Uterine fibroids are benign tumors that are made up of the
muscle and connective tissue from the wall of the uterus (womb). Fibroids may
grow as a single nodule or in clusters and may range in size from 1 mm to more
than 20 cm (8 inches) in diameter. They may grow within the wall of the uterus
or they may project into the interior cavity or toward the outer surface of the
uterus. In rare cases, they may grow on stems projecting from the surface of the
uterus.
What causes uterine fibroids?
The causes of fibroids are not known. Most fibroids occur in
women of reproductive age, and according to some estimates, they are diagnosed
in black women 2-3 times more frequently than in white women. They seldom are
seen in young women who have not begun to menstruate. The symptoms of uterine
fibroids usually stabilize or go away in women after menopause.
According to the U.S. National Institutes of Health (NIH), at
least 25%-80% of women suffer from uterine fibroids.
Are fibroids cancer?
No. Fibroids are not associated with cancer. They are benign
tumors that rarely develop into cancer. Patients who have rapid growth of
uterine fibroids, or fibroids that grow during the menopause, should be
evaluated immediately.
Who is at risk for uterine fibroids?
Risk factors for uterine fibroids include obesity, family
history, not having children, early onset of menstruation, and late age for
menopause. (A person is considered obese if he or she is more than 20% over his
or her ideal body weight.)
What are the symptoms of uterine fibroids?
Most fibroids do not cause any symptoms and do not require
treatment other than regular observation by a doctor. Fibroids may be discovered
during routine gynecologic examinations or during prenatal care. Some women who
have uterine fibroids may experience the following symptoms:
- Excessive or painful bleeding during menstruation
- Bleeding between periods
- A feeling of fullness in the lower abdomen
- Frequent urination resulting from a fibroid that compresses the
bladder
- Pain during sexual intercourse
- Low back pain
- Constipation
- Chronic vaginal discharge
- Inability to urinate
- Severe menstrual cramps
- Infertility
How are uterine fibroids treated?
More and more, doctors are beginning to realize that uterine
fibroids may not require any intervention or, at most, limited treatment. For a
woman with uterine fibroids that are not causing symptoms, the best therapy may
be watchful waiting. Periodic pelvic examination and ultrasound may be
recommended by your physician, depending on the size or symptoms of the fibroid.
Some women never exhibit any symptoms nor have any problems associated with
fibroids, in which case no treatment is necessary.
If a woman is experiencing anemia caused by heavy, prolonged
menstrual bleeding; moderate to severe pain; infertility; or urinary tract or
bowel problems; then she will require therapy. The type of treatment offered is
determined by the number, size, location, and symptoms related to fibroids.
Additionally, the desire for fertility will also determine whether certain
options are feasible. Treatment options include:
Medications. For women who experience occasional pelvic
pain or discomfort, a mild, over-the counter anti-inflammatory or pain-killing
drug such as Naproxen or ibuprofen often will be effective. More bothersome
cases may require stronger drugs available by prescription. Additionally, these
medications may also decrease the amount of menstrual bleeding, clotting, and
gushing of blood that some women experience.
Some fibroids are treated with hormones that reduce the amounts
of the female hormone estrogen. Doctors believe that fibroids grow best when
there are high levels of estrogen.
Birth control pills (oral contraceptives) can be used to treat
the bleeding symptoms and menstrual cramps caused by uterine fibroids because
they decrease the production of female hormones and prevent ovulation. Birth
control pills do not reduce the size of uterine fibroids but often help to
regulate menses and decrease the quantity of bleeding and cramps. Rarely do oral
contraceptives contribute to the growth of fibroids.
Surgery. Fortunately, a woman now has a number of
surgical and less invasive options for treatment of uterine fibroids that can
control symptoms, preserve the uterus, and preserve fertility. In the past, a
woman with growing uterine fibroids was only considered a candidate for
hysterectomy (the surgical removal of the uterus). Performing a hysterectomy in
a woman of reproductive age means that she will no longer be able to have
children and will not have a menstrual cycle. Today, many women and their
doctors are considering other minimally invasive treatment options, which may
eliminate symptoms.
If a fibroid is particularly troublesome, the surgeon often can
remove only the tumor, leaving the uterus intact. This procedure is called
myomectomy. This is done when a woman wants to be able to have children or
wishes to retain her uterus as a personal choice.
There are a number of techniques that can be used to perform a
myomectomy. The technique is determined by the size, number, and location of the
fibroid(s), and the physician’s surgical expertise. These techniques include:
- Laparoscopic myomectomy (or robotic myomectomy), which involves the
use of a thin, telescope-like instrument attached to a small video
camera called a laparoscope inserted through a tiny incision at the
belly button. The surgeon uses specialized surgical instruments inserted
through this incision and two or three additional small incisions in the
abdomen to remove the fibroids.
- Hysteroscopic myomectomy, a procedure in which some fibroids are
removed through the vagina using a surgical instrument called a
hysteroscope (a thin, telescope-like instrument inserted through the
cervix and into the uterus). This technique can be employed when the
fibroid is within the uterine cavity.
- Laparotomy, which involves an abdominal incision to remove all
fibroids, no matter the size or location of the tumors.
Fibroid embolization. This treatment works by
decreasing the blood supply to the fibroids, causing them to shrink. This is a
minimally invasive procedure performed by an interventional radiologist.
Patients are typically able to return home the day after the procedure. This
treatment is not offered to women who want children.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/3/2009…#9130
