Uterine Fibroids (Q & A)

Uterine Fibroids (Q & A)

What are uterine fibroids?
Uterine fibroids are benign growth of the uterus (womb) and they are called leiomyomas or myomas in medical terms. A woman can have one or many fibroids and they can vary in size. Fibroids develop from the same muscle tissue as the uterine wall. They can be found inside the uterus, outside the uterus, attached to the outer surface of the uterus or within the uterine wall. They have different names based on their locations and they are usually round shape. Uterine fibroids may either get bigger or smaller with time.

Are uterine fibroids cancerous?
No, uterine fibroids are benign so they are non-cancerous.

How common are uterine fibroids?
Uterine fibroids are very common. Approximately 75 to 80 percent of women have uterine fibroids at some point in their lives and many of them do not have any symptoms.

What age group is more likely to have fibroids?
Uterine fibroids can occur at any age but it is more common among women who are in their 30s and 40s. It seems to be rare among teenagers.

Are there any risk factors for uterine fibroids?
Uterine fibroids tend to run in the families. If your mother or sister has uterine fibroids, you may be at higher risk for developing fibroids. Uterine fibroids are more common among African American women for unknown reason. They tend to have fibroids at younger ages. On the other hand, childbirth and taking oral contraceptive (birth control pills) may decrease your risk of developing uterine fibroids.

What causes uterine fibroids?
Researchers do not know the exact causes of uterine fibroids. Female hormones called estrogen and progesterone appear to be associated with fibroids. Since estrogen and progesterone stimulate the growth of uterine lining to prepare for pregnancy during the monthly cycle, it also promotes the growth of uterine fibroids.

In early pregnancy, fibroids may grow in size due to increased estrogen but it shrinks after childbirth. In addition, uterine fibroids tend to shrink after menopause when estrogen and progesterone are decreased significantly.

What are the symptoms of uterine fibroids?
Many women with uterine fibroids do not have any symptoms. Common symptoms include heavy or prolonged menstrual period and spotting between periods. Too much blood loss during menstruation can cause iron deficiency anemia where you have low blood count and most common symptom is fatigue. Furthermore, you may experience pain or pressure in your lower belly. The pain can be either sharp or dull and you may have pain during sexual intercourse.

If the fibroid is large, it can obstruct nearby structures. For instance, if it is pressing on the bladder, you may experience frequent urination or difficulty urinating. If it presses on the rectum, you will have constipation or difficulty with bowel movement. Some women experience cramps and enlarged uterus. Depending on the location of the fibroids, you may have difficulty getting pregnant. Fibroids can cause miscarriage but it is not common.

Pain the lower belly could be from uterine fibroids.

How are uterine fibroids diagnosed?
Uterine fibroids are often found during a pelvic exam when a woman has no symptoms. Your doctor will notice the irregular shape of the uterus. Pelvic ultrasound is used to confirm the diagnosis. Ultrasound uses sound waves to take pictures of the uterus and the surrounding organs. The probe can be placed on the belly or inside the vagina (transvaginal ultrasound).

Other imaging tests are available but they are often not necessary. Pelvic CT or MRI is hardly used to diagnose uterine fibroids. If a doctor wants to see the fibroids inside the uterus, he or she can use hysteroscopy in an office setting. It is a small device inserted through the vagina. Sonohysterography is a procedure in which fluid is put into the uterus before the ultrasound exam to get better images of the uterine lining. Hysterosalpinography is a procedure that allows doctors to see both uterus and fallopian tubes (uterine tubes).

Does everyone need treatments for uterine fibroids?
No. However, it depends on many factors such as symptoms, age, fertility, size and location. If you are premenopausal, fibroids tend to shrink after menopause. Without any symptoms, treatment may not be necessary.

Treatment is required when it interferes with getting pregnant. Some fibroids grow very slowly or not at all then, treatment is not required. In that case, your doctor will monitor it with pelvic exam and ultrasound periodically.

What are medical treatments for uterine fibroids?
There are several medications available to treat uterine fibroids and those include birth control pills, long-term birth control methods, NSAIDs, GnRH agonists, iron supplement and other medicines.

