From Causes to Cures: A Deep Dive Into Fibroids

• What are Fibroids?
• What are the Risk Factors for Developing Fibroids?
• What is the Cause of Uterine Fibroids?
• What Symptoms Do Fibroids Cause?
• Can Fibroids Become Cancerous?
• How are Fibroids Diagnosed?
• How are Fibroids Treated?
• Do You Always Need to Treat Fibroids?
• What are the Different Medications That Treat Fibroids?
• What Non-Invasive Procedure Treats Fibroids?
• What Minimally Invasive Procedures Treat Fibroids?
• What are the surgical options for treating fibroids?
• Additional Resources

Key Takeaways

• Fibroids are non-cancerous “growths” or “tumors” in or on the uterus wall.
• Fibroids are the most common non-cancerous tumors in women of childbearing age.
• About 70% of White women and 80% of African American women will develop at least one fibroid by the age of 50 years.
• The size, shape, and location of fibroids can vary greatly.
• The exact reason that some women develop fibroids is not known.
• Some women with fibroids do not experience symptoms. Instead, their doctors find them during a routine gynecological exam.
• Medications don’t eliminate fibroids but may shrink them, and they can treat symptoms such as heavy menstrual bleeding and pain.
• The only way to physically remove fibroids is through surgery.

What are Fibroids?

Fibroids are non-cancerous “growths” or “tumors” in or on the uterus wall. They form from the smooth muscle cells of your uterus.

Here are 6 facts to know about fibroids:

1. The medical names for fibroids are leiomyomas (pron. lie-oh-my-oh-mas) or myomas.
2. They are the most common non-cancerous tumors in women of childbearing age.
3. About 70% of White women and 80% of African American women will develop at least one fibroid by the age of 50 years.
4. You can have a single fibroid or multiple fibroids.
5. Most fibroids grow slowly. A fast-growing fibroid may be a sign of cancer and must be evaluated immediately. Cancerous fibroids are called leiomyosarcoma (pron. lie-oh-my-oh-sar-coma).
6. Fibroids can range from the size of a green pea to the size of a watermelon.

Fast-growing cancers can signify a cancerous malignancy. Fibroids that are growing rapidly need immediate evaluation.

Doctors classify fibroids based on their location. The types of fibroids include:

1. Submucosal:  inside the uterus just underneath the uterine lining
2. Subserosal: on the outer surface of the uterus
3. Intramural: within the wall of the uterus
4. Pedunculated: attached to the uterus by a stem or stalk-like structure

Who is at risk for developing fibroids?

The following factors increase your chances of having fibroids:

• Fibroids are most commonly found in women of childbearing age (ages 30-40). However, they can occur in women of all ages. Fibroids often shrink after menopause.
• Fibroids occur more often in black women than in white women. They also develop at a younger age, grow larger, and cause more severe symptoms in African American women than they do in white women. The reason for this is unclear.
• Obesity
• Family history of uterine fibroids
• Early age of your first period
• Older age at menopause
• High blood pressure
• No prior pregnancies
• Vitamin D deficiency
• Food additive consumption
• Use of soybean milk

Having multiple pregnancies or long-term use of oral or injectable contraceptives has been shown to lower your risk of developing fibroids.

What is the cause of uterine fibroids?

The exact reason that some women develop fibroids is not known.

Scientists believe fibroids happen because of various interacting factors:

• Genetics
• Hormones such as estrogen and progesterone
• Certain micronutrients, such as an excess of iron, vitamin A, and vitamin C, or a deficiency of vitamin D

What symptoms do fibroids cause?

Some women with fibroids do not experience symptoms. Instead, their doctors find them during a routine gynecological exam.

