What is a fibroid?
Fibroids are the most common tumors found in the female reproductive system. Fibroids are dense growths that are made of smooth muscle cells and fibrous connective tissue, which develops in the uterus. Some estimations show as high as 77 percent of women will eventually acquire fibroids sometime during their reproductive years, although only a few of these fibroids are large enough to be identified by a physician during a physical examination.
They typically appear in women between the ages of 35 and 50. African-American women and those with a family history are more likely to develop fibroids. In most fibroid cases, the tumors are benign (non-cancerous). Even though these tumors are not malignant, they can cause prolonged bleeding, anemia, abdominal swelling and pelvic pain. They are also the leading cause of a hysterectomy in premenopausal women.
While the exact cause of fibroids is unknown, it is believed that tumors grow from an abnormal muscle cell in the uterus, which then grows rapidly due to the influence of estrogen.
When it comes to the treatment of fibroids, our gynecologic experts focus on improving your quality of life by emphasizing nutrition and exercise. However, we recognize not every fibroid condition is the same, so we make it a point to get to know you, your condition and your lifestyle so we can recommend the best possible treatment.
We also know how complex uterine fibroids can be. That’s why we perform vital and thorough tests to exclude diseases such as cancer before making a recommendation. Each of our professionals is proactive and enthusiastic about working with you to improve your condition.
Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids; however, each individual may experience symptoms differently. Symptoms of uterine fibroids may include:
- Heavy or prolonged menstrual periods
- Abnormal bleeding between menstrual periods
- Pelvic pain (caused as the tumor presses on pelvic organs)
- Frequent urination
- Lower back pain
- Pain during intercourse
- A firm mass, often located near the middle of the pelvis, which can be felt by the physician
In some cases, heavy or prolonged menstrual periods or abnormal bleeding between periods can lead to iron-deficiency anemia, which also requires treatment.
There are several factors that may cause fibroids:
- Hormones—Both estrogen and progesterone, two hormones that are associated with the development of the uterine lining during each menstrual cycle, appear to stimulate the growth of fibroids.
- Heredity—If a family member has fibroids, you may be at an increased risk of developing them.
- Race—African-American women are more likely to have fibroids than women of other races.
- Environmental aspects—Aspects such as early-age menstruation, use of birth control, obesity and alcohol use seem to increase your risk of developing fibroids.
How is it diagnosed?
Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history, physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
- X-ray—Electromagnetic energy used to produce images of bones and internal organs onto film
- Transvaginal ultrasound (also called ultrasonography)—An ultrasound test using a small instrument, called a transducer, is placed in the vagina
- Magnetic resonance imaging (MRI)—A noninvasive procedure that produces a two-dimensional view of an internal organ or structure
- Hysterosalpingography—X-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction
- Hysteroscopy—Visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina
- Endometrial biopsy—A procedure in which a sample of tissue is obtained through a tube, which is inserted into the uterus
A blood test may be done to check for iron-deficiency anemia if heavy bleeding is caused by the tumor.
Treatments for fibroids include:
- Hysterectomy—Hysterectomies involve the surgical removal of the entire uterus. Fibroids remain the No. 1 reason for hysterectomies in the United States. Conservative surgical therapy uses a procedure called myomectomy, which removes the fibroids but leaves the uterus intact to enable a future pregnancy.
- Gonadotropin releasing hormone agonists (GnRH agonists)—This approach lowers the levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
- Anti-hormonal agents—Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
- Fibroid embolization—Uterine artery embolization is a newer, minimally invasive (without a large abdominal incision) technique that cuts off the blood supply to the fibroids.
- Myomectomy—A myomectomy is the surgical removal of a fibroid, often performed as an alternative to a hysterectomy to conserve your uterus and your childbearing abilities.