How do birth control pills affect fibroids?
Oral contraceptive or birth control pills help regulate period so they reduce symptoms such as heavy period and menstrual cramps. However, they do not shrink uterine fibroids. You can get the same benefit from skin patch and vaginal ring. It may take a few months before you see any changes in your period.

What are long-term birth control methods?
Intrauterine device or IUD is a long-term method of birth control and it releases hormone called progestin. The doctor will place it inside the uterus. Even though it has no effect on the fibroids directly, it can reduce heavy period up to five years. Another option for long-term birth control is depo-Provera shot every three months and it also contains progestin hormone. These are good options for women who do not plan to start a family in the near future.

Do I need iron supplement?
If your period is heavy, taking iron supplement may help lower the risk of anemia.

What other medicines can I take for menstrual cramps?
NSAIDs or nonsteroidal anti-inflammatory drugs are recommended for cramps and pain but they do not reduce heavy bleeding. You can obtain over-the-counter ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn) for pain relief.

What medication can reduce the size of fibroids?
Gonadotropin-releasing hormone (GnRH) agonists and androgen (Danazol) are medicines that can reduce the size of fibroids. GnRH agonist is often given three to six months before the surgery to shrink the fibroids. Androgen is a steroid hormone and less commonly used due to its side effects such as weight gain, unwanted hair growth, acne, reduced breast size, mood swing and depression.

How do GnRH agonists work?
GnRH agonists work by decreasing estrogen and progesterone which are made by the ovaries. Without these hormones, fibroids shrink. However, it also stops your period so put you in menopause temporarily. You may experience menopausal symptoms such as hot flashes, vaginal dryness and sleep problem. It is not used for long-term because of high risk for osteoporosis (thinning of the bones).

What types of surgery are available to treat fibroids?
Surgery options are often discussed after medical treatment fails or shows very little improvement. Hysterectomy and myomectomy are surgical procedures for treating fibroids. If you do not want to have any more children, hysterectomy will be an option for you. The surgeon will remove your entire uterus and it is an invasive procedure. You may leave the ovaries so you do not go into menopause.

Myomectomy is a procedure where the doctor only removes the fibroids, leaving your uterus in place. There is a chance that fibroids may come back in the future and you may need treatment again. It is an option for women who still want to have children.
There are different ways to do myomectomy and it depends on the size and location of the fibroids. For larger fibroids, abdominal myomectomy is required. The doctor will make an incision in the lower belly to remove the fibroids. Smaller and fewer fibroids can be removed by laparoscopic myomectomy where only very small incisions are made in your belly to insert the camera and tools. If the fibroids are completely inside the uterus, the doctor can perform hysteroscopic myomectomy. The doctor will remove the fibroids through vagina and cervix.

Are there any less invasive procedures beside surgery to treat fibroids?
Yes, there are a few less invasive procedures to treat fibroids. They include endometrial ablation, uterine artery embolization (UAE), magnetic resonance guided focused ultrasound and others.

What is endometrial ablation?
Endometrial ablation destroys the lining of the uterus by heat or electric current. It can only be used for fibroids inside the uterus and it is done to reduce heavy period. In some women, endometrial ablation may stop the period. Pregnancy is not recommended after endometrial ablation, therefore; you will need some forms of birth control after the procedure.

What is uterine artery embolization (UAE)?
Uterine artery embolization (UAE) is a procedure that cuts off the blood supply to the fibroids by injecting tiny particles into the blood vessels leading to the uterus. Without adequate blood supply, fibroids shrink within weeks or months. Pregnancy is not recommended after the procedure so you will need some forms of birth control afterward.

What is magnetic resonance guided focused ultrasound?
This procedure uses multiple ultrasound waves to directly destroy the fibroids through the skin and it is guided by MRI machine. Again, pregnancy is not recommended after the procedure.

Are there any complications with uterine fibroids?
Pain, discomfort and anemia from heavy period are common complications from fibroids. If the fibroid is outside the uterus and attached to it by a stem, it can get twisted. When it happens, you may have sharp pain in the lower belly and nausea.
Fibroids usually do not interfere with pregnancy and may not require treatment. Some fibroids depending on the location may require removal because it may block the uterine tube in order for conception to occur or prevent implantation of the embryo in the uterus.

Contributed by Patricia Hsiao M.D.