Fibroids

Signs and Symptoms

Fibroids are non-cancerous or benign growths that develop in the uterus. As many as 30 percent of women have one or more of these tumors, which range in size from as small as a pea to as large as a melon. Most women with fibroids have no symptoms and don't need treatment. But if symptoms occur, you should seek medical attention.

At UCSF, the Comprehensive Fibroid Center offers a wide range of treatments, depending on the size and location of the fibroid.

Symptoms of fibroids may include:

• Heavy Vaginal Bleeding — Some women experience excessive menstrual bleeding. Some women describe soaking through sanitary protection in less than an hour, passing blood clots and being unable to leave the house during the heaviest day of flow. If this blood loss occurs, you may develop anemia, or a low blood count, that can cause fatigue or lightheadedness.

• Pelvic Pressure or Discomfort — Women with large fibroids may have a sense of heaviness or pressure in the lower abdomen or pelvis. This discomfort is similar to pregnancy when the enlarging uterus presses against surrounding structures.

• Bladder Changes — The most frequent bladder symptom is the need to urinate more frequently. You may awaken several times during the night to urinate or you may be unable to urinate despite the sensation of a full bladder. Bladder symptoms are caused by fibroids pressing against the bladder, reducing its capacity to hold urine or blocking the urine from flowing.

• Pelvic Pain — A less common symptom is severe pain. This occurs when a fibroid goes through a process called degeneration, usually because it outgrows its blood supply. The pain is usually localized and subsides within two to four weeks.

• Low Back Pain — Fibroids that press against the muscles and nerves of the lower back can cause back pain.

• Rectal Pressure — Fibroids also can press against the rectum and cause a sense of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Occasionally, fibroids can lead to the development of a hemorrhoid.

See Fibroid FAQs and UCSF Comprehensive Fibroid Center.

Diagnosis

Fibroids can be diagnosed in a number of ways including:

• Pelvic Examination — During a routine gynecologic exam, a doctor can feel the size and shape of the uterus. If the uterus is enlarged or irregularly shaped, fibroids may be present. Several tests can be performed to confirm the diagnosis.

• Ultrasonography — Sound waves are used to create an image of the uterus and ovaries.

• Saline Hysterosonography — This test is also called water ultrasound. Fluid is placed in the uterus and an ultrasound is performed. This test can identify fibroids in the uterine cavity.

• Magnetic Resonance Imaging (MRI) — A large magnet is used to create very detailed images of the uterus and other pelvic structures. This expensive test is reserved for special circumstances when the precise location of fibroids is needed.

• Hysteroscopy — A slender "telescope" is inserted through the vagina and cervix into the uterine cavity to allow a physician to see fibroids inside the uterus.

See Fibroid FAQs and UCSF Comprehensive Fibroid Center.

Treatment

Treatment for fibroids can range from no treatment at all to surgery. Unless fibroids are causing excessive bleeding, discomfort or bladder problems, treatment often isn't necessary.

If you have fibroids, you should be evaluated periodically to review symptoms, and to monitor the fibroid and uterus size with abdominal and pelvic examinations.

The following are treatment options for fibroids:

Medical Therapy

Medical treatments may improve symptoms, but don't eliminate the fibroids. Several promising new drugs that will treat the fibroids themselves and not just the symptoms are currently being developed and tested in clinical trials.

Contraceptive Pills and Progestational Agents

Women with heavy menstrual periods and fibroids are often prescribed hormonal medications to try to reduce bleeding and regulate the menstrual cycle. Medications will not shrink fibroids or cause them to grow at a faster rate. If the medication has not improved your bleeding after three months, consult your doctor. Women over the age of 35 who smoke should not use oral contraceptives.

GnRH Agonists (Lupron)

GnRH agonists are a class of medications that temporarily shrink fibroids and stop heavy bleeding by blocking production of the female hormone, estrogen. Lupron is the most well known of these drugs. Although Lupron can improve fibroid symptoms, it causes unpleasant, menopausal symptoms such as hot flashes. Long-term use can cause bone loss.

Lupron is recommended for very specific cases. It may be recommended if you have heavy bleeding and serious anemia, creating the need for a blood transfusion during fibroid surgery. If you take Lupron for two to three months before surgery, your periods may temporarily stop and eliminate the need for a blood transfusion. Lupron also may be recommended if you have very large fibroids — greater than 10 to 12 centimeters — prior to fibroid surgery. Lupron should not be used solely to shrink fibroids unless surgery is planned because fibroids will re-grow to their original size as soon as you stop taking Lupron.

Intrauterine Devices (IUD)

Although intrauterine devices (IUD) are typically used to prevent pregnancy, they have other benefits as well. An IUD that releases a small amount of hormone into the uterine cavity can decrease bleeding caused by fibroids. An IUD can be inserted during a routine office appointment. Ask you doctor for more information about this treatment option.

Myomectomy

A myomectomy involves removing the fibroids while preserving the uterus. This technique can be performed if the fibroids are in the uterine cavity but not if they're imbedded in the uterine wall. The procedure can be performed several ways depending on the size, number and location of the fibroids.

Most myomectomies are performed by making an incision across the lower abdomen, called an abdominal myomectomy. This allows for the removal of all types and sizes of fibroids and for the reconstruction of the uterus to its former size and contour.

If the surgery is performed with a small telescope called an hysteroscope, it's called a hysteroscopic myomectomy. The hysteroscope is passed through the cervix to view the uterine cavity. A tiny camera attached to the telescope provides a magnified view that's projected onto a video monitor. Electrical current is passed through a thin wire attached to the hysteroscope that cuts through the fibroid. As the fibroid is shaved, the instrument sears blood vessels so blood loss is minimized. Patients can go home the same day as the surgery and return to normal activity in three days.

The advantages of a hysteroscopic myomectomy are a shorter hospital stay and shorter recovery. The risks are possible complications to the intestines and possible regrowth of fibroids.

Myomectomy is a very effective treatment, but fibroids can regrow. The younger you are at the time of myomectomy and the more fibroids you have, the more likely you'll develop fibroids in the future. Women nearing menopause are the least likely to have recurring fibroids. Read more about myomectomies.

Hysterectomy

Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy.

There are several hyterectomy surgical approaches. A vaginal hysterectomy involves removing the uterus through an incision in the vagina. An abdominal hysterectomy is performed through an incision on the lower abdomen. A laparoscopic hysterectomy is performed through four tiny incisions in the abdomen. The type of hysterectomy will depend on the size of the uterus and several other factors.

The ovaries are not necessarily removed during a hysterectomy. You should discuss the pros and cons of ovarian removal with your doctor. Read more about hysterectomies.

Uterine Artery Embolization (UAE)

This is a relatively new procedure and an alternative to conventional surgery for fibroids. Embolization blocks the blood flow to fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.

UAE is performed in a radiology suite rather than an operating room. A substance is released into the blood vessels leading to the fibroids, blocking the blood flow. You'll be given pain medicine but will not be completely asleep. After the procedure, you'll experience pain for one to three days but can return to work and full activities in a week. Ninety percent of women report improvement in pelvic pressure and heavy bleeding.

Because there is little information about long-term results, UCSF does not recommend this procedure for women who want to have children. Read more about uterine artery embolization.

See Fibroid FAQs and UCSF Comprehensive Fibroid Center.