Other women with fibroids may experience:

• Changes in menstruation
  • Longer, more frequent, or heavier menstrual periods
  • Menstrual pain (cramps)
  • Vaginal bleeding between periods
  • Anemia

• Pressure
  • A feeling of fullness in your lower abdomen
  • Difficulty urinating and more frequent urination (fibroid presses on the bladder)
  • Constipation, rectal pain, or difficulty having bowel movements (fibroid presses on the rectum)
  • An enlarged abdomen

• Pain
  • Pain during intercourse
  • Lower back pain
  • Abdominal pain (can be a dull, heavy, aching feeling or a sharp pain)
  • Abdominal cramping
  • Pedunculated fibroids can twist and cause pain, fever, and nausea
  • Fibroids that grow rapidly or that start to degenerate can cause pain and fever

• Reproductive Problems
  • Infertility
  • Miscarriages

• Pregnancy Complications
  • Early-onset (pre-term) labor
  • Increased chance of needing a cesarean section for delivery
  • Breech Babies
  • Increase blood loss during cesarean section

Can fibroids become cancerous?

• Fibroids are almost always benign (not cancerous).
• It’s rare (less than 1 per 1000) that a fibroid becomesa cancer ( called leiomyosarcoma).
• Having fibroids does not increase your risk of developing leiomyosarcoma or other forms of uterine cancer.

How are fibroids diagnosed?

Pelvic Examination: During your gynecological (gyn) exam, your doctor may be able to feel that your uterus is enlarged, irregularly shaped, or has a discrete fibroid in it.

Ultrasound: Also called a sonogram, an ultrasound uses sound waves to create a picture of the uterus and fibroids.

Hysteroscopy: Hysteroscopy is a surgical procedure where your doctor inserts a slim, lighted telescope, called a hysteroscope, through the vagina and cervix and into the uterus. The inside of the uterus can be seen, along with any fibroids that may be present. There are no incisions with a hysteroscopy. Hysteroscopy can be performed either in the office or the outpatient surgery department. During operative hysteroscopy, your doctor can surgically remove small fibroids that are seen with the hysteroscope.

Sonohysterography: Sonohysterography is a procedure where your doctor pushes fluid through the vagina and cervix and into the uterus. At the same time, your doctor takes ultrasound pictures of the inside of the uterus. The fluid helps show more detail than ultrasound alone. You can do this test in your gynecologist’s office or a hospital’s ultrasound department. It usually takes less than 30 minutes.

Hysterosalpingography (HSG): HSG is a detailed X-ray test in which your physician injects contrast material into the uterus and then takes pictures. This test detects changes in the size and shape of the uterus. Doctors use it more as part of an infertility evaluation to check for blockages in the tubes, but they can also use it to detect fibroids inside the uterus.

Magnetic resonance imaging (MRI): MRI is an imaging test that does not use radiation. MRI uses a strong magnetic field and radio waves to generate images of body parts that cannot be seen with X-rays, CT scans, or ultrasound. It can show the size and location of fibroids in great detail.

Laparoscopy: Laparoscopy is a minimally invasive surgical procedure. A laparoscope is a thin, lighted telescope. Once you are under anesthesia, your doctor inserts the laparoscope into your abdomen through a tiny incision below your belly button. Your pelvic organs, including any fibroids on the outer uterine wall, can be seen.

How are fibroids treated?

Before deciding on a treatment for your fibroids, it’s important to consider:

• Your general health
• Your age
• The location of the fibroids
• The type and size of your fibroids
• The severity of your symptoms
• Your plans for pregnancy

Treatments for fibroids fall into five main categories:

• Watch and monitor (observation)
• Medications
• Non-Invasive Procedures
• Minimally Invasive Procedures
• Surgery

Do you always need to treat fibroids?

Observation and monitoring your fibroids may be the best thing for you if:

• Your fibroids are small
• Fibroid size has remained small over a long period of time
• You do not have symptoms like heavy periods, abnormal bleeding, or pain
• You are nearing menopause (they often shrink after menopause)

What are the different Medications that treat fibroids?

Medications used to treat uterine fibroids target hormones that regulate your menstrual cycle.

Medications don’t eliminate fibroids but may shrink them, and they can treat symptoms such as heavy menstrual bleeding and pain.

• Over-the-counter medications such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) help to relieve pain due to fibroids.

• The use of combined estrogen-progestin contraception is commonly used for the treatment of fibroids. This reduces the pain and heavy menstrual bleeding associated with uterine fibroids. For women who wish to avoid pregnancy, this is a first-choice option.

