Uterine Fibroids

Definition

Fibroids are noncancerous growths in the wall of the uterus (womb). These common growths may be as small as a seed or as large as a melon. A woman may have one or many. Most fibroids stay inside the uterus. Others may extend and affect nearby organs.

Causes

The cause of fibroids is not known. Genetics may play a role.

Fibroid growth is stimulated by estrogen and progesterone hormones. This causes fibroids to grow during pregnancy and shrink after childbirth. It also causes them to become less of a problem after menopause.

Risk Factors

The risk of fibroids increases in women until the start of menopause. Other things that may raise the risk are:

• Never having children
• Early menstruation (periods)
• Periods that happen more often than normal
• Painful periods
• Having other family members with this problem
• Obesity

Symptoms

Some women may not have symptoms. Others may have mild to severe problems. It depends on the size and location of the fibroids. Problems may be:

• Pelvic pain or pressure
• Belly swelling
• Heavy menstrual bleeding
• Blood clots in menstrual flow
• Periods that last longer than normal
• Bleeding between periods
• Cramping during periods
• Pain during sex
• Frequent need to urinate
• Constipation
• Low back or leg pain

Diagnosis

The doctor will ask about symptoms and past health. Most fibroids are found during routine pelvic exams. Blood tests will also be done.

Pictures may be taken with:

• Ultrasound
• MRI scan
• Hysterosalpingography
• Hysteroscopy

Treatment

Not all fibroids need to be treated. They will be watched for any changes. The goal will be to manage symptoms. This may be done with medicines, such as:

• Prescription or over the counter pain relievers
• Hormonal therapy, such as oral contraceptives
• Gonadotropin releasing hormone agonists to shrink fibroids
• Tranexamic acid to control heavy bleeding

Women who are not helped by these methods and who are not planning to become pregnant may need treatment, such as:

• Uterine fibroid embolization to block blood flow to the fibroids to cause them to shrink
• Ultrasound therapy to use focused sound waves to destroy the fibroids
• Myomectomy to remove fibroids
• Hysterectomy to remove the uterus, which means pregnancy is no longer possible

Prevention

There are no current guidelines to prevent fibroids.