Fibroids are benign tumors in the uterus. Although fibroids are common and aren't always a cause for concern, large fibroids or fibroids that are located in certain areas in the uterus can become problematic.
While some women are not bothered by their fibroids, the location and size of fibroid tumors can cause symptoms that can affect a woman’s quality of life, including impacting fertility. However, there are treatment options that can help. The physicians at The University of Kansas Health System specialize in diagnosing and treating uterine fibroids with the most advanced and least invasive treatment options.
What are uterine fibroids?
Uterine fibroids are benign (noncancerous) tumors that grow on or within the muscle tissue of the uterus. It is common for a woman to have multiple fibroid tumors, and different types of fibroids can cause different symptoms.
Growth patterns of uterine fibroids can vary. They can grow slowly or rapidly, or they can remain the same size. Some fibroids will go through growth spurts, and some could shrink on their own. During pregnancy, many fibroids that have been present may shrink or disappear afterwards as the uterus goes back to a normal size.
Because fibroid tumors can be small and spread out within the uterus, there are usually more fibroids present than can be detected. Even a woman who has only 1 visible fibroid should consider that there may be multiple uterine fibroids present when discussing treatment options.
It’s unclear exactly what causes fibroid tumors to develop. Each woman may have a very different experience with fibroids – the tumors can grow at a different pace, the number of fibroid tumors can vary, and the location of the fibroids can be different from person to person.
Types of uterine fibroids
There are different types of fibroids and the size can range from very small (walnut size) to as large as a cantaloupe or even larger. The location of the uterine fibroid can affect the symptoms felt and how they're treated.
There are 4 primary types of fibroids.
Intramural fibroids typically develop within the uterine wall and expand from there. These types of uterine fibroids are the most common. As these fibroids grow, they can cause excessive menstrual bleeding and pelvic pain. This happens from the additional pressure placed on surrounding organs by the growth of the fibroids, which consequently can cause frequent urination and pressure.
Pedunculated uterine fibroids occur when a fibroid tumor grows on a stalk. Symptoms associated with pedunculated fibroid tumors include pain and pressure as the fibroids can sometimes twist on the stalk.
Submucosal fibroids are the least common of the various types of fibroid tumors. These fibroids develop just under the lining of the uterine cavity. Large submucosal fibroid tumors may increase the size of the uterus cavity and can block the fallopian tubes, which can cause complications with fertility.
Subserosal fibroids typically develop on the outer uterine wall and can continue to grow outward, increasing in size. The growth of a subserosal fibroid tumor will put additional pressure on the surrounding organs, so symptoms of subserosal fibroid tumors usually cause pelvic pain and pressure.
Uterine fibroid symptoms and risks
Symptoms of uterine fibroids can depend on the location, size and number of fibroids. Some of the most common symptoms of uterine fibroids include heavy, excessive menstrual bleeding, pelvic pain and pressure, and urinary incontinence and frequency. Fibroids are hormonally sensitive, so symptoms are frequently cyclical like menstruation.
Several different factors can influence the development of uterine fibroids:
- Age: Most women who have fibroids are diagnosed between the ages of 35 and 55, but women can experience symptoms from fibroids before the age of 35.
- Family history: Developing fibroids is genetic, so you’re at an increased risk if fibroids run in your family, especially if your mother or sister had fibroids.
- Lifestyle and environmental factors: Having a balanced diet, limiting alcohol consumption and maintaining a healthy weight have all shown to reduce the risk of developing fibroids.
- Race: Not only are African American women more likely to develop fibroids, but they also tend to develop fibroids at a younger age and have larger, more symptomatic fibroids.
Uterine fibroid diagnosis and screening
Uterine fibroids can often be found during a routine well-woman checkup and pelvic exam because fibroids can cause irregularities in the shape of the uterus. Your doctor will also take a full medical history and have you describe any symptoms. To confirm the presence of fibroids, your doctor may recommend an ultrasound, MRI or other imaging tests.
Uterine fibroid treatment
Fibroids that don’t cause symptoms may not require any treatment other than watchful waiting. Many women use over-the-counter pain medications to manage the painful symptoms of uterine fibroids.
Other possible fibroid treatment options include:
Endometrial ablation is a procedure that destroys the endometrium (uterine lining) with the goal of reducing menstrual flow. In some women, menstrual flow may stop completely. Women with fibroids should only consider endometrial ablation as a treatment option if they have small (less than 1 inch in diameter) submucosal fibroids.
Hormone-based medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids but may shrink them. In almost all cases, once hormone therapy has been stopped, fibroids tend to grow back, possibly reaching their original size again.
Hysterectomy is a surgery that removes the uterus and all fibroids. The ovaries are typically retained, preventing menopause and associated symptoms. This method is the most definitive management of fibroids.
MRGFUS uses high intensity focused ultrasound waves to heat an area of the fibroid, causing cell death. Pulses of ultrasound energy are repeatedly applied to treat the fibroid.
Myomectomy is a surgical procedure that removes just the uterine fibroids and repairs the uterus so that future pregnancy is possible. In expert hands, many of these procedures can be done through small, bandage-sized incisions.
Uterine fibroid embolization (UFE) can permanently shrink fibroids by 30-50%. UFE is performed by interventional radiologists to selectively cut off the major blood supply to the fibroids, causing cell death. The entire treatment requires only a small incision, typically lasts less than an hour and is performed as an outpatient therapy.