Uterine FibroidsQ: Whatarefibroids?A: Fibroidsaremusculartumorsthat

growinthewalloftheuterus(womb).Anothermedicaltermforfibroidsisleiomyoma(leye-oh-meye-OH-muh)orjustmyoma.Fibroidsarealmostalwaysbenign(notcancerous).Fibroidscangrowasasingletumor,ortherecanbemanyofthemintheuterus.Theycanbeassmallasanappleseedorasbigasagrapefruit.Inunusualcasestheycanbecomeverylarge.

Q: Whyshouldwomenknowaboutfibroids?

A: About20percentto80percentofwomendevelopfibroidsbythetime

theyreachage50.Fibroidsaremostcommoninwomenintheir40sandearly50s.Notallwomenwithfibroidshavesymptoms.Womenwhodohavesymptomsoftenfindfibroidshardtolivewith.Somehavepainandheavymenstrualbleeding.Fibroidsalsocanputpressureonthebladder,causingfrequenturination,ortherectum,caus-ingrectalpressure.Shouldthefibroidsgetverylarge,theycancausetheabdo-men(stomacharea)toenlarge,makingawomanlookpregnant.

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Fallopian tubeconnects the ovary to the uterus

Ovaries two small glands next to the uterus that make hormones, such as estrogen, which spark the start of your menstrual cycle, and release one egg about once a month until menopause

Uterus (womb)an inside area or pocket where a baby grows

Cervixthe narrow entryway in between the vagina and uterus Vaginaa hollow canal or tube made of muscle that can grow wider to deliver a baby that has finished growing inside the uterus

Q: Whogetsfibroids?A: Therearefactorsthatcanincreasea

woman'sriskofdevelopingfibroids.

Age.Fibroidsbecomemorecom-monaswomenage,especiallydur-ingthe30sand40sthroughmeno-pause.Aftermenopause,fibroidsusuallyshrink.

Family history.Havingafam-ilymemberwithfibroidsincreasesyourrisk.Ifawomansmotherhadfibroids,herriskofhavingthemisaboutthreetimeshigherthanaver-age.

Ethnic origin.African-Americanwomenaremorelikelytodevelopfibroidsthanwhitewomen.

Obesity.Womenwhoareover-weightareathigherriskforfibroids.Forveryheavywomen,theriskistwotothreetimesgreaterthanaver-age.

Eating habits.Eatingalotofredmeat(e.g.,beef)andhamislinkedwithahigherriskoffibroids.Eatingplentyofgreenvegetablesseemstoprotectwomenfromdevelopingfibroids.

Q: Wherecanfibroidsgrow?A: Mostfibroidsgrowinthewallofthe

uterus.Doctorsputthemintothreegroupsbasedonwheretheygrow:

Submucosal(sub-myoo-KOH-zuhl)fibroidsgrowintotheuterinecavity.

Intramural(ihn-truh-MYOOR-uhl)fibroidsgrowwithinthewalloftheuterus.

Subserosal (sub-suh-ROH-zuhl)fibroidsgrowontheoutsideoftheuterus.

Somefibroidsgrowonstalksthatgrowoutfromthesurfaceoftheuterusorintothecavityoftheuterus.Theymightlooklikemushrooms.Thesearecalledpedunculated(pih-DUHN-kyoo-lay-ted)fibroids.

Q: Whatarethesymptomsoffibroids?

A: Mostfibroidsdonotcauseanysymp-toms,butsomewomenwithfibroidscanhave:

heavybleeding(whichcanbeheavyenoughtocauseanemia)orpainfulperiods

feelingoffullnessinthepelvicarea(lowerstomacharea)

enlargementofthelowerabdomen

frequenturination

painduringsex

lowerbackpain

complicationsduringpregnancyandlabor,includingasix-timegreaterriskofcesareansection

reproductiveproblems,suchasinfertility,whichisveryrare

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Q: Whatcausesfibroids?A: Nooneknowsforsurewhatcauses

fibroids.Researchersthinkthatmorethanonefactorcouldplayarole.Thesefactorscouldbe:

hormonal(affectedbyestrogenandprogesteronelevels)

genetic(runsinfamilies)

Becausenooneknowsforsurewhatcausesfibroids,wealsodon'tknowwhatcausesthemtogroworshrink.Wedoknowthattheyareunderhor-monalcontrolbothestrogenandprogesterone.Theygrowrapidlydur-ingpregnancy,whenhormonelevelsarehigh.Theyshrinkwhenanti-hor-monemedicationisused.Theyalsostopgrowingorshrinkonceawomanreachesmenopause.