• Hormonal IUDs (Mirena, Liletta, Skyla) release progestin hormone into the lining of the uterus. Studies show that hormonal IUDs decrease heavy periods caused by fibroids. Because the effect of these types of IUDs is limited to the inside of the uterus, they are well-tolerated and effective at preventing pregnancy. Studies have shown that fibroids may cause the IUDs to fall out more frequently. You must check for the IUD string monthly.

• For women who are unable to or choose not to take birth control pills, the use of progesterone-only pills is the next best option. These pills also reduce the pain and heavy menstrual flow associated with uterine fibroids. Their effectiveness is slightly decreased compared to combination oral contraceptive pills (OCP). However, one benefit is that you only need to take the progesterone only pills on or around the time of your menstrual cycle, unlike OCP, which is taken daily.
• Tranexamic acid (Lysteda, Cyklokapron) is a non-hormonal medication that helps reduce heavy menstrual periods. It is taken only on the days there is heavy bleeding.

• Gonadotropin-releasing hormone agonists (GnRHa). These medications (Lupron, Zoladex, Eligard) treat fibroids by blocking the production of the hormones estrogen and progesterone. It puts you in a temporary “menopause-like” state. As periods stop, the fibroids shrink in size. Because this treatment can cause side effects that mimic the symptoms of menopause (hot flashes, night sweats, vaginal dryness, bone loss), it is not meant for long-term use. Most of the time, these medicines are used for no more than three to six months to reduce the size of the fibroids and correct anemia before a planned surgery.

What non-invasive procedure treats fibroids?

MRI Guided Focused Ultrasound Surgery

In 2004, the FDA approved magnetic resonance imaging-guided focused ultrasound surgery (FUS) to treat fibroids. Focused ultrasound (FUS) allows you to keep your uterus and requires no incisions. You do not need to be hospitalized after this procedure; you can go home once the procedure is completed.

Focused ultrasound happens while inside an MRI (magnetic resonance imaging) scanner. Your doctor will identify the precise location of the fibroid and then direct high-intensity ultrasound waves into the fibroid to destroy small areas of fibroid tissue. FUS is a newer technology, so researchers continue to study it for its long-term safety and effectiveness. The data collected so far shows that FUS for uterine fibroids is safe and effective.

What minimally invasive procedures treat fibroids?

• Endometrial ablation is a procedure that uses electrical current, microwave energy, or freezing to destroy the endometrium (the lining of the uterus). It also destroys any small fibroids that may be present there. Women who get pregnant after having an endometrial ablation are at higher risk for miscarriage and other pregnancy problems, so doctors don’t recommend becoming pregnant after endometrial ablation. You should remain on birth control until reaching menopause.

• Radiofrequency ablation uses ultrasound to locate the uterine fibroids. During laparoscopy, an instrument is placed into the fibroid, and heat is applied. The heat destroys the myoma (fibroid) and shrinks the blood vessels that feed them, causing them to shrink. This can be done through two small incisions in the abdomen during a laparoscopy or through the cervix. Most women undergoing the procedure go home the same day and return to regular activities after 5 to 7 days of recovery.

• Uterine artery embolization (UAE), or uterine fibroid embolization (UFE), is performed by a specialized radiologist called an interventional radiologist. The radiologist physician makes a small cut in the groin area and inserts a catheter (tube) into the large blood vessel there. She then pushes the catheter until it reaches the arteries that supply blood to the uterus. Next, they inject tiny plastic or gel particles through the catheter into the arteries. The particles block blood flow to the fibroids, so they eventually shrink and die. UAE successfully treats fibroids, but studies have shown that approximately one-third of women who have UAE need some form of treatment again for fibroids within 5 years. Complications may occur if the blood supply to your ovaries or other organs gets compromised by drifting particles. Some research has shown an increased risk of miscarriage in women who become pregnant after UAE, so doctors don’t recommend UAE if you plan to become pregnant. UAE is the preferred option for women who are at high risk of surgical complications. Women who choose not to have surgery and are approaching menopause may also be suitable candidates for the UAE procedure.

What are the surgical options for treating fibroids?

