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Definition
Who is affected?
Where are fibroids located?
What are the symptoms of fibroids?
How are fibroids diagnosed?
Definition
Uterine fibroids are tumors or lumps made of muscle cells and other tissues that grow within the wall of the uterus. Although fibroids are called “tumors,” they are not cancer.
Who is affected?
The lifetime incidence for uterine fibroids is ~70% for African American women and ~60% for Caucasian women. However, not all fibroids cause problems or symptoms.
Who is affected?
Where are fibroids located?
What are the symptoms of fibroids?
How are fibroids diagnosed?
Definition
Uterine fibroids are tumors or lumps made of muscle cells and other tissues that grow within the wall of the uterus. Although fibroids are called “tumors,” they are not cancer.
Who is affected?
The lifetime incidence for uterine fibroids is ~70% for African American women and ~60% for Caucasian women. However, not all fibroids cause problems or symptoms.
Most of the time fibroids grow in women of childbearing age, but can be found in women of all ages. We now recognize several risk factors for uterine fibroids:
- African-American women are three to five times at greater risk than white women.
- Women who are overweight or obese for their height (based on body mass index or BMI) are at slightly higher risk.
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Women who have given birth appear to be at lower risk.
Where are fibroids located?
Although fibroids can grow in any part of the uterus they are classified into three groups based on where they grow.
- Just underneath the internal lining of the uterus (submucosal)
- In the muscular wall of the uterus (intramural)
- On the outside of the uterus (subserosal)
Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (pedunculated fibroids) that grow out from the surface of the uterus, or into the cavity of the uterus.
Below is a picture of the various locations of fibroids.
What are the symptoms of fibroids?
Many women don’t feel any symptoms with uterine fibroids. But fibroids can cause the following:
Many women don’t feel any symptoms with uterine fibroids. But fibroids can cause the following:
- heavy or painful periods
- bleeding between periods
- feeling "full" in the lower abdomen - sometimes called "pelvic pressure"
- urinating often (from a fibroid pressing on the bladder)
- pain during sex
- lower back pain
- reproductive problems, such as infertility and multiple miscarriages
What causes uterine fibroids?
Currently, little is known about what causes uterine fibroids. Many theories exist, but none of these ideas explain fibroids completely. Most likely, fibroids are the end result of many factors interacting with each other. These factors could be genetic, hormonal, environmental or a combination of all three.
For a more detailed review see: http://www.ehponline.org/members/2003/5787/5787.html#2
How are fibroids diagnosed?
Usually, fibroids are found by abdominal or pelvic examination or pelvic ultrasound. To confirm a diagnosis, the doctors at NY Pelvic Pain and Minimally Invasive Gynecologic Surgery may use imaging technology such as ultrasound or magnetic resonance imaging (MRI). X-rays and CT “cat”- scans have almost zero value in diagnosing and managing fibroids and should not be used as tests to do so. Surgery should not be used as a primary tool to confirm or refute the diagnosis of a fibroid. While sometimes fibroids are seen unexpectedly at the time of surgery performed for other reasons, the diagnosis should be made pre-operatively when the reason for surgery is fibroids.
How are fibroids treated?
There are several factors to consider when considering your physician’s recommendation for treating fibroids.
- What are the symptoms?
- How do those symptoms affect your quality of life?
- Is future fertility desired?
- How large are the fibroids?
- What is your age?
- What, if any, has been the prior treatment?
Often a combination of treatments is necessary. The doctors at NY Pelvic Pain and Minimally Invasive Gynecologic Surgery can help guide you through your treatment options and work closely with you while you choose the one(s) that fit you best.
Some of the treatment options may include:
Observation
Sometimes fibroids simply do not need to be treated. In our experience this is often a best option for patients.
Contraceptives and other hormones
We do not recommend this for long term treatment of abnormal bleeding associated with fibroids.
Pain Medication
Use is limited to relief of general pain and discomfort.
Gonadotropin Releasing Hormone Agonists (Zoladex, Lupron)
Block the body from making the homones that cause women to menstruate or have their periods. If you have symptoms, have health conditions that make surgery less advisable and are near menopause or do not want any other intervention you may consider this treatment.
Other antihormonal agents
Such as mifepristone or other experimenatal agents may slow or stop the growth of fibroids.
An interventional radiologist on our team will place small tubes in the blood vessels of your legs and block the blood supply to your fibroids so they can no longer grow.
Magnetic Resonance Guided Fibroid Ultrasound Surgery (MRGFUS)
Approved by the FDA in 2004- it is still experimental. Uses ultrasound energy to destroy the fibroids ability to grow. While this procedure holds promise, certain types of fibroids may not be appropriate for this procedure4. Early reports suggest 51% symptom reduction at 12 months.
The following items are surgical options. If you do choose a surgical option please remember the doctors at NY Pelvic Pain and Minimally Invasive Gynecologic Surgery can almost always offer you a minimally invasive option. There is often a way to give you the benefits of minimally invasive surgery and still give you the best treatment for your fibroids.
- Myomectomy is surgery that removes only the fibroids and leaves the healthy tissue of the uterus in place. This procedure can often be done laparoscopically. You may be an appropriate candidate for a robotically assisted laparoscopic myomectomy.
- Endometrial ablation disables the inside lining of the uterus such that bleeding returns to normal, is minimized or menses no longer occur. This can be done in our office via one of several techniques. You can have relief from your bleeding symptoms and return to work the next day with this treatment.
- Hysterectomy removes the entire body of the uterus. This can be done by leaving the cervix in or removing it. It can often be done laparoscopically.
Do uterine fibroids lead to cancer?
Fibroids do not increase your risk for uterine cancer. It is possible for there to be cancer within a uterine fibroid. This is the case ~1-2% of the time. There is no way to determine if a fibroids is cancerous based simply on its rate of growth and size. The only way to tell is with a biopsy or removal or the fibroid or uterus itself.
References and Credit
- A large portion of the text on this page was excerpted from the Illinois Department of Public Health’s Website: http://www.idph.state.il.us/about/womenshealth/factsheets/ufibroids.htm
- Kenneth A. Levey MD MPH is responsible for the content of this page.
- Uterine leiomyosarcomas: a surprising pathology. Review of the literature. Six case reports. J Gyn Ob Reprod Biol. 1996:25(7):710-5.
- J. Min Inv Gyn. (2007) 14, 616-21.
- ACOG Practice Bulletin #96, August 2008.Alternative to Hysterectomy in the Management of Leiomyomas. Ob / Gyn 112(2):387-400.
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