Q: Canfibroidsturnintocancer?A: Fibroidsarealmostalwaysbenign(not

cancerous).Rarely(lessthanonein1,000)acancerousfibroidwilloccur.Thisiscalledleiomyosarcoma(leye-oh-meye-oh-sar-KOH-muh).Doctorsthinkthatthesecancersdonotarisefromanalready-existingfibroid.Havingfibroidsdoesnotincreasetheriskofdevelopingacancerousfibroid.Havingfibroidsalsodoesnotincreaseawomanschancesofgettingotherformsofcancerintheuterus.

Q: WhatifIbecomepregnantandhavefibroids?

A: Womenwhohavefibroidsaremorelikelytohaveproblemsduringpreg-nancyanddelivery.Thisdoesntmeantherewillbeproblems.Mostwomenwithfibroidshavenormalpregnancies.Themostcommonproblemsseeninwomenwithfibroidsare:

Cesareansection.Theriskofneed-ingac-sectionissixtimesgreaterforwomenwithfibroids.

Babyisbreech.Thebabyisnotpositionedwellforvaginaldelivery.

Laborfailstoprogress.

Placentalabruption.Theplacentabreaksawayfromthewalloftheuterusbeforedelivery.Whenthishappens,thefetusdoesnotgetenoughoxygen.

Pretermdelivery

Talktoyourobstetricianifyouhavefibroidsandbecomepregnant.Allobstetricianshaveexperiencedeal-ingwithfibroidsandpregnancy.MostwomenwhohavefibroidsandbecomepregnantdonotneedtoseeanOBwhodealswithhigh-riskpregnancies.

Q: HowdoIknowforsurethatIhavefibroids?

A: Yourdoctormayfindthatyouhavefibroidswhenyouseeherorhimforaregularpelvicexamtocheckyouruterus,ovaries,andvagina.Thedoctorcanfeelthefibroidwithherorhisfin-gersduringanordinarypelvicexam,asa(usuallypainless)lumpormassontheuterus.Often,adoctorwilldescribehowsmallorhowlargethefibroidsarebycomparingtheirsizetothesizeyouruteruswouldbeifyouwerepregnant.Forexample,youmaybetoldthatyourfibroidshavemadeyouruterusthesizeitwouldbeifyouwere16weekspregnant.Orthefibroidmightbecomparedtofruits,nuts,oraball,suchasagrapeoranorange,anacornorawalnut,oragolfballoravolleyball.

Yourdoctorcandoimagingteststoconfirmthatyouhavefibroids.Thesepage

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areteststhatcreatea"picture"oftheinsideofyourbodywithoutsurgery.Thesetestsmightinclude:

Ultrasoundusessoundwavestoproducethepicture.Theultrasoundprobecanbeplacedontheabdomenoritcanbeplacedinsidethevaginatomakethepicture.

Magnetic Resonance Imaging(MRI)usesmagnetsandradiowavestoproducethepicture

X-raysusesaformofradiationtoseeintothebodyandproducethepicture

Cat Scan(CT)takesmanyX-raypicturesofthebodyfromdifferentanglesforamorecompleteimage

Hysterosalpingogram(hiss-tur-oh-sal-PIN-juh-gram)(HSG)orsonohysterogram(soh-noh-HISS-tur-oh-gram)AnHSGinvolvesinjectingx-raydyeintotheuterusandtakingx-raypictures.Asono-hysterograminvolvesinjectingwaterintotheuterusandmakingultra-soundpictures.

Youmightalsoneedsurgerytoknowforsureifyouhavefibroids.Therearetwotypesofsurgerytodothis:

Laparoscopy(lap-ar-OSS-koh-pee)Thedoctorinsertsalong,thinscopeintoatinyincisionmadeinornearthenavel.Thescopehasabrightlightandacamera.Thisallowsthedoctortoviewtheuterusandotherorgansonamonitordur-ingtheprocedure.Picturesalsocanbemade.

Hysteroscopy(hiss-tur-OSS-koh-pee)Thedoctorpassesalong,thinscopewithalightthroughthevagi-naandcervixintotheuterus.No

incisionisneeded.Thedoctorcanlookinsidetheuterusforfibroidsandotherproblems,suchaspolyps.Acameraalsocanbeusedwiththescope.

Q: WhatquestionsshouldIaskmydoctorifIhavefibroids?

A: HowmanyfibroidsdoIhave?

Whatsizeismyfibroid(s)?

Whereismyfibroid(s)located(outersurface,innersurface,orinthewalloftheuterus)?

CanIexpectthefibroid(s)togrowlarger?

Howrapidlyhavetheygrown(iftheywereknownaboutalready)?

HowwillIknowifthefibroid(s)isgrowinglarger?

Whatproblemscanthefibroid(s)cause?

Whattestsorimagingstudiesarebestforkeepingtrackofthegrowthofmyfibroids?

Whataremytreatmentoptionsifmyfibroid(s)becomesaproblem?

