If you have a uterus, there is a good chance that at some point in your life, you’ll have uterine fibroids. Also known as leiomyomas, fibroids are typically benign smooth muscle tumors that commonly grow in and around the uterus during a woman’s childbearing years. Fibroids don’t usually require treatment, but treatment may be advised if they cause severe discomfort or fertility issues. Here are seven things you should know if you have (or think you might have) uterine fibroids.
Uterine fibroids are very common.
Experts estimate that 30% of women develop fibroids by age 35, and nearly 80% will have them by age 50.
2. Fibroids come in different sizes, shapes, and locations.
Leiomyomas can be so tiny that they can’t be seen with the unaided eye or so large that they can make a woman appear pregnant. Most, however, are a few centimeters to a few inches in diameter. The tumors can grow inside the uterus, on its surface, within the uterine wall, or they can be attached to the uterus by a stem-like structure. They can grow alone or in clusters.
3. Some women are more likely than others to develop fibroids.
Leiomyomas commonly appear when women are in their 30s or 40s and recede after menopause, but they can occur at any time. There are a few other factors that can also affect a woman’s chances of developing fibroid tumors:
- Having a mother or sister with fibroids
- Early onset of menstruation
- Overweight or obesity
- High consumption of red meat
- Low intake of fruit, vegetables, and dairy
- African ancestry
- Alcohol consumption
- Vitamin D deficiency
4. Some women with fibroids have no symptoms; others have severe symptoms.
While only about 1 in 5 women who have fibroids experience symptoms, those who do often suffer from excessive bleeding, intense cramping, constipation, and urinary tract problems. Not only is this uncomfortable, but heavy menstrual bleeding can also lead to anemia. Seeking treatment for fibroids before symptoms become severe can allow for a broader range of treatment options and quicker relief.
5. Fibroids could complicate pregnancy.
Most women with fibroids can successfully complete a pregnancy with no adverse consequences. However, research suggests that in 10% to 30% of cases, the presence of uterine fibroids causes complications. These can include miscarriage, bleeding during early pregnancy, preterm labor, and placental issues. Fibroids can also complicate labor and delivery, resulting in a higher rate of breech births and cesarean deliveries.
6. Fibroids do not elevate your risk of developing cancer.
Cancerous fibroid tumors, called leiomyosacromas, are rare, occurring in just 1 in 1,000 cases. There is currently no evidence that having benign fibroids raises the risk of developing a leiomyosarcoma or any other cancer of the uterus.
7. A range of treatment options are available for uterine fibroids.
Whether and what type of treatment is advised will depend on your symptoms, the size of the tumors, your age, and other factors. Be sure to discuss any course of treatment you’re considering with your doctor, who can share the most up-to-date information about available therapies and their potential outcomes. Below are some of the most common treatment recommendations:
Watch & Wait
Fibroids often shrink after menopause, and symptoms may subside. If you’re approaching menopause and your symptoms aren’t severe, your doctor may advise waiting to see if your condition gets better rather than worse. Likewise, watchful waiting may be advised if fibroids show up on an imaging test but aren’t causing problematic symptoms.
For some women, estrogen- and progestin-containing oral contraceptives are effective at controlling uterine fibroid symptoms such as heavy and irregular bleeding. Progestin-only therapies, which include contraceptive shots, implants, and vaginal rings as well as oral medications, can also help reduce bleeding. Other medications may also be prescribed to shrink fibroids, reduce pain, or control bleeding.
Uterine Fibroid Embolization
A tumor needs a blood supply to grow. Uterine fibroid embolization (UFE) is a minimally invasive procedure designed to eliminate blood supply to fibroid tumors. An interventional radiologist makes a tiny incision and inserts a small plastic tube into an artery in the groin. Using a moving X-ray image called fluoroscopy, the radiologist then guides the tube into the target uterine artery and injects a blood vessel-blocking agent, cutting off blood to the tumor. Studies show that 80–90% of women who undergo UFE experience a reduction in symptoms. UFE is not an option for women who are currently pregnant, and the surgery may prevent or complicate future pregnancies.
Endometrial ablation is a minor surgery that destroys the uterine lining in order to control excessive bleeding from uterine fibroids. Because this surgery inhibits fertility—and a makes pregnancy risky if it does occur—endometrial ablation is not recommended for women who may wish to become pregnant in the future.
Myomectomy is a surgery to remove fibroid tumors, leaving the uterus intact. This can be performed in various ways, depending on the size and location of tumors. Fibroids inside the uterus are often removed vaginally, eliminating the need for incision. Laparoscopic surgery uses a tiny incision (less than a centimeter) and may be used to remove small tumors, while larger tumors may require a traditional open incision. Myomectomy is the procedure of choice for removing fibroids in women who desire future pregnancy.
Sometimes, a tool called a power morcellator is used in laparoscopic surgery to break fibroids into smaller pieces so they can be removed through the tiny incision. The FDA has issued a warning about this practice because if a woman also has uterine sarcoma at the time she has fibroids removed (which can be difficult to determine), use of a power morcellator can spread cancerous tissue and decrease the patient’s chances of long-term survival. If you and your doctor are discussing myomectomy, find out whether a power morcellator will be used and if so, make sure to fully discuss all risks involved before moving ahead.
Hysterectomy is a major surgery to remove the uterus and all attached fibroids. Pregnancy is not possible after hysterectomy, but it provides a permanent solution to fibroid symptoms.
Fibroids are extremely common and usually no cause for concern. If symptoms become bothersome, however, or if you’re planning to become pregnant, talk with your doctor about whether treatment is advisable and what options might offer you the greatest benefits.
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