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 ultrasound examination. Fibroids were discovered in Lesli's uterus 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.
A Fibroid is Considered a Benign Tumor
Fibroids 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 obesity.
In many women, fibroids go unnoticed and do not produce symptoms. In others, symptoms may include:
- Heavy and prolonged menstrual cycles
- Pelvic pain
- Urinary frequency and/or incontinence
- A sensation of pelvic heaviness
- Pain with sexual intercourse
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 one 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, MRI scan, 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 contraceptive steroids 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 hysterectomy 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.
What Is Right for You?
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.
- Reviewer: Michael Woods, MD, FAAP
- Review Date: 05/2017 -
- Update Date: 05/03/2017 -