Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes, these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign (noncancerous). The cause of fibroids is unknown.
According to the National Institutes of Health (NIH), about 70 to 80 percent of women have them by the age of 50, but most women do not have any symptoms.
Different fibroids develop in different locations in and on the uterus.
Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.
Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.
When subserosal tumors develop a stem (a slender base that supports the tumor), they become pedunculated fibroids.
These types of tumors develop in the middle muscle layer (myometrium) of your uterus. Submucosal tumors are not as common as other types, but when they do develop, they may cause heavy menstrual bleeding and trouble conceiving.
It is unclear why fibroids develop, but several factors may influence their formation.
Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.
Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.
Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you are pregnant.
Women are at greater risk for developing fibroids if they have one or more of the following risk factors:
- a family history of fibroids
- being over the age of 30
- being of African-American descent
- having a high body weight
Your symptoms will depend on the location and size of the tumor(s) and how many tumors you have. If your tumor is very small, or if you are going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause.
Symptoms of fibroids may include:
- heavy bleeding between or during your periods that includes blood clots
- pain in the pelvis and/or lower back
- increased menstrual cramping
- increased urination
- pain during intercourse
- menstruation that lasts longer than usual
- pressure or fullness in your lower abdomen
- swelling or enlargement of the abdomen
You will need to see a gynecologist to get a pelvic exam. This exam is used to check the condition, size, and shape of your uterus. You may also need other tests, which include:
An ultrasound uses high frequency sound waves to produce images of your uterus on a screen. This will allow your doctor to see its internal structures and any fibroids present. A transvaginal ultrasound, in which the ultrasound wand (transducer) is inserted into the vagina, may provide clearer pictures since it is closer to the uterus during this procedure.
This in-depth imaging testing produces pictures of your uterus, ovaries, and other pelvic organs.
Your doctor will develop a treatment plan based on your age, the size of your fibroid(s), and your overall health. You may receive a combination of treatments.
Medications to regulate your hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.
Other options that can help control bleeding and pain, but will not shrink or eliminate fibroids, include:
- an intrauterine device (IUD) that releases the hormone progestin
- over-the-counter anti-inflammatory pain relievers, such as ibuprofen
- birth control pills
Surgery to remove very large or multiple growths (myomectomy) may be performed. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted.
Your physician may perform a hysterectomy (removal of your uterus) if your condition worsens, or if no other treatments work. However, this means that you will not be able to bear children in the future.
Minimally Invasive Procedures
A newer and completely noninvasive surgical procedure is forced ultrasound surgery (FUS). You will lie down inside a special MRI machine that allows doctors to visualize the inside of your uterus. High-energy, high-frequency sound waves will be directed at the fibroids to destroy (ablate) them.
Similarly, myolysis shrinks fibroids using an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, hot water, or microwaves.
Your prognosis will depend on the size and location of your fibroids. Fibroids may not need treatment if they are small or do not produce symptoms. If you are pregnant and have fibroids, or become pregnant and have fibroids, your physician will carefully monitor your condition. In most cases, fibroids do not cause problems during pregnancy. Speak with your doctor if you expect to become pregnant and have fibroids.