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Uterine Fibroids

What are Uterine Fibroids?

Uterine fibroids are benign growths of the uterus.  They are also called uterine leiomyomas or myomas.  The uterus is made of muscle, and fibroids grow from the muscle.  Fibroids can bulge from the inside or outside of the uterus.  Fibroids are not cancerous and are not thought to be able to become cancerous.

Fibroids are common.  Approximately 80 percent of women will have fibroids in their lifetime, usually during the reproductive years.  Most women do not have bothersome fibroid symptoms.  Treatments are available for women who have fibroid-related problems like heavy or irregular bleeding, pain or pressure in the pelvis, urinary or bowel or problems with pregnancy or infertility.

Fibroid Causes

The cause of fibroids is unknown.  Fibroids seem to respond to the female hormones estrogen and progesterone; some women have specific genes that may predispose them to fibroids.  Lifestyle and reproductive factors may influence fibroids.  Some fibroids grow with time and others shrink.  Fibroids can also have growth spurts where they grow quickly over a short period of time.


Increased menstrual bleeding

Fibroids can increase the amount and number of days of menstrual bleeding.  Women who have excessive menstrual bleeding are at risk for a low blood count (iron deficiency anemia).

Pelvic pressure and pain

Larger fibroids can cause a sense of pelvic pressure of fullness in the abdomen, similar to the feeling of being pregnant.  Sometimes women can even look pregnant when they are not due to the fibroids.

Problems with fertility and pregnancy

Most women with fibroids are able to become pregnant without a problem.  However, certain fibroids that distort the inside of the uterus can cause trouble becoming pregnant or with miscarriage and removing these fibroids can optimize fertility.  Fibroids in the outer part of the uterus may have a mild effect on decreasing fertility, but surgically removing these fibroids does not appear to decrease the risk.  Women with fibroids and reproductive problems should go through a basic infertility evaluation before concluding the fibroids are responsible for the problem.

Fibroids can also cause other symptoms, depending upon where they are located in the uterus.  As an example, if a fibroid is pressing on the bladder, the woman may feel like she needs to go to the bathroom frequently.  Similarly, a fibroid pressing on the rectum can cause constipation.


Fibroids may be diagnosed during a pelvic exam and/or a pelvic ultrasound.  A doctor or other healthcare provider may suspect fibroids if your uterus is enlarged or has an irregular shape.  A pelvic ultrasound is needed to confirm that fibroids are present.  Ultrasound uses sound waves to create a picture of the uterus.  Other imaging tests may be done for a more precise view of your uterus.  Hysteroscopy and laparoscopy use a thin lighted tube to see inside of the body.  With hysteroscopy, the scope is passed through your vagina and cervix.  The physician looks through it to see fibroids that extend into the uterine cavity.  Laparoscopy is done to look at the surface of the uterus.  This procedure uses tiny incisions and special instruments to check for fibroids.

Fibroid Treatment

Women who have no symptoms from their fibroids do not need to have treatment.  Women with significant symptoms may try medical or surgical treatment.  The best treatment depends on which symptom is most bothersome.  The size, number and locations of fibroids and your desire for future pregnancy also factor into most treatment decisions.

Keeping your Symptoms in Check

Fibroids may change size or shape.  If your healthcare provider thinks that your fibroids re likely to shrink, he or she may suggest monitoring them instead of removal.  Fibroids can be monitored by regular ultrasound tests or pelvic exams.  Monitoring fibroids may be a good option if they are small or if you are nearing menopause.  At menopause, fibroids often shrink naturally due to decreasing levels of the hormone estrogen.

Removing the Fibroids

Myomectomy is surgery to remove a fibroid.  Myomectomy may be a good option for women who plan to have children.  In some cases not all fibroids can be removed, and fibroids may grow back later.  Before surgery your physician may prescribe medications to shrink the fibroids.  Myomectomy can be done in different ways: ° Hysteroscopy myomectomy, where fibroids are removed through the vagina, °Abdominal myomectomy (laparotomy) which removes fibroids through an abdominal incision, and   °Laparoscopic myomectomy, which removes small fibroids through tiny incisions.

A hysterectomy (removal of the uterus) may be a good choice of treatment depending on the fibroids, your symptoms, and if you do not plan on future pregnancy.  After a hysterectomy, fibroids will not return.  During hysterectomy the entire uterus may be removed or only the top, leaving the cervix.  The ovaries may be kept in place so hormone production can continue.  The surgeon can remove the uterus through an abdominal incision, through the vagina, or laparoscopically with tiny incisions.

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