Lesli complained to her gynecologist that her lower back hurt. She was told that she had probably lifted something incorrectly. She sought a second opinion and an
examination .Ovarian cysts,
endometrial tissue, and
were discovered around Lesli's ovaries and were removed by
laparoscopy. Over 10 years later, Lesli began experiencing problems again. This time, the culprit was a tennis ball-sized fibroid above her uterus.
are benign tumors composed of smooth muscle cells wrapped in a fibrous covering. They are found in the wall of the uterus and sometimes on the cervix. They are also known as myomas, leiomyomas, or fibromyomas.
Fibroids are more common in women in their 30s and 40s. Other risk factors for fibroids include family history, ethnicity (African-American women are more likely to have fibroids than Caucasian women), and
In many women, fibroids go unnoticed and do not produce symptoms. In others, symptoms may include: Heavy and prolonged menstrual cyclesBackachePelvic pain
Urinary frequency and/or
incontinenceA sensation of pelvic heavinessPain with sexual intercourse
In some cases, fibroids have been associated with
Fibroids can form inside or outside the uterus, or within the uterine wall. They can grow larger than a grapefruit or remain as tiny as a pea. It is possible to have more than 1 fibroid, and have them in different sizes.
Although an exact cause is not known, it appears that estrogen affects the growth of fibroids. Many fibroids are discovered during pregnancy because they tend to become larger as pregnancy causes an increase in estrogen. Conversely, as estrogen production tapers off during
menopause, fibroids may shrink or even disappear.
Fibroids are often discovered during a gynecologic exam. An ultrasound,
, or sonohysterography may be used to confirm the diagnosis. If the fibroid is large enough, you may be able to feel it yourself by placing your hand on top of it.
If you are found to have fibroids, you will probably be monitored for a period of time to determine their growth rate. If they are not especially large or problematic and are not suspected as a cause of infertility, continued monitoring may be the right treatment for you.
There are a number of treatment options available, including medications and surgical procedures. Again, small fibroids may just be monitored, rather than treated.
There are several medications that treat symptoms of fibroids, while there are others that can be used to shrink the fibroids. Medication options include: Nonsteroidal anti-inflammatory drugs (NSAIDs)
help reduce pain and cramping associated with menstrual periods.
Oral and intrauterine
help control abnormal bleeding and also help reduce pain and cramping associated with menstrual periods .
Aromatase inhibitors (AIs)
are used to shrink fibroids. AIs can be used in conjunction with other treatments.
Gonadotropin-releasing hormone (GnRH) agonists
are used to shrink fibroids. However, fibroids can recur within several months after the GnRH drugs are stopped. Sometimes these medications are used to shrink fibroids prior to surgery so that the procedure is less complicated.
If drug therapies prove unsuccessful, surgery is an alternative. Individual fibroids can be removed using a procedure called
myomectomy, which removes the fibroids, but retains the uterus. There are 3 approaches to this particular surgery:
Laparotomy—Incisions are made in the abdomen, and the fibroids are removed.Laparoscopy—Small tools and a laparoscope are inserted through small abdominal incisions. Fibroids are surgically removed through the laparoscope or destroyed by a laser or electric current.
Hysteroscopy—A hysteroscope is inserted through the cervix and into the uterine cavity. Fibroids inside the uterus are located through the hysteroscope and can be removed with a wire loop device or a laser.
Myomectomy does have risks, and some women have fibroids even after surgery.
In severe cases, a
may be advised, which involves removing the uterus.
Less invasive procedures are available, though, such as: Endometrial ablation—The lining of the uterus is destroyed which can remove small fibriods found in the uterus.Uterine fibroid embolization—The blood supply to the fibroid is cut off, which causes the fibroid to shrink.Magnetic resonance imaging–guided ultrasound surgery—Sound waves are used to destroy the fibroid tissue.
Your doctor will consider a number of factors, such as your age, overall health, and fibroid symptoms before recommending a treatment approach. Get as much information as you can about fibroids and do not be afraid to ask your doctor questions. It is your responsibility to learn more about your condition and explore your options.
Christiansen JK. The facts about fibroids: presentation and latest management options.
Committee on practice bulletins—gynecology.
Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women.
Obstet Gynecol. 2012;120(1):197-206.
Fibroids: symptoms and treatment.
National Women's Health Report.
Hutchins FL. Uterine fibroids: diagnosis and indications for treatment.
Obstetrics and Gynecology Clinics of North America.
Uterine fibroids. The American Congress of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20130912T1222293657. Updated May 2011. Accessed July 6, 2015.
Uterine fibroids fact sheet. US Office on Women's Health website. Available at:
http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html. Updated January 15, 2015. Accessed July 6, 2015.
Uterine leiomyoma. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated April 24, 2015. Accessed July 6, 2015.
Last reviewed June 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.