Uterine Fibroids: Test Your Medical IQ

Fibroids (also called leiomyomas or myomas) are a type of muscular tumors that grows within the uterus (womb), in the uterine wall, or on the outside surface of the uterus. Women may develop a single uterine fibroid, or there may be many. Fibroids can vary widely in size and can be so small they are invisible to the naked eye or even as large as a grapefruit or bigger.

Some women are at higher risk for developing uterine fibroids, including:

• Women in their 30s and 40s. Fibroids usually shrink after menopause.
• Women with a family history of fibroids. If a woman's mother has fibroids, she is at 3 times higher risk than average of getting fibroids.
• African-American women
• Obese women have a 2-3 times greater than average risk
• Women who eat a lot of red meat and ham.

The cause of uterine fibroids is unknown, but it is believed to be influenced by hormones and/or genetics. Both estrogen and progesterone can affect the growth of fibroids; they grow when hormone levels are high, such as during pregnancy, and shrink during menopause or when anti-hormone medications are used.

Fibroids often do not cause any symptoms, however, when symptoms occur, they may include:

• Heavy bleeding
• Painful menstrual periods
• Bleeding between periods (spotting)
• Enlarged lower abdomen
• Feeling of fullness, pressure, or pain in the pelvic area/lower abdomen
• Frequent urination
• Pain during sex
• Lower back pain
• Constipation

If fibroids are suspected, a doctor will usually start with a history asking about your symptoms. They can often feel fibroids during a pelvic exam. Imaging tests may also be ordered to check for the presence of fibroids, including:

• Ultrasound
• Magnetic resonance imaging (MRI)
• Cat scan (CT)
• Hysterosalpingogram (HSG) or sonohysterogram

• Laparoscopy – a long, thin scope with a light and camera is inserted into a tiny incision made in or near the navel which allows the doctor to view the uterus and other organs
• Hysteroscopy – a long, thin scope with a light and sometimes a camera is inserted through the vagina and cervix into the uterus so the doctor can look inside the uterus for fibroids and other problems, such as polyps.

Fibroids often do not cause symptoms and many women do not need treatment. For women whose symptoms are more severe, medications may be used to control symptoms, such as:

• Over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) to treat pain
• Iron supplements if you have heavy bleeding to prevent or treat anemia
• Low-dose birth control pills, and progesterone-like injections (e.g., Depo-Provera), an IUD (intrauterine device) called Mirena and can help control heavy bleeding
• "Gonadotropin releasing hormone agonists" (GnRHa) such as Lupron can be used to help shrink fibroids

In some cases when symptoms are severe or do not respond to treatment, surgery may be recommended to treat uterine fibroids. Surgical options include:

• Myomectomy - removes fibroids and leaves healthy tissue intact
• Hysterectomy - removal of the uterus
• Endometrial ablation - removes the lining of the uterus to control heavy bleeding
• Myolysis - uses electric current or freezing to destroy the fibroids
• Uterine fibroid embolization (UFE), or uterine artery embolization (UAE) - used to block the blood supply to the fibroids, causing them to shrink

While most women with fibroids have normal pregnancies, fibroids can predispose a woman to complications with pregnancy and delivery. Common problems in pregnant women with fibroids include:

• C-section risk is much greater for women with fibroids
• Miscarriage
• Baby is breech
• Slowed labor
• Placental abruption
• Preterm delivery

Most fibroids are benign (not cancerous). In rare cases (less than one in 1,000) a cancerous fibroid called leiomyosarcoma will develop however, it is believed these cancers do not occur from an already-existing fibroid. Having fibroids does not increase a woman's risk for developing a cancerous fibroid or other forms of uterine cancer.