Uterine Fibroids

Why should women know about fibroids?

Uterine fibroids are the most common, benign tumors in women of childbearing age, but no one knows exactly what causes them. They can be frustrating to live with because there are limited treatment options, and they are the cause of many hysterectomies (surgery to remove the uterus).

Where can fibroids grow?

Fibroids are placed into three groups based on where they grow, such as just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus, or into the cavity of the uterus.

What are the symptoms of fibroids?

Most fibroids do not cause any symptoms, but some women with fibroids can have:

• Heavy bleeding or painful periods
• Bleeding between periods
• Feeling of fullness in the pelvic area (lower abdomen)
• Urinating often
• Pain during sex
• Lower back pain
• Reproductive problems - such as infertility, having more than one miscarriage, or having early onset of labor during pregnancy

What causes fibroids?

No one knows for sure what causes fibroids. Researchers have some theories, but most likely, fibroids are the result of many factors interacting with each other. These factors could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. But, this is not true for all women with fibroids.

Can fibroids turn into cancer?

Fibroids are almost always benign, or not cancerous, and they rarely turn into cancer (less than 0.1 percent of cases). Having fibroids does not increase a woman's chances of getting cancer of the uterus.

Who gets fibroids?

Most of the time, fibroids grow in women of childbearing age. While no one knows for sure what will increase a woman's chances of getting fibroids, researchers have found that African American women are 2 to 3 times more likely to get them than women of other racial groups are. African American women also tend to get fibroids at a younger age than do other women with fibroids. Women who are overweight or obese also are at a slightly higher risk for fibroids than women who are not overweight. Women who have given birth appear to be at a lower risk for fibroids. Research is now being done to figure out who is at risk for fibroids.

Uterine Fibroids: Diagnosis and Treatment

How do I know for sure that I have fibroids?

Your Minnesota Women's Care provider may find that you have fibroids when you see him for a regular pelvic exam (to check your uterus, ovaries, and vagina). Often, a health care provider will describe how small or large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 8 weeks pregnant.

We can perform imaging tests, or tests that create a "picture" of the inside of your body without surgery, in order to confirm that you have fibroids. These tests might include:

• Ultrasound (which uses sounds waves to produce the picture)
• Magnetic Resonance Imaging (often called MRI) which uses magnets and radio waves to produce the picture
• X-rays (which use a form of radiation to see into the body and produce the picture)
• Cat scan or (CT scan) - which makes many pictures of the body from different angles to provide a more complete image

Besides imaging tests, you also might need a surgery to know for sure if you have fibroids:

• Laparoscopy is surgery with general anesthesia in which your doctor places a small tube with a light inside your abdomen to see any fibroids.
• Hysteroscopy is surgery in which your doctor inserts a long tube with a camera into the vagina and directly into the uterus to see any fibroids. It also shows any growths or problems inside the uterus.

What is the treatment for fibroids?

Talk with our providers about the best way to treat your fibroids. They will consider a number of things before helping you choose a treatment. Some of these things include whether or not you are having symptoms from the fibroids, if you might want to become pregnant, how large the fibroids are, and your age. If you have fibroids, but do not have any symptoms, you may not need any treatment. Your provider will check during your regular exams to see if they have grown.

If you have fibroids and have mild symptoms, we might only suggest pain medication. Over-the-counter anti-inflammatory drugs (like Advil or Motrin) or other painkillers (like Tylenol) can be used for mild pain. If pain becomes worse, a stronger painkiller may be prescribed. Other drugs used to treat fibroids are called "gonadotropin releasing hormone agonists" or GnRHa. These drugs can decrease the size of the fibroids. Sometimes they are used before surgery, to shrink the fibroids, making them easier to remove. Side effects can include hot flushes, depression, not being able to sleep, decreased sex drive, and joint pain. Anti-hormonal agents, such as a drug called mifepristone, also can stop or slow the growth of fibroids. It is important to know that these drugs only offer temporary relief from the symptoms of fibroids; once you stop the therapy, the fibroids often grow back.

If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them.

Myomectomy is a surgery to remove fibroids without taking out the healthy tissue of the uterus. There are many ways this surgery can be performed. It can be major surgery (with an abdominal incision) or minor surgery. The type, size, and location of the fibroids will determine what type of procedure will be done. Talk with us about the different types of surgery. One disadvantage of myomectomies is that fibroids often return in 25 to 30% of cases.

Hysterectomy is a surgery to remove the uterus, and is the only sure way to cure uterine fibroids. This surgery is used when a woman's fibroids are large, or if she has heavy bleeding, and is either near or past menopause and does not want children. There are different types of this surgery that differ in how invasive they are. Sometimes, if the fibroids are large, a woman might need the type of this surgery that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the surgeon might be able to reach the uterus through the vagina, instead of making a cut in the abdomen.

Are there other ways to treat fibroids besides medication and surgery?

Other ways to treat fibroids are being developed, and our physicians might offer them as treatment options to you. But because these methods are not yet "standard" treatment options, your health insurance might not cover them. Cryomyolysis is a treatment in which your doctor shrinks the fibroids by placing a freezing agent on them. Uterine Artery Embolization (UAE) is a treatment that cuts off the blood supply to the uterus and the fibroids so they shrink. Schedule an appointment with a provider at Minnesota Women’s Care to discuss the many options for controlling fibroids.

Additional myomectomy information:

A new category of minimally invasive myomectomy, da Vinci® Myomectomy, combines the best of open and laparoscopic surgery. With the assistance of the da Vinci Surgical System, our surgeons can remove uterine fibroids through small incisions with precision and control. Click here to read more about the da Vinci assisted myomectomy.