Whatareyourviewsontreatingfibroidswithahysterectomyversusothertypesoftreatments?

Asecondopinionisalwaysagoodideaifyourdoctorhasnotansweredyourquestionscompletelyordoesnotseemtobemeetingyourneeds.

Q: Howarefibroidstreated?A: Mostwomenwithfibroidsdonot

haveanysymptoms.Forwomenwhodohavesymptoms,therearetreat-mentsthatcanhelp.Talkwithyour

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doctoraboutthebestwaytotreatyourfibroids.Sheorhewillconsidermanythingsbeforehelpingyouchooseatreatment.Someofthesethingsinclude:

whetherornotyouarehavingsymptomsfromthefibroids

ifyoumightwanttobecomepreg-nantinthefuture

thesizeofthefibroids

thelocationofthefibroids

yourageandhowclosetomeno-pauseyoumightbe

Ifyouhavefibroidsbutdonothaveanysymptoms,youmaynotneedtreat-ment.Yourdoctorwillcheckduringyourregularexamstoseeiftheyhavegrown.

Medications

Ifyouhavefibroidsandhavemildsymptoms,yourdoctormaysuggesttakingmedication.Over-the-counterdrugssuchasibuprofenoracetamino-phencanbeusedformildpain.Ifyouhaveheavybleedingduringyourperi-od,takinganironsupplementcankeepyoufromgettinganemiaorcorrectitifyoualreadyareanemic.

Severaldrugscommonlyusedforbirthcontrolcanbeprescribedtohelpcon-trolsymptomsoffibroids.Low-dosebirthcontrolpillsdonotmakefibroidsgrowandcanhelpcontrolheavybleed-ing.Thesameistrueofprogesterone-likeinjections(e.g.,Depo-Provera).AnIUD(intrauterinedevice)calledMirenacontainsasmallamountofprogesterone-likemedication,whichcanbeusedtocontrolheavybleedingaswellasforbirthcontrol.

Otherdrugsusedtotreatfibroidsare

gonadotropinreleasinghormoneagonists(GnRHa).TheonemostcommonlyusedisLupron.Thesedrugs,givenbyinjection,nasalspray,orimplanted,canshrinkyourfibroids.Sometimestheyareusedbeforesur-gerytomakefibroidseasiertoremove.SideeffectsofGnRHascanincludehotf lashes,depression,notbeingabletosleep,decreasedsexdrive,andjointpain.MostwomentolerateGnRHasquitewell.MostwomendonotgetaperiodwhentakingGnRHas.Thiscanbeabigrelieftowomenwhohaveheavybleeding.Italsoallowswomenwithanemiatorecovertoanormalbloodcount.GnRHascancausebonethinning,sotheiruseisgenerallylim-itedtosixmonthsorless.Thesedrugsalsoareveryexpensive,andsomeinsurancecompanieswillcoveronlysomeornoneofthecost.GnRHasoffertemporaryrelieffromthesymp-tomsoffibroids;onceyoustoptakingthedrugs,thefibroidsoftengrowbackquickly.

Surgery

Ifyouhavefibroidswithmoderateorseveresymptoms,surgerymaybethebestwaytotreatthem.Herearetheoptions:

Myomectomy(meye-oh-MEK-tuh-mee)surgerytoremovefibroidswithouttakingoutthehealthytissueoftheuterus.Itisbestforwomenwhowishtohavechildrenaftertreatmentfortheirfibroidsorwhowishtokeeptheiruterusforotherreasons.Youcanbecomepregnantaftermyomec-tomy.Butifyourfibroidswereimbeddeddeeplyintheuterus,youmightneedacesareansection

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todeliver.Myomectomycanbeperformedinmanyways.Itcanbemajorsurgery(involvingcuttingintotheabdomen)orperformedwithlaparoscopyorhysteroscopy.Thetypeofsurgerythatcanbedonedependsonthetype,size,andlocationofthefibroids.Aftermyo-mectomynewfibroidscangrowandcausetroublelater.Allofthepossiblerisksofsurgeryaretrueformyomectomy.Therisksdependonhowextensivethesurgeryis.

Hysterectomy(hiss-tur-EK-tuh-mee)surgerytoremovetheuterus.Thissurgeryistheonlysurewaytocureuterinefibroids.Fibroidsarethemostcommonreasonthathysterectomyisper-formed.Thissurgeryisusedwhenawoman'sfibroidsarelarge,ifshehasheavybleeding,iseithernearorpastmenopause,ordoesnotwantchildren.Ifthefibroidsarelarge,awomanmayneedahysterectomythatinvolvescuttingintotheabdo-mentoremovetheuterus.Ifthefibroidsaresmaller,thedoctormaybeabletoreachtheuterusthroughthevagina,insteadofmakingacutintheabdomen.Insomecaseshysterectomycanbeperformedthroughthelaparoscope.Removaloftheovariesandthecervixatthetimeofhysterectomyisusuallyoptional.Womenwhoseovariesarenotremoveddonotgointomeno-pauseatthetimeofhysterectomy.Hysterectomyisamajorsurgery.Althoughhysterectomyisusuallyquitesafe,itdoescarryasignificantriskofcomplications.Recoveryfromhysterectomyusuallytakessev-eralweeks.

