormones. Try to get 7-8 hours of restorative sleep a night. Incorporate exercise into your regimen but do not over exercise as that may increase your stress hormones. Excess stress can also cause bleeding irregularities. Try some meditative breathing practices.
If you have fibroids and have mild symptoms, your doctor may suggest taking medication.
These are known to decrease prostaglandins (the hormone released by the uterus during our periods causing both pain as well as bleeding). Motrin, Advil, Aleve. Aspirin not as helpful nor is acetaminophen (Tylenol).
Of note, Omega-3 fatty acids found in oily fish, flax and chia seeds also have anti-prostaglandin action. If taking as a supplement, take 3,000 mg daily and fish-based supplements are more effective
Can be used to decrease the bleeding caused by fibroids. It is not a pain reliever but typically if you have less menstrual bleeding you will also have less pain. This drug prevents enzymes in the body from breaking down blood clots and is used to treat heavy menstrual bleeding. Unlike contraception, this is only taken with heavy bleeding (up to 5 days each cycle).
These drugs can shrink fibroids (temporarily) by decreasing estrogen levels and putting women into a medical menopause. Due to ill effects of menopause, they will be usedfor ashort amount of time and often with asmall dose of estrogen known as add back therapy. Lupron is an injectible version A newer oral version called Orilissa is now available. Recent studies have looked at its effectiveness in treating bleeding from fibroids.
a thin stick-like device with a camera is inserted though the vagina into the uterus for a direct visual inspection of the uterine cavity. Submucosal fibroids may be identified with this visual procedure. The portion of the fibroid that is visualized in the cavity can often be removed.
the lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis. There maybe greater risk of failure when fibroids are present. A woman cannot have children after this procedure.
a thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. This is not receommended if a woman wants to retain her fertility.
surgery to remove fibroids without taking out the healthy tissue of the uterus.
It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver.
surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids.
Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children.