Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous tumors that grow inside a woman’s uterus (womb).
While uterine fibroids are common, with 20-80% of women experiencing them before turning 50, not all women who have them realize it. Depending on their size, number, and location, fibroids symptoms vary from pain and heavy bleeding to no symptoms at all.
Sometimes, women discover they have uterine fibroids during a routine pelvic exam. In other instances, symptoms like pelvic pressure and menstrual cycle complications lead to a diagnosis of uterine fibroids. Symptoms may be more severe when a woman has more or larger fibroids.
The treatment of uterine fibroids varies from case to case—for some, doctors will adopt a “watch and wait” approach, while for others, a doctor may recommend surgery.
What Are Fibroids?
Fibroids are muscular tumors that can grow in the wall of a woman’s uterus during childbearing years. Usually, fibroids are benign (non-cancerous) and don’t cause symptoms.
Fibroids can be as tiny as a seed or as large as a grapefruit, though the larger they are, the more likely you are to experience symptoms. With larger tumors or even multiple smaller ones, your uterus can enlarge, potentially leading to weight gain and an expansion of your lower abdominal area, similar to pregnancy.
Many women have uterine fibroids and never realize it because they don’t experience symptoms. Often, fibroids are diagnosed during routine pelvic exams when a doctor feels a mass on the uterus with their fingers. Fortunately, fibroids don’t usually turn into cancer and also aren’t associated with an increased risk of cancer.
In addition to the most common fibroids—uterine fibroids—women can also experience other types of fibroids including:
- Breast fibroids: Some women have what doctors call fibrocystic breasts, in which breast tissue feels lumpy or rope-like in texture. Fibrocystic breasts don’t involve true fibroid tumors, but they can still be bothersome, often causing breast pain and tenderness before menstruation.
- Ovarian fibroids: While ovarian fibroids are not a common condition, some women may experience ovarian ovarian cysts, or fluid-filled sacs in their ovaries. Usually, these cysts develop with the follicle that forms with each month’s developing egg, and they may cause symptoms like pelvic pain or pressure. Some women may have a condition called polycystic ovary syndrome, or PCOS, where their eggs turn into cysts because they don’t develop or release properly.
Not all cases of uterine fibroids cause symptoms, and fibroids symptoms can vary based on the number of fibroids, how large the masses are, and where they are located in the uterus.
The most common symptoms of uterine fibroids include:
- Heavy menstrual bleeding
- Prolonged menstrual periods, typically lasting longer than a week
- A sensation of pelvic pressure or pain
- Abdominal pain
- Frequent urination
- Lower back pain
- Enlargement of the upper abdomen
- Pain during sex
- Difficulty fully emptying the bladder
- Pregnancy complications, such as a higher risk of cesarean section
- Rarely, they cause reproductive problems such as infertility
What Causes Fibroids?
Doctors aren’t entirely sure what causes fibroids to grow in the uterus, though believe that fibroids can be caused by:
- Genetics: Some experts believe uterine fibroids run in families.
- Hormones: Fibroids have been found to contain more receptors of two hormones —progesterone and estrogen— than normal uterine cells. These hormones help develop the uterine lining during your menstrual cycle to prepare for a pregnancy and may influence the growth of fibroids.
Because hormones are involved in the growth of uterine fibroids, many women experience enlarged fibroids during pregnancy. Often, these fibroids shrink to a smaller size as the uterus gets smaller after pregnancy.
How to Diagnose Fibroids
If you suspect you might have fibroids, it’s a good idea to talk to a doctor. Your doctor can diagnose you through a physical exam during which they’ll likely perform a pelvic exam. If they feel fibroids, further testing may not be required. Other tests your doctor may perform include:
- Ultrasound imaging: If your doctor needs visual confirmation that you have uterine fibroids, they may order an ultrasound, which uses sound waves to identify and measure fibroids. Ultrasounds of the uterus can be performed either over your abdomen (transabdominal ultrasound) or through your vagina (transvaginal ultrasound).
- Laboratory testing: If you’re having significant issues such as pain or abnormal vaginal bleeding, your doctor may order blood tests to find out what’s causing your symptoms. Common lab tests include a complete blood count (CBC) to determine if you’re anemic and coagulation studies to determine if you have a bleeding disorder.
