Patient  Information

Dear Patient,

This following information is intended to help you understand the nature of a medical condition called Symptomatic Uterine Fibroids and the various treatment options. This information is available in order to answer common questions and to help you make an informed and careful decision about your treatment options. As you read this information, bear in mind that all forms of medical treatment are highly personal matters. That means that no matter how common your medical condition may be, your doctor will recommend treatment based on your individual needs.

There are a variety of benefits and risks associated with any type of medical or surgical procedure. Your doctor will help you to understand these benefits and risks. And remember, if you have any questions about your medical condition or the treatment options discussed in this website – please ask your doctor.

This information is not designed as a substitute for professional medical care or advice. Only your physician is qualified to diagnose and appropriately treat your pain and related problems.

The Healthy Uterus

The uterus is one of the main female organs involved in reproduction. It is the source of the bleeding and cramping that occurs with menstrual periods. The walls of the uterus are made of muscle and often contain tumors or growths called fibroids.

What Are Fibroids?

Fibroids are common tumors or growths made up of muscle that occur in the wall of the uterus. The cause of uterine fibroid tumors is unknown. Eighty percent of all women develop these tumors during their lifetime, and almost 70% of Caucasian women and over 80% of African-American women have fibroids in the uterus by age 50. Women who have fibroids usually have more than one. Only 0.1% of fibroids that are removed surgically are found to be cancerous. Fibroids vary in size but can become very large (over 7 inches in diameter).
 

Why Are Fibroids Important?

About 25-30% of women who have fibroids have symptoms from them. These symptoms include heavy menstrual periods, increased menstrual pain, abdominal enlargement, pelvic pain, pain with sexual intercourse, increased frequency of urination, and feelings of abdominal pressure or fullness.
As a result of these symptoms, physicians often recommend surgical removal of the uterus (hysterectomy). In fact, uterine fibroids are the most common medical condition for which hysterectomy is performed (235,000 cases/year in the U.S.).
Fibroids may be located in different areas of the uterine wall and go by different names:
• Subserosal fibroids develop in the outer portion of the uterine wall and grow outward. These fibroids can be painful if they are large and press on other organs. They usually don't affect a woman's menstrual flow.
• Intramural fibroids develop in the middle portion of the uterine wall. Most fibroids are intramural in location.
• Submucosal fibroids develop just under the lining of the uterine cavity and may grow into the cavity of the uterus. These are the least common type of fibroid. They often cause very heavy, long menstrual periods.
• Pedunculated uterine fibroids occur when the fibroid grows on a stalk. These can grow into the uterus or on the outside of the uterus.
Fibroids also have alternative names such as “leiomyoma, fibromyoma, or myoma.

The Natural Course of Fibroids

Fibroids are usually detected in women greater than 40 years of age. They are rarely detected in women younger than 30. Prior to menopause, fibroids may grow slowly, rapidly, or not at all. They usually do not decrease in size without treatment. After menopause, new fibroids rarely develop, but fibroids already present may be maintained or grow and cause symptoms if hormone replacement therapy is taken. If hormone replacement therapy is not taken, then the uterus and the fibroids will decrease in size. Once fibroids start to cause symptoms, they usually continue to do so. The frequency and severity of the symptoms may increase over time. Occasionally, patients with fibroids that are causing symptoms find that their symptoms decrease over time without treatment. The cause for this is unknown, but it may be that the fibroids start to die and become less problematic.
 

The Effect on Fertility, Pregnancy, and Birth

The effect of fibroids upon fertility is controversial, however more and more evidence suggests that they may sometimes cause infertility. The exact mechanism by which this happens is not well-defined. After a pregnancy is established, existing fibroids may grow due to the increased blood flow and hormone levels. Submucosal fibroids, those that enter the uterine cavity, increase miscarriage or loss of early pregnancies. Larger fibroids (greater than 5 cm in diameter) are thought to increase premature delivery. Fibroids also increase postpartum hemorrhage and uterine muscle tone, which result in heavy bleeding after delivery of the baby and afterbirth. If fibroids are present during pregnancy, they may increase in size rapidly, or stay about the same size. If they increase in size, they may cause significant pain. Fibroids also may outgrow their blood supply and start to die, resulting in pain. Cesarean section may be needed for delivery since fibroid tumors can occasionally block the birth canal or cause the baby to be positioned in a way that is unsafe for a vaginal delivery.

Diagnosing Fibroids

Uterine fibroids are most often discovered through a pelvic examination which may reveal an irregularly shaped, lumpy, or enlarged uterus. In patients with heavy menstrual bleeding, physicians may perform or order an ultrasound examination to visualize the uterus and detect fibroid tumors. Sometimes an MRI may be performed to confirm the previous findings and to make sure no other abnormal conditions are present.

Contacting Your Health Care Provider

There are many treatment options available to women with fibroids. You will need to call your health care provider if gradual changes in your menstrual pattern occur (heavier flow, increased cramping, bleeding between periods), or if fullness or heaviness develops in your lower abdomen. There may be associated pressure or discomfort and occasionally interference with normal urinary function. Your health care provider can discuss the risks and benefits of the various treatment options available to you.

References

L Speroff, M Fitz. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Lippincott Williams & Wilkins; 2004.

Casini ML, Rossi F, Agostini R, Unfer V. Effects of the position of fibroids on fertility. Gynecol Endocrinol. 2006 Feb;22(2):106-9.

Note to patients: The information on this website is not intended to replace the advice of a doctor or a qualified medical provider. Only your doctor or qualified medical provider can determine if any medical technology, therapy, or intervention is appropriate for you. If you are a patient with questions regarding the information on this website, you should discuss them with your doctor.