Uterine Fibroids

What Are Uterine Fibroids?

Uterine Fibroids, also known as leiomyomata or myomas, are solid tumors arising from the muscle cells of the uterus, and are the most common pelvic tumor women experience. They develop during the reproductive years, typically in the decades of the 30’s and 40’s, although they can occur earlier, particularly in women of African descent.

When we hear the word “tumor”, it is natural to immediately think of cancer. Thankfully, only a very small percentage—less than 1 percent—of fibroid tumors become cancerous. Fibroids can range in size from as small as an apple seed to larger than a grapefruit. It is estimated that 70–85% of women will have developed fibroids by the time they reach menopause, and most will have multiple fibroids rather than just one.

Fibroids are characterized somewhat arbitrarily based on their location:

  1. Intramural: Tumors growing between the muscle fibers within the walls of the uterus
  2. Subserosal: Tumors which arise just beneath the outer lining of the uterus and, as a result, protrude away from the uterine wall as they grow
  3. Submucosal: Fibroids which start under the uterine lining and tend to grow into the uterine cavity
  4. Cervical: Tumors which originate in the cells of the cervix (these are not common)
  5. Parasitic: Fibroids which, as they grow, completely separate from the uterus where they originated, establishing an independent blood supply in the process (rare)

Signs & Symptoms Of Uterine Fibroids

Given how common fibroid tumors are, it is fortunate the majority of them remain asymptomatic. If they do become symptomatic, the symptoms will typically depend on the location of the fibroids. By far, the most common symptom of uterine fibroids is an increase in the heaviness and duration of a woman’s menstrual flow, but other symptoms can also occur:

  • Heavy and/or long-lasting menstrual periods
  • Pelvic pain or pressure
  • Infertility or complications with pregnancy such as miscarriage or preterm delivery
  • Frequent urination
  • Constipation
  • Lower back or leg pain
  • Presence of a lump or mass in the lower abdomen
  • Painful intercourse
  • Spotting between periods

Causes of Uterine Fibroids

Despite years of research, the cause of uterine fibroids remains obscure. The uterus is the only muscular organ in the body that has shown the tendency to produce benign tumors of this type. There are, however, some factors that affect the likelihood of women having or developing fibroids:

  • 40 years of age or older
  • African descent (also increases the risk of developing fibroids earlier in life)
  • Family history of uterine fibroids
  • Nulliparity (women who have never given birth)
  • Early menarche (start of periods)
  • Obesity
  • High consumption of red meat
  • Alcohol consumption (particularly beer)
  • Chronic hypertension

Diagnosis of Uterine Fibroid Tumors

Any woman in her late 20’s or beyond who begins experiencing unusually heavy or prolonged bleeding should be evaluated for fibroids. Fibroid tumors are sometimes suspected during a physical exam when an enlarged or irregularly shaped uterus is felt or perceived.

In terms of imaging…

  • Ultrasound is the most common way to evaluate for the presence of fibroid tumors, and can provide important information regarding size, number and location.
  • MRI is also an excellent way to image the uterus for fibroids, but is less readily available and is a more expensive option.
  • Fibroids are frequently an incidental finding when CT scans are performed of the abdomen and pelvis, but Computed Tomography (CT) is inferior to both ultrasound and MRI for imaging the pelvic organs.

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Options For Uterine Fibroids Treatment

Most fibroids will never require treatment and the mere presence of fibroid tumors is not an indication for removal. Moreover, if they do not cause problems prior to menopause, it is unlikely they will become symptomatic later in life as, once deprived of the ovarian hormone production, they tend to shrink and become dormant. Nevertheless, because they are a common tumor, some uterine fibroids will cause symptoms that require treatment.

Medications

There are two situations in which hormonal therapy may play a role. First, it can be used to try to control bleeding which is excessive and prolonged. Second, under certain circumstances, medications can be prescribed to temporarily reduce the bleeding and size of uterine fibroids long enough to allow anemia to be corrected or to make surgery less difficult. However, because fibroids are solid tumors, surgical management is the cornerstone of treatment.

Myomectomy (Surgical Removal of Uterine Fibroids)

A myomectomy is a surgical procedure to remove the fibroids. This option is normally recommended by doctors for women who wish to preserve the ability to become pregnant as the uterus is not removed. Depending on the location, number, and size of the tumors, a myomectomy can be done either through an incision on the abdominal wall, via laparoscopy, or by using a small camera inserted into the uterus through the cervix (hysteroscopy).

Hysterectomy (Surgical Remove of Uterus)

A hysterectomy is a surgical procedure to remove the uterus along with the fibroids.

The best uterine fibroid treatment for you will depend on several factors but it’s best that you discuss any of these options with your doctor first, so that an individualized plan can be designed that meets your specific needs.

At Associates in Women’s Health in Gillette, WY, Dr. Jones and his team are experts in the evaluation and management of fibroids, and will work with you to make sure you have all of the knowledge you need to make an informed decision about treatment.