Uterine Fibroids

Uterine fibroids (also called leiomyomas or uterine myomas) are growths made of muscle and tissue that form in or on the wall of your uterus. These growths are very common and aren’t usually cancerous.

A fibroid in your uterus can cause a variety of symptoms, like pain and heavy, irregular vaginal bleeding. Sometimes, you have no symptoms and don’t know you have fibroids. Treatment typically depends on your symptoms and how they impact your life.

Types of uterine fibroids

There are different types of fibroids depending on where they’re located and how they attach to your uterus. Specific types include:

• Intramural fibroids: These fibroids grow in the muscular wall of your uterus. They’re the most common type.
• Submucosal fibroids: These fibroids grow under the inner lining of your uterus.
• Subserosal fibroids: This type grows under the outer surface of your uterus. They can become quite large and grow into your pelvis.
• Pedunculated fibroids: These attach to your uterus with a stalk or stem. They’re often described as mushroom-like because they have a stalk and a wide top. These are the least common type.

Symptoms of uterine fibroids

Most small fibroids don’t cause symptoms or require treatment. You may not even know you have them. Your healthcare provider may recommend regular checkups to monitor them. Larger fibroids can cause a variety of symptoms, including:

• Excessive or painful bleeding during your period
• Bleeding between your periods
• A feeling of fullness in your lower belly (bloating)
• Abdominal enlargement that may make you look pregnant
• Peeing more often
• Pain during sex
• Constipation
• Low back pain
• More vaginal discharge
• Difficulty peeing

What do they look like?

Fibroids are typically rounded growths that look like smooth bumps. In some cases, they can be attached with a thin stem, giving them a mushroom-like appearance. They can grow as a single nodule (one growth) or in a cluster. Clusters of fibroids can range in size from 1 millimeter to more than 20 centimeters (8 inches) in diameter or even larger. For comparison, fibroids can be as small as a seed or get as large as a watermelon.

Uterine fibroid causes

The exact cause is unknown, but healthcare providers believe the hormones estrogen and progesterone play a role. Studies show that fibroids tend to grow when hormone levels are higher (like during pregnancy) and shrink when hormone levels are low (like during the transition to menopause).

Risk factors

Several risk factors can play a role in your chances of developing fibroids. These can include:

• Having obesity
• Family history of fibroids
• Not having children
• Getting your first period before age 11
• Reaching menopause after age 55

Fibroids happen most often in people between 30 and 50 years old. They’re rare before your first period. It’s uncommon for fibroids to grow after menopause.

Complications of fibroids

Most uterine fibroids don’t cause serious complications. The most common complications of fibroids are:

• Pain that becomes unmanageable
• Swelling of your abdomen or pelvic area
• Excessive bleeding
• Anemia

How doctors diagnose fibroids

Healthcare providers often find uterine fibroids during a pelvic exam. Heavy bleeding and other symptoms may also point to the condition.

Several tests can confirm fibroids and show their size and location. These may include:

• Imaging: Your provider can use ultrasound, MRI or CT scans to get images of your uterus.
• Hysteroscopy: Your provider puts a thin, flexible tube with a camera on the end through your vagina and into your uterus. This lets them see some fibroids better.
• Sonohysterography (saline ultrasound): Your provider inserts a catheter through your vagina and cervix into your uterus. They then use the catheter to inject saline into your uterus. This extra fluid helps to create a clearer image of your uterus than you would see during a standard ultrasound.

How are fibroids treated?

Treatment for uterine myomas can vary depending on the size, number and location of the fibroids, as well as what symptoms they’re causing. Possible treatments can include medications and/or surgery.

You should also consider your plans for pregnancy in the future. Talk to your healthcare provider about your fertility goals when discussing treatment options. Only you and your provider can decide the best course of treatment or if treatment is necessary.

If you don’t have any symptoms, or you have small fibroids, you may not need treatment. In these cases, your provider may recommend monitoring the fibroids with pelvic exams or ultrasounds. If you have large fibroids or your symptoms are causing you pain or excessive bleeding, getting treatment may be the best option.

Medications

Medications can help manage symptoms like heavy bleeding and anemia.

• Over-the-counter (OTC) pain medications: Medications like acetaminophen and ibuprofen help manage pain and discomfort caused by fibroids.
• Iron supplements: If you have anemia from excess bleeding, your provider may suggest you take an iron supplement.
• Birth control: Birth control can also help with symptoms of fibroids, like heavy bleeding and menstrual cramps. There are many birth control options you can use.
• Gonadotropin-releasing hormone (GnRH) agonists and antagonists: These medications are used to treat heavy uterine bleeding in people who haven’t reached menopause and have fibroids. They may also work by shrinking fibroids. They’re sometimes used to shrink fibroids before surgery, making them easier to remove. These medications are temporary, so if you stop taking them, the fibroids can grow back.
• Oral medications: Tranexamic acid is an oral medication that helps treat heavy menstrual bleeding caused by fibroids. Talk to your provider about the pros and cons of these medications.

Fibroid surgery

The type of surgery for fibroid removal depends on several factors, including the size, location and number of fibroids, and your plans for future pregnancy. Some options preserve your uterus so you can get pregnant in the future.

Myomectomy is surgery to remove uterine fibroids while keeping your uterus in place. The best option for you depends on the size, number and location of the fibroids. Types of myomectomy include:

• Hysteroscopy: Your provider uses a thin, flexible tube with a camera inserted through your vagina and cervix. Then they pass small tools through the tube to cut away at the fibroids.
• Laparoscopy: Your provider removes the fibroids using a thin tube with a camera placed through small cuts in your belly.
• Laparotomy: Your provider removes the fibroids through one larger cut in your belly.

If you aren’t planning to become pregnant in the future, your healthcare provider may recommend other options. These treatments can be very effective, but they usually prevent pregnancy. These can include:

• Hysterectomy: Your provider removes your uterus. A hysterectomy is the only way to cure fibroids. By removing your uterus completely, the fibroids can’t come back, and your symptoms should go away.
• Uterine fibroid embolization: A small catheter is placed into the uterine artery. Then, tiny particles are injected to block blood flow to the fibroids. This helps the fibroids shrink and may improve symptoms.
• Radiofrequency ablation (RFA): This treatment uses microwave (RF) energy to treat smaller uterine fibroids.

How large do fibroids need to be before being surgically removed?

There isn’t one size that automatically means it needs to be removed. For example, fibroids the size of a small marble may still cause excessive bleeding depending on their location. Your healthcare provider can discuss symptoms that might require surgical treatment.

When should I see my healthcare provider?

Contact your healthcare provider if you have symptoms of uterine fibroids, like:

• Heavy and irregular vaginal bleeding
• Bleeding between periods
• Pelvic pain
• Pain during sex
• A feeling of pressure or fullness in your belly

What can I expect if I have this condition?

Fibroids are very common, and many people live with them without any serious problems. They aren’t usually dangerous. Your healthcare provider will monitor the fibroids over time, and focus on managing any symptoms if they develop. Treatments for fibroids are very effective. Your healthcare provider can discuss the best treatment option for you based on your situation.

Will fibroids go away on their own?

Fibroids can shrink after menopause. This happens because hormone levels decrease. When the fibroids shrink, your symptoms may go away. Small fibroids may not need treatment if they aren’t causing any symptoms.

Can I get pregnant if I have uterine fibroids?

Yes, you can get pregnant. If you already have fibroids when you become pregnant, your healthcare provider will monitor them during your pregnancy. During pregnancy, hormone levels increase. These hormones support the pregnancy, but they can also make fibroids grow. Large fibroids can lead to complications during pregnancy.