Uterine Fibroids

According to the National Cancer Institute (NCI), a fibroid is a benign (or noncancerous) tumor. Fibroids very rarely spread to other parts of the abdomen. They also rarely turn into cancer (less than 0.1 percent of cases), according to the National Women's Health Information Center (NWHIC). (Read about "Uterine Cancer")

Uterine fibroids are basically spherical nodules of smooth muscle cells and fibrous connective tissue. They can range in size from 1 mm to more than several inches in diameter. They can exist alone or in groups. And they are fairly common. According to the American Academy of Family Physicians (AAFP), between 20 and 40 percent of women older than 35 years or age have fibroids. The National Institute of Child Health and Human Development (NICHD) says fibroids are also diagnosed in African American (Read about "Minority Health") women two to three times more frequently than in white women.

According to NICHD, for most women, fibroids do not pose a problem and do not require treatment other than regular observation by a physician. In fact, a woman may be unaware she even has fibroids, until they are discovered during routine gynecologic examination or during prenatal care. (Read about "Prenatal Care")

However, NICHD says some women who have uterine fibroids may experience symptoms such as:

• excessive or painful bleeding during menstruation (Read about "Menstrual Disorders")
• bleeding between periods
• a feeling of fullness or enlargement in the lower abdomen
• frequent urination resulting from a fibroid that compresses the bladder (Read about "The Urinary System")
• pain during sexual intercourse
• low back pain

These symptoms can also indicate a number of other conditions. For example, excessive bleeding can be a sign of endometriosis or cancer of the uterus. (Read about "Endometriosis" "Uterine Cancer") Frequent urination, fullness and pain can indicate a urinary tract infection. (Read about "Urinary Tract Infections") Because of this, any women experiencing unusual symptoms should see her doctor or healthcare provider at once.

In addition, NICHD says reproductive issues such as infertility (Read about "Infertility"), miscarriage and early onset of labor during pregnancy, resulting in premature births, have been attributed to fibroids. Many women with fibroids have successful pregnancies, with no increased incidence of miscarriage or other problems. (Read about "Healthy Pregnancy")

Treatment

When fibroids are causing problems or symptoms, there are several options. The National Women's Health Resource Center says fibroids are the number-one reason for hysterectomies. A hysterectomy is the removal of the uterus. (Read about "Hysterectomy") As a result, a woman will no longer menstruate and she can no longer have children. A hysterectomy is also major surgery, although there are less-invasive options including vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH) and robotic hysterectomy. (Read about "Robotic Surgery") Laparoscopic (Read about "Endoscopy") supracervical hysterectomy (LSH) is a more recent option. This procedure removes only the uterus and leaves the cervix in place. The recovery time is shorter, but a woman will still need to continue Pap tests to be sure that cervical cancer does not develop. (Read about "Cervical Cancer") Because of its seriousness, hysterectomy is usually considered the best option when bleeding or pain resulting from fibroids is severe, or if the fibroid or fibroids are growing rapidly or are infected.

There are options besides hysterectomy when fibroids are causing symptoms. According to the Agency for Healthcare Research and Quality (AHRQ), non-surgical options include gonadotropin releasing hormone (GnRH) which can cause fibroids to shrink, at least temporarily. This may be used to make surgery easier by reducing the size of the fibroids, according to AHRQ.

A surgical alternative to hysterectomy, involves removal of only the fibroids, leaving the uterus intact, in what's called myomectomy. There are many ways a surgeon can perform this procedure. It can be major surgery (with an abdominal incision) or a less invasive procedure. The type, size and location of the fibroids will determine what type of procedure can be done. Some women may be eligible for a laparoscopic myomectomy, which minimizes the size of the abdominal incision. The American College of Obstetricians and Gynecologists (ACOG) says fibroids, located inside the uterine canal, may also be removed through the cervix via the vagina, using what's called a hysteroscope. Another option is laser surgery, also using a hysteroscope, which usually is an outpatient procedure. With laser surgery, the doctor uses a high-intensity light to remove small fibroids. Robotic surgery is also now being used on fibroids. (Read about "Robotic Surgery")

In addition, in cases where fibroids are causing problems, another procedure that's being used is uterine fibroid embolization (UFE). It is also called uterine artery embolization (UAE). With UFE, small particles, about the size of a grain of sand, are placed into the blood vessels that supply the fibroid(s). The American Academy of Family Physicians (AAFP) says this procedure cuts off the flow of blood to the fibroid, causing it to shrink over time.

Hospitalization time after this procedure is shorter than for hysterectomy and so is recovery time. Many women can have UFE and go home the same day. Hysterectomy and abdominal myomectomy can involve a recuperation period of one to two months or more. The National Women's Health Information Center (NWHIC) says recent studies suggest that most fibroid tumors are not likely to re-grow after UFE, although more long-term data is needed.

UFE can have side effects, some of them serious. There is a small risk of infection in the treated fibroid, but that is usually managed with antibiotics. (Read about "Antibiotics") NWHIC says sometimes after UFE, the particles that are put into the fibroids to cut off their blood supply may travel to the ovaries. In a few women, the ovaries then stop working for a short time or permanently. This can cause a woman to go into sudden menopause. (Read about "Menopause") If a women still wants to have children, she should discuss this issue with her healthcare provider prior to undergoing UFE.

According to NWHIC, there is also a medical device that uses magnetic resonance image (MRI) guided and focused ultrasound to target and destroy uterine fibroids. (Read about "MRI - Magnetic Resonance Imaging" "Ultrasound Imaging") The device is intended to treat women who have completed child bearing or do not intend to become pregnant. It is non-invasive surgery. It spares the uterus and is an alternative. The procedure combines two systems. First, a magnetic resonance imaging (MRI) machine is used to visualize the patient's anatomy and make a map of the fibroid tissue to be treated. It then monitors the temperature of the uterine tissue after heating. A focused ultrasound beam heats and destroys the fibroid tissue using high frequency, high-energy sound waves. The treatment requires repeated targeting and heating of fibroid tissue while the patient lies inside the MRI machine. The procedure can last as long as three hours. The device can be used to treat some - but not all - fibroids, according to NWHIC. Fibroids close to sensitive organs such as the bowel or bladder and those outside the image area cannot be treated.

It is important to remember that every woman's needs are different; therefore, women should always carefully discuss all options with their doctors or healthcare providers.

Finally, it's possible that a woman's fibroids may not require any treatment, for example, if symptoms are either non-existent or can be managed with over-the-counter painkillers. In addition, at menopause, fibroids are likely to become smaller and sometimes disappear entirely on their own. Again, however, every woman's case is different, so make sure you discuss all options with your physician.

Related Information:

    Menopause

    Learn About Your Procedure

    At the Hospital: For Patients

    Anesthesia

    Genital Health - Female

    Woman's Health Terms Glossary