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Fibroids

Uterine fibroids are common in women over the age of 30 and can cause heavy bleeding during periods, bleeding between periods, pelvic pain, and fertility issues.

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What Are Uterine Fibroids?

Uterine fibroids are noncancerous growths that develop from the muscle tissue of the uterus. They can occur in any person with a uterus.

You can have just one fibroid or multiple fibroids, and they may vary in size or shape. Over time, fibroids can grow, shrink, or stay the same size. Often harmless, fibroids are also known as myomas or leiomyomas.

How common are fibroids?

Fibroids are very common. An estimated 20% to 80% of women have fibroids by age 50.

What are the types of fibroids?

Doctors categorize fibroids based on where they grow in the uterus. All fibroids start in the uterine muscle. Fibroids can remain completely within the uterine muscle tissue (intramural), grow into the uterine cavity (submucosal) or grow to the outer layer of the uterus (subserosal).

What causes fibroids?

The exact cause of fibroids is not known, but several factors may contribute to their development:

  • Hormones — Estrogen and progesterone may be linked to fibroid growth.
  • Genetic changes — Many fibroids contain genes that differ from those in normal uterine muscle cells, which cause them to grow.

Who is at risk of developing fibroids?

Any person with a uterus who has completed puberty can develop fibroids. Certain factors can increase your risk of developing fibroids:

  • Age — Childbearing age and above. Fibroids are more common in patients in their 30s and 40s.
  • Family history — Having a family member with fibroids increases your risk.
  • Ethnic origin — People of African descent are more likely to develop fibroids than other racial groups.
  • Diet — A diet high in red meat and low in green vegetables, fruit, and dairy may be linked to fibroids.

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What are the Signs and Symptoms of Fibroids?

Many people with fibroids experience no symptoms and may not even be aware that they have them.

However, when symptoms do occur, they can include:

  • Heavy bleeding during your period.
  • Long duration of bleeding during your period.
  • Bleeding between periods.
  • Pressure or pain in the pelvis, back, or legs.
  • Swollen or enlarged abdomen.
  • Frequent urination or trouble emptying your bladder.
  • Constipation.
  • Pain during sex.

Fibroids may also lead to anemia since heavy bleeding can decrease iron levels. In rare cases, they may cause infertility, depending on where they are in the uterus.

When should I see a doctor about my fibroid symptoms?

You should tell your doctor if you have more painful or heavier periods than usual over three to six months or have any of the symptoms above.

Your primary care doctor may be able to help you, but for specialized care, consult your gynecologist.

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How Do You Diagnose Fibroids?

Because fibroids don't always cause symptoms, they often go unnoticed. Your doctor may be able to detect a fibroid during a pelvic exam. If your doctor suspects that you have fibroids based on your exam or symptoms, they may suggest an imaging test to confirm the diagnosis.

Tests to diagnose fibroids

Imaging techniques let your doctor visualize the inside of your uterus and determine if you have fibroids, as well as the best means of treatment.

These tests include:

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How Do You Treat Fibroids?

Treatment for fibroids depends on the severity of your symptoms, the size and location of the fibroids, and your plans for becoming pregnant in the future. Options include:

Watchful waiting

If you have no symptoms or mild symptoms, your doctor may recommend monitoring your fibroids over time with ultrasounds or other imaging to assess for growth

Medication

Hormonal medications

  • Contraceptives (birth control) — These medications help to regulate menstrual cycles and reduce, or even stop, bleeding and pain during periods. These medications do not typically shrink fibroids. Birth control options include oral contraceptive pills, the contraceptive patch, vaginal ring, progestin-releasing intrauterine device (IUD), or Depo-Provera® injection.
  • Gonadotropin-releasing hormone (GnRH) analogues —This class of medications reduces estrogen and progesterone levels by temporarily blocking the body’s ability to produce these hormones, which can shrink fibroids and reduce or stop bleeding and pain. These medications are used if birth control is ineffective. GnRH analogues are recommended typically for short-term treatment due to potential side effects such as menopausal-like symptoms and bone thinning. Common examples include leuprolide (Lupron®), Oriahnn®, and Myfembree®.