- Magnetic resonance imaging (MRI): If your doctor needs more information about the size and location of your uterine fibroids to determine the best course of treatment, they may order an MRI, which uses magnets and radio waves to produce an image of your uterus.
Fibroid Treatment Options
There are many treatment options for uterine fibroids, some less invasive than others. Your doctor will determine the best course of treatment depending on the size, location, and severity of your uterine fibroids.
Because fibroids aren’t cancerous and often grow slowly, you may not need any treatment—especially if your fibroids aren’t bothering you or interfering with your quality of life. If this is the case, your doctor may recommend a “watch and wait” approach and forego treatment until you begin to experience symptoms or develop complications.
If your fibroids are causing symptoms, or your doctor has reason to be medically concerned about them, they may recommend medication that can help with symptoms or shrink—but not eliminate—the growths. Common medications used to treat fibroids include:
- Gonadotropin-releasing hormone (GnRH) agonists: These medications simulate menopause by blocking estrogen and progesterone production that may contribute to fibroid growth.
- Progestin-releasing intrauterine device (IUD): An IUD can decrease excessive bleeding that may be caused by fibroids.
- Oral contraceptives: Oral contraceptives may relieve heavy bleeding, but don’t decrease the size of uterine fibroids.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Pain medications can help manage any pain or discomfort caused by fibroids.
- Iron supplements: If you have anemia caused by a heavy menstrual flow due to fibroids, your doctor may prescribe an iron supplement.
There are also more invasive procedures to remove fibroids from the uterus. Some of these procedures include:
- Myomectomy: A myomectomy is a surgery that removes fibroids from the uterus without taking out healthy tissue. It can be performed through abdominal surgery, or by laparoscopy or hysteroscopy, procedures which use a camera to ensure smaller incisions.
- Myolysis: During this procedure, your doctor will insert a needle directly into your fibroids through a laparoscopy, and use an electric current to freeze to destroy your fibroids.
- Uterine fibroid embolization (UFE): With UFE, a doctor threads a thin tube into the blood vessels that bring blood to a fibroid. The tube sends tiny plastic or gel particles into the fibroids, which blocks the fibroids’ blood supply and stops its growth.
- Hysterectomy: The only way to cure fibroids entirely is to remove the uterus altogether with a procedure called a hysterectomy. A doctor will typically only recommend this procedure if you have very large fibroids that cause severe symptoms, or if you’re close to menopause or do not want to have children.
Risk Factors and Complications
The primary risk factor for developing uterine fibroids is being of reproductive age, due to the higher levels of reproductive hormones during that time. Other factors that are believed to be connected to the development of uterine fibroids include:
- Race: It’s more common for black women to develop fibroids. Black women also often have larger, more symptomatic fibroids, and develop them at a younger age.
- Genetics: If your mother had uterine fibroids, you are about three times more likely to develop them yourself.
- Obesity: Overweight women are also at a higher risk for developing uterine fibroids. For women who are very overweight, the risk is 2-3 times higher than average.
Typically, fibroids aren’t considered medically dangerous. Some women with uterine fibroids may have a heavy menstrual flow, leading them to develop anemia, a condition in which the body doesn’t have enough red blood cells to carry oxygen to its tissues.
Fibroids and Pregnancy
In some cases, people with large or poorly positioned fibroids may experience pregnancy loss or have a difficult time getting pregnant. Fibroids may also increase the risk of some pregnancy complications, like preterm delivery or restricted fetal growth.
Fibroids and Cancer
It’s extremely rare for fibroids to be cancerous. Fewer than one in 1,000 uterine fibroid cases include a cancerous fibroid, which doctors call a leiomyosarcoma. Keep in mind that having fibroids does not increase your risk of uterine cancer, and doctors don’t believe that cancerous fibroids come from existing fibroids.
When to See a Doctor
If you’re experiencing pain or discomfort that you suspect could be caused by uterine fibroids, reach out to your provider or a K doctor. Common symptoms to watch for include:
- Pelvic pain
- Prolonged or painful periods
- Difficulty fully emptying your bladder
- Anemia, which may cause fatigue, shortness of breath, or lightheadedness
Seek medical care immediately for any severe vaginal bleeding or sudden, severe, or worsening pelvic pain, which could potentially indicate medical emergencies such as infection or a pregnancy complication.
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