Endometrial Ablation(en-doh-MEE-tree-uhluh-BLAY-shuhn)theliningoftheuterusisremovedordestroyedtocontrolveryheavybleeding.Thiscanbedonewithlaser,wireloops,boilingwater,elec-triccurrent,microwaves,freezing,andothermethods.Thisprocedureusuallyisconsideredminorsurgery.Itcanbedoneonanoutpatientbasisoreveninadoctorsoffice.Complicationscanoccur,butareuncommonwithmostofthemeth-ods.Mostpeoplerecoverquickly.Abouthalfofwomenwhohavethisprocedurehavenomoremenstrualbleeding.Aboutthreein10womenhavemuchlighterbleeding.But,awomancannothavechildrenafterthissurgery.

Myolysis(meye-OL-uh-siss)Aneedleisinsertedintothefibroids,usuallyguidedbylaparoscopy,andelectriccurrentorfreezingisusedtodestroythefibroids.

Uterine Fibroid Embolization(UFE),orUterine Artery Embolization(UAE)Athintubeisthreadintothebloodves-selsthatsupplybloodtothefibroid.Then,tinyplasticorgelparticlesareinjectedintothebloodvessels.Thisblocksthebloodsupplytothefibroid,causingittoshrink.UFEcanbeanoutpatientorinpatientprocedure.Complications,includ-ingearlymenopause,areuncom-monbutcanoccur.StudiessuggestfibroidsarenotlikelytogrowbackafterUFE,butmorelong-termresearchisneeded.NotallfibroidscanbetreatedwithUFE.ThebestcandidatesforUFEarewomenwho:

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sityultrasoundbeam.TheMRIscannerhelpsthedoctorlocatethefibroid,andtheultrasoundsendsoutveryhotsoundwavestodestroythefibroid.TheExAblate2000Systemisamedicaldevicethatusesthismethodtodestroyuterinefibroids.

Somehealthcareprovidersuselaserstoremoveafibroidortocutoffthebloodsupplytothefibroid,makingitshrink.

Mifepristone,andotheranti-hor-monaldrugsbeingdeveloped,couldprovidesymptomreliefwithoutbone-thinningsideeffects.Thesearepromisingtreatments,butnoneareyetavailableorFDAapproved.

Othermedicationsarebeingstudiedfortreatmentoffibroids.

havefibroidsthatarecausingheavybleeding

havefibroidsthatarecausingpainorpressingonthebladderorrectum

dontwanttohaveahysterectomy

dontwanttohavechildreninthefuture

Q: Areothertreatmentsbeingdevelopedforuterinefibroids?

A: Yes.Researchersarelookingintootherwaystotreatuterinefibroids.Thefol-lowingmethodsarenotyetstandardtreatments;soyourdoctormaynotofferthemorhealthinsurancemaynotcoverthem.

MRI-guidedultrasoundsurgeryshrinksfibroidsusingahigh-inten-

For more Information . . . Formoreinformationaboututerinefibroids,callwomenshealth.govat1-800-994-9662orcontactthefollowingorganizations:

National Institute of Child Health and Human Development Clearinghouse PhoneNumber(s):(800)370-2943InternetAddress:http://www.nichd.nih.gov/publications/pubs.cfm

American College of Obstetricians and Gynecologists (ACOG) Resource Center PhoneNumber(s):(202)863-2518(Publicationsrequestsonly)InternetAddress:http://www.acog.org/

Center for Uterine Fibroids PhoneNumber(s):(800)722-5520(Askoperatorfor525-4434)InternetAddress:http://www.fibroids.net

National Uterine Fibroids Foundation PhoneNumber(s):(800)874-7247InternetAddress:http://www.nuff.org/

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AllmaterialcontainedinthisFAQisfreeofcopyrightrestrictions,andmaybecopied,reproduced,orduplicatedwithoutpermissionoftheOfficeonWomen'sHealthintheDepartmentofHealthandHumanServices.Citationofthesourceisappreciated.

ThisFAQwasreviewedby:SteveEisinger,MD,FACOGProfessorofFamilyMedicineProfessorofObstetricsandGynecologyUniversityofRochesterSchoolofMedicineandDentistry

ContentlastupdatedMay 13,2008.