Myomectomy is a surgery to remove fibroids without taking out the healthy uterine tissue.

• It is a good option if you want to have children after treatment for the fibroids.

• If the removal of your fibroids requires extensive surgical dissection, your doctor will recommend a cesarean delivery for all future pregnancies.

• Studies show that myomectomy can relieve fibroid-related symptoms in 80% to 90% of women.

• After a myomectomy, new fibroids can grow and require further treatment.

• Depending on the size, location, and type of fibroids you have, your doctor can perform surgery in one of three ways:

• • Hysteroscopy: your doctor first places a long, thin, lighted telescope through the vagina and cervix and into the uterus. Then, while injecting fluid into the uterus, your doctor uses a device to either cut out the fibroids or destroy them with electricity.
  • Laparoscopic (including Robotic) Myomectomy: your doctor places a long, thin, lighted telescope through two small incisions on your abdomen. The fibroids can be seen and removed with the help of another tool.
  • Laparotomy: Your doctor makes an incision in the abdomen and directly removes the fibroids through this larger incision. The incision is usually transverse and just a few inches above the pubic bone, which many women refer to as a bikini cut. If you have very large fibroids extending above your belly button, the incision may need to be vertical—in the up and down plane—to be adequately removed. For most women with fibroids this large, a hysterectomy will be recommended simply because the blood loss associated with myomectomy with large fibroids is usually excessive.

Hysterectomy is a surgery that removes both the fibroids and the healthy uterine tissue.

• A hysterectomy is the only way to ensure your fibroids will never return.

• This is often a good option if your fibroids are large, cause heavy bleeding, or if you have already undergone previous treatments for fibroids and they have recurred.

• If you choose to have a hysterectomy, your ovaries do not have to be removed. You can keep your ovaries so that they continue to make the hormones and prevent you from going into immediate menopause. You and your doctor will decide, before surgery, the best way to handle your ovaries at the time of your hysterectomy.

• You can no longer become pregnant after having a hysterectomy.

• There are several ways that a hysterectomy can be performed:
  • Abdominal hysterectomy: your doctor removes the uterus through an incision in the abdomen, similar to the incision made for a cesarean section. This type of hysterectomy requires a longer hospital stay and longer recovery time (6 weeks) than the following three methods.
  • Vaginal hysterectomy: your doctor removes the uterus through the vagina instead of the abdomen. This method is less invasive than an abdominal hysterectomy, so recovery time is shorter (3 to 4 weeks). A vaginal hysterectomy may not be an option if your fibroids are very large.
  • Laparoscopic hysterectomy: your doctor places a long, thin, lighted telescope through two small incisions on your abdomen. Most of the surgery is performed through the laparoscope. Then, your doctor removes the uterus either through the vagina in a laparoscopic-assisted vaginal hysterectomy (LAVH) or through the laparoscope in a laparoscopic hysterectomy. While these surgeries are minimally invasive and have much shorter recovery times, not all fibroids can be removed laparoscopically.
  • Robotic Hysterectomy: during robotic surgery, your doctor sits at a console next to the operating room table and guides a robotic arm to perform the laparoscopic surgery. The incisions are small, so recovery is shorter (3-4 weeks). Since this is a newer technique, researchers are studying it to compare its outcomes with other more established surgical treatments.

Additional Resources:

Living with the chronic symptoms and potential fertility effects associated with the problems caused by fibroids can take an emotional toll. Many women find that joining a support group and talking to other women who have fibroids provide the emotional support they need. Hospitals and health clinics may offer support groups for women and families affected by fibroids. Your healthcare provider may be able to refer you to a support group. The following resources may be helpful:

• Living with uterine fibroids
• Fibroids Fact Sheet
• Fibroids and Fertility
• Fibroid Patient Education Video
• Treatment of Fibroids
• The Fibroid Foundation and Newsletter
• National Uterine Fibroid Foundation (NUFF)
• National Institutes of Health Research on Fibroids

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Copyright: myObMD, Inc | Author: Lisa Shephard, MD | Editor: Jennifer Abayowa and Dayna Smith, MD | Reviewed June 3, 2024.

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