Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female reproductive organ.
Leiomyoma; Fibromyoma; Myoma; Fibroids
Causes, incidence, and risk factors
Uterine fibroids are common. As many as 1 in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Half of all women have fibroids by age 50.
Fibroids are rare in women under age 20. They are more common in African-Americans than Caucasians.
The cause of uterine fibroids is unknown. However, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.
Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there are more than one.
Fibroids are often described by their location in the uterus:
Myometrial -- in the muscle wall of the uterus
Submucosal -- just under the surface of the uterine lining
Subserosal -- just under the outside covering of the uterus
Pendunculated -- occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus
More common symptoms of uterine fibroids are:
Bleeding between periods
Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
Menstrual periods that may last longer than normal
Need to urinate more often
Pelvic cramping or pain with periods
Sensation of fullness or pressure in lower abdomen
Pain during intercourse
Note: There are often no symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause.
Signs and tests
The health care provider will perform a pelvic exam. This may show that you have a change in the shape of your womb (uterus).
It can be difficult to diagnose fibroids, especially if you are extremely overweight.
An ultrasound may be done to confirm the diagnosis of fibroids. Sometimes, a pelvic MRI is done.
An endometrial biopsy (biopsy of the uterine lining) or laparoscopy may be needed to rule out cancer.
Treatment depends on several things, including:
Severity of symptoms
Type of fibroids
Whether you are pregnant
If you want children in the future
Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid's growth.
Treatment for the symptoms of fibroids may include:
Birth control pills (oral contraceptives) to help control heavy periods
Intrauterine devices (IUDs) that release the hormone progestin to help reduce heavy bleeding and pain
Iron supplements to prevent or treat anemia due to heavy periods
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn for cramps or pain
Short-term hormonal therapy injections to help shrink the fibroids
Surgery and procedures used to treat fibroids include:
Hysteroscopic resection of fibroids: Women who have fibroids growing inside the uterine cavity may need this outpatient procedure to remove the fibroid tumors.
Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. Women who may want to become pregnant in the future should discuss this procedure with their health care provider.
Myomectomy: This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility. More fibroids can develop after a myomectomy.
Hysterectomy: This invasive surgery may be an option if medicines do not work and other surgeries and procedures are not an option.
Rodriguez MI, Warden M, Darney PD. Intrauterine progestins, progesterone antagonists, and receptor modulators: a review of gynecologic applications. Am J Obstet Gynecol. 2010 May;202(5):420-8. Epub 2009 Dec 23. Review.
Moss J, Cooper K, Khaund A, et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011 Jul;118(8):936-944.
Peddada SD, Laughlin SK, Miner K, et al. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci USA. 2008 Dec 16;105(50):19887-92. Epub 2008 Dec 1.
Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009;301:82-93.
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112:387-400.
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.