Questions about Uterine Fibroids Answered

Uterine fibroids affect nearly half the women in the United States. Being diagnosed with uterine fibroids is not only a scary experience, but understanding the condition can be an intimidating process.

Here are some common topics about fibroids to consider.

1.) Do I have uterine fibroids?

Typically forming during reproductive age, fibroids are often discovered due to heavy or sustained menstrual bleeding, pelvic pain, difficultly emptying the bladder, constipation or leg pain.

Women who are concerned about getting or staying pregnant often receive a uterine fibroid diagnosis from their ob-gyn.

On consultation an ob-gyn will perform an ultrasound – either abdominally or transvaginally – to look for abnormal growths on the uterus. Uterine fibroids vary greatly in both presentation of symptoms and the ancillary effects on a woman’s health.

2.) What are uterine fibroids? Should I be worried about them? Are they common?

Uterine fibroids, also known as leiomyomas or myomas, are noncancerous growths of the uterus that appear most often during childbearing years. They are considered benign tumors, because they do not increase the risk for uterine cancer and rarely develop further into a form of cancer.

While prevalence data varies, research suggests that anywhere from 50 to 80 percent of all women are affected by uterine myomas.

A recent study shows that race plays a role in the presence of uterine fibroids. By age 35 uterine fibroids appeared in 60 percent of African-American women, increasing to 80 percent by age 50. Conversely, Caucasian women showed an incidence of 40 percent by age 35 and almost 70 percent by age 50.

3.) What causes fibroids? Are they genetic?

The cause of uterine fibroids has puzzled doctors for years, but research and clinical experience show that familial predisposition, starting menstrual periods at an early age and being overweight are important factors in the prevalence of the condition.

Evidence suggests that estrogen and progesterone – the two hormones that stimulate development of the uterine lining during each menstrual cycle – increase the chance for uterine fibroids. Fibroids are therefore more prevalent with the onset of menarche – the beginning of the menstrual function – and regress after menopause.

Evidence also supports the notion that fibroids may be hereditary. It has been shown that identical twins are more likely to both have fibroids than non-identical twins.

4.) Is surgery to remove fibroids necessary? What other treatment options exist?           

Luckily, there are many treatment options for the successful removal of fibroids.

Surgery for uterine fibroids is recommended when they interfere with daily activity and quality of life (i.e. fibroid pain, urinary or bowel problems, anemia or heavy uterine bleeding) or when pregnancy is desired.

Two surgical options to remove fibroids exist: myomectomy and hysterectomy. A hysterectomy is the complete removal of the uterus and is the only treatment that prevents the regrowth of fibroids. For women planning on having children, a myomectomy removes fibroids while leaving the uterus intact and can significantly increasing a woman’s chances of having a child.

Because it is not urgent, such as surgery for cancer, and because removal is not mandatory for patients who are not bothered by their symptoms, uterine fibroid surgery is considered elective. If a woman chooses not to have surgery, she can be examined at regular intervals to monitor her progress.

Non-surgical treatments for fibroids:

With all medical treatments, fibroids will return back to their pretreatment size once medication is stopped. Medical treatments include:

  • GnRH agonists – Gonadotropin-releasing hormone (GnRH) agonists may be prescribed to shrink fibroids and reduce anemia.
  • SERMs – Selective estrogen receptor modulators may be used to shrink fibroids without causing symptoms of menopause.
  • Hormone therapy – To help prevent additional growth of fibroids, your doctor may recommend that you stop taking birth control pills or hormone replacement therapy.

Other Procedures

  • Embolization – In this procedure, polyvinyl alcohol (PVA) is injected into the arteries that feed the fibroid, blocking the blood supply to the fibroid and causing it to shrink. It requires an overnight stay in the hospital and pain medication for 2-3 days. There are some studies showing risk of decreased ovarian function after this procedure but htat risk seems to be decreased in centers that have more experience.
  • MRI directed ultrasound – In this procedure, sound waves are focused on the fibroid, destroying the tissue.  Pregnancy following this procedure has not been studied. If you have an abdominal scar from previous surgery, this procedure cannot be done safely.
  • Accessa- this is a laparoscopic procedure where prongs are inserted into the fibroid and the tissue is destroyed.  Pregnancy following this procedure has not been studied.

Compare fibroid treatments

5.) Is my ability to get pregnant reduced? Will staying pregnant after fibroids be difficult?

The reason many women with uterine fibroids may not get pregnant is because the fibroid mass prevents the embryo from implanting into the uterus. Most often this is caused by a submucosal fibroid – located just under the lining of the uterus – that makes the uterine lining hostile to a fertilized egg.

If it’s discovered by pelvic exam or ultrasound that you have fibroids after becoming pregnant, the likelihood that the fibroid will affect the child is minimal, however the chance for pregnancy loss or early delivery might be increased with the presence of a fibroid.