Nonhormonal medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDS), including ibuprofen and naproxen, help to relieve pain caused by fibroids.
  • Tranexamic acid is a nonhormonal medication that can help reduce the amount of bleeding during a period.

Surgery for fibroids

Surgical solutions for fibroids include:

Myomectomy — The surgical removal of fibroids while preserving the uterus. It is an option for the patient who wishes to preserve their uterus.

Techniques include:

  • Hysteroscopic myomectomy — This procedure is done through the vagina and cervix using a small camera with surgical instruments (hysteroscope) to remove fibroids within the uterine cavity. This procedure is outpatient, and recovery is typically three days.
  • Laparoscopic myomectomy — This minimally invasive surgery uses small incisions through the abdomen to remove fibroids. This procedure is outpatient, and recovery is typically two to four weeks.
  • Abdominal myomectomy—This abdominal surgery is performed through a large incision to remove fibroids. It is indicated for patients with a very large number or size of fibroids. The procedure requires several nights in the hospital after surgery and four to six weeks of recovery.

Uterine fibroid embolization — This minimally invasive procedure, also called uterine artery embolization, blocks the blood supply to the fibroids, causing them to shrink. A catheter is inserted into the arm or groin and guided to the uterine arteries, where small particles are injected to block blood flow to the fibroids. Recovery is one to two weeks.

Radiofrequency ablation — Thermal energy is used to shrink fibroids by placing an instrument directly into the fibroids and applying heat. Radiofrequency ablation is a relatively new technique for the treatment of fibroids. Therefore, the available data on future pregnancy after this procedure is limited. At this time, radiofrequency ablation is typically recommended for patients who do not desire future pregnancy.

Techniques include:

  • Laparoscopic radiofrequency ablation (Acessa®) — This minimally invasive procedure uses a small incision through the abdomen to insert the radiofrequency device into the fibroid. This procedure is outpatient, and recovery is typically one to two weeks.
  • Hysteroscopic radiofrequency ablation (Sonata®) — This procedure is done through the vagina and cervix to insert the radiofrequency device into the fibroids. This procedure is outpatient, and recovery is typically three days.

Hysterectomy — This procedure is the removal of the uterus with the fibroids. A hysterectomy is the only permanent solution to fibroids. When the uterus is removed, fibroids cannot grow back. This procedure is recommended for patients who do not desire future pregnancy.

A hysterectomy only refers to the removal of the uterus. This does not include the removal of the ovaries, which produce estrogen and progesterone (female hormones). The decision to keep or remove the ovaries is based on your personal and family history and is an individual decision that you make with your doctor.

Techniques include:

  • Laparoscopic hysterectomy — This minimally invasive procedure uses small incisions through the abdomen to remove the uterus and fibroids. This procedure is outpatient, and recovery is two to four weeks.
  • Vaginal hysterectomy — This minimally invasive procedure uses only incisions through the vagina to remove the uterus. This procedure is typically recommended for patients who do not have large fibroids and who have delivered babies vaginally. This procedure is outpatient, and recovery is two to four weeks.
  • Abdominal hysterectomy — This is an abdominal surgery performed through a large incision to remove the uterus and fibroids. This procedure is indicated for patients with a very large number of fibroids or very large sizes of fibroids. This procedure requires several nights in the hospital after surgery and four to six weeks of recovery.

How effective is treatment?

A hysterectomy is the only permanent solution to fibroids. The effectiveness of medications and other surgeries varies depending on the size and number of fibroids, patient age, and specific symptoms being treated.

Living with Uterine Fibroids

Managing uterine fibroids can be challenging, but many people find that they can manage their symptoms with the right treatment and support. Discuss your symptoms, treatment goals, and personal health history with your doctor to find the best management plan for you and your health goals.

Last reviewed by a UPMC medical professional on 2024-09-05.