Are You at Risk for Uterine Fibroids?

by Linda Bradley, MD

Uterine Fibroids

Uterine fibroids are benign tumors that are made up of the muscle and connective tissue from the wall of the uterus (womb). Fibroids may grow as a single nodule or in clusters and may range in size from 1 mm to more than 20 cm (8 inches) in diameter. They may grow within the wall of the uterus or they may project into the interior cavity or toward the outer surface of the uterus. In rare cases, they may grow on stems projecting from the surface of the uterus.

What causes uterine fibroids?

The causes of fibroids are not known. Most fibroids occur in women of reproductive age, and according to some estimates, they are diagnosed in black women 2-3 times more frequently than in white women. They seldom are seen in young women who have not begun to menstruate, and the symptoms of uterine fibroids usually stabilize or go away in women after menopause.

According to the U.S. National Institutes of Health (NIH), at least 25-80 percent of women suffer from uterine fibroids.

Are fibroids cancer?

Fibroids are not associated with cancer. They are benign tumors that almost and rarely develop into cancer. Patients who have rapid growth of uterine fibroids or if their fibroids grow during menopause, should be evaluated immediately.

Who is at risk for uterine fibroids?

Risk factors have been found for uterine fibroids, including:

• obesity (A person is considered obese if he or she is more than 20% over his or her ideal body weight.)
• family history
• not having children
• early onset of menstruation
• late age for menopause

What are the symptoms of uterine fibroids?

Most fibroids do not cause any symptoms and do not require treatment other than regular observation by a doctor. Fibroids may be discovered during routine gynecologic examinations or during prenatal care. Some women who have uterine fibroids may experience the following symptoms:

• Excessive or painful bleeding during menstruation
• Bleeding between periods
• A feeling of fullness in the lower abdomen
• Frequent urination resulting from a fibroid that compresses the bladder
• Pain during sexual intercourse
• Low back pain
• Constipation
• Chronic vaginal discharge
• Inability to urinate
• Severe menstrual cramps
• Infertility

How are uterine fibroids treated?

More and more, doctors are beginning to realize that uterine fibroids may not require any intervention or, at most, limited treatment. For a woman with uterine fibroids that are not causing symptoms, the best therapy may be watchful waiting. Periodic pelvic examination and ultrasound may be recommended by your physician, depending on size or symptoms Some women never exhibit any symptoms nor have any problems associated with fibroids, in which case no treatment is necessary.

If a woman is experiencing anemia caused by heavy, prolonged menstrual bleeding, moderate to severe pain, infertility or urinary tract or bowel problems, then she will require therapy. The type of treatment offered is determined by the number, size, location and symptoms related to fibroids. Additionally, the desire for fertility will also determine whether certain options are feasible. Treatment options include:

Medications

For women who experience occasional pelvic pain or discomfort, a mild, over-the counter anti-inflammatory or pain-killing drug such as Naproxen or ibuprofen often will be effective. More bothersome cases may require stronger drugs available by prescription. Additionally, these medications may also decrease the amount of menstrual bleeding, clotting, and gushing of blood that some women experience.

Some fibroids are treated with hormones that reduce the amounts of the hormone estrogen. Doctors believe that fibroids grow best when there are high levels of the female hormone estrogen.

Birth control pills can be used to treat the bleeding symptoms and menstrual cramps caused by uterine fibroids because they decrease the production of female hormones and prevent ovulation. Birth control pills (oral contraceptives) do not reduce the size of uterine fibroids but often help to regulate menses, decrease the quantity of bleeding and cramps. Rarely, do oral contraceptives contribute to the growth of fibroids.

Surgery

Fortunately a woman now has a number of surgical and less-invasive options for treatment of uterine fibroids that can control symptoms, preserve the uterus, and preserve fertility. In the past, a woman with growing uterine fibroids was only considered a candidate for hysterectomy (the surgical removal of the uterus). Performing a hysterectomy in a woman of reproductive age means that she will no longer be able to have children and will not have a menstrual cycle. Today, many women and their doctors are considering other minimally invasive treatment options, which may eliminate symptoms.

If a fibroid is particularly troublesome, the surgeon often can remove only the tumor, leaving the uterus intact. This procedure is called myomectomy. This is done when a woman wants to be able to have children or wishes to retain her uterus as a personal choice.

There are a number of techniques that can be used to perform a myomectomy which are determined by the size, number, location, and physician surgical expertise. These include:

• Laparoscopic myomectomy or robotic myomectomy - involves the use of a thin, telescope-like instrument attached to a small video camera called a laparoscope inserted through a tiny incision at the belly button. The surgeon uses specialized surgical instruments inserted through this incision and two or three additional small incisions in the abdomen to remove the fibroids.
• Hysteroscopic myomectomy - a procedure in which some fibroids are removed through the vagina using a surgical instrument called a hysteroscope (a thin, telescope-like instrument inserted through the cervix and into the uterus). This technique can be employed when the fibroid is within the uterine cavity. Laparotomy involves an abdominal incision to remove all fibroids, no matter the size or location of the tumors.

Fibroid embolization

This treatment works by decreasing the blood supply to the fibroids, causing them to shrink. This is a minimally invasive procedure performed by an interventional radiologist. Patients are typically able to return home the day after the procedure. This is not offered to women who want children.

For more information, visit Cleveland Clinic’s Center for Specialized Women’s Health.