What Are Fibroids?

Uterine fibroids (also called myomas or leiomyomas) are benign (noncancerous) tumors of muscle tissue that can change the shape or size of the uterus and sometimes the cervix. They start in the smooth muscle cells inside the wall of the uterus (myometrium). Fibroids usually occur in the form of multiple tumors, although single fibroids are sometimes possible. Fibroids are noted in 20% of women in the reproductive years. Whether fibroids cause symptoms or require any type of treatment depends on their location and size in the uterus. Fibroids occur when a single muscle cell in the wall of the uterus multiplies to form a noncancerous tumor. The exact cause of uterine fibroids is unclear, but there is evidence that it may be a combination of genetic, hormonal, and environmental factors.

Fibroids are usually found in or around the body of the uterus, but they sometimes occur in the cervix. Fibroids within the uterus can be divided into three categories: subserous (located in the outer wall of the uterus); intramural (found in the muscular layers of the uterine wall); and submucous (protruding into the uterine cavity).

Can fibroids decrease fertility?
Uterine fibroids are common, and they are found in 5-10% of infertile women. Certain types of fibroids are known to decrease fertility. They include fibroids that are inside the uterine cavity and very large fibroids (>6 cm in diameter) that are located within the wall of the uterus. Because most women with fibroids will not be infertile, they and their partners should have a thorough evaluation to detect other problems that can decrease fertility. A fertility specialist can help determine if fibroids might be hampering their ability to conceive.

How do fibroids cause infertility?
There are several explanations for why uterine fibroids may reduce fertility.

  • Changes in the position of the cervix (the vaginal opening to the womb) due to fibroids located above it may affect the number of sperm that can travel through the cervix.
  • Changes in the shape of the uterus can interfere with sperm movement.
  • Blockage of the fallopian tubes by the fibroids.
  • Affecting the blood flow to the uterine cavity where the embryo would implant.
  • Changes in the uterine muscle that prevents movement of the sperm or the embryo.

Summary
Uterine fibroids are common and can affect fertility in many ways. They can affect ovulation, fertilization and implantation. Treatment options vary, but treatment will help to address the gynecologic symptoms of fibroids and improve overall fertility. Our fertility experts will work to address your individual situation, as the proper management of uterine fibroids will depend upon the severity of your symptoms.

Find more information in the Fertility Library.

Uterine Fibroids

What are fibroids?

Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 50 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 30 to 77 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a health care provider during a physical examination.

In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.

What causes fibroid tumors?

While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.

Who is at risk for fibroid tumors?

Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.

Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.

What are the symptoms of fibroids?

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

  • Low 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, the heavy or prolonged menstrual periods, or the abnormal bleeding between periods, can lead to iron-deficiency anemia, which also requires treatment.

How are fibroids 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 and 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, that is placed in the vagina.

  • Magnetic resonance imaging (MRI). A non-invasive 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.

  • Blood test (to check for iron-deficiency anemia if heavy bleeding is caused by the tumor).

Treatment for fibroids

Since most fibroids stop growing or may even shrink as a woman approaches menopause, the health care provider may simply suggest "watchful waiting." With this approach, the health care provider monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.

In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by your health care provider(s) based on:

  • Your overall health and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

  • Your desire for pregnancy

In general, treatment for fibroids may include:

  • Hysterectomy. Hysterectomies involve the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the United States.

  • Conservative surgical therapy. Conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.

  • Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers 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.

  • Uterine artery embolization. Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Health care providers continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.

  • Anti-inflammatory painkillers. This type of drug is often effective for women who experience occasional pelvic pain or discomfort.

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 30 years. Dr. Carrell is ... Read More

Specialties:

Andrology, In Vitro Fertilization, Reproductive Endocrinology & Infertility

Locations:

Andrology & IVF Laboratories (801) 581-3740

Jessie A. Dorais, M.D.

Jessie Dorais, M.D. as a Clinical Assistant Professor, in the Division of Reproductive Endocrinology and Infertility. Dr. Dorais received a Bachelor of Science degree in Biology from Brigham Young University in 2003, and her M.D. from the University of Illinois, College of Medicine in 2007. She completed her O... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal

Locations:

South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

James M. Hotaling, M.D., FECSM

Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-sp... Read More

Specialties:

Andrology, General Urology, Men's Health, Reproductive Endocrinology & Infertility, Urology

Locations:

Utah Center for Reproductive Medicine (801) 587-1454

Erica B. Johnstone, M.D.

Erica B. Johnstone, M.D., M.H.S., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Johnstone clinical interests include reproductive endocrine disorders and all types of infertility, and she also works with hormonal disorders in children and ad... Read More

Specialties:

In Vitro Fertilization, Menopause, Reproductive Endocrinology & Infertility

Locations:

Centerville Health Center
Madsen Health Center
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

William R. Keye, M.D.

William R. Keye, M.D., is a board-certified physician specializing in obstetrics and gynecology, as well as reproductive endocrinology and infertility. He received his medical degree from the University of Minnesota, and was an original member of the University of Utah’s I.V.F.(in vitro fertilization) team. He s... Read More

Specialties:

Reproductive Endocrinology & Infertility

Locations:

Redstone Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Specialties:

Reproductive Endocrinology & Infertility

Locations:

A location has not yet been added by this physician.

Andrew K. Moore, M.D.

As a sixth-generation resident of Utah Valley, Dr. Moore is pleased to bring the University of Utah’s world-class reproductive medicine closer to home for Utah Valley and southern Salt Lake county residents. He has office hourse daily in Orem, and also each week in South Jordan. During his first year of practi... Read More

Specialties:

Endometriosis, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pelvic Pain, Polycystic Ovary Syndrome, Recurrent Miscarriage, Reproductive Endocrinology & Infertility, Robotic Surgery, Tubal Ligation Reversal

Locations:

Parkway Health Center (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834
Utah Valley Regional Medical Center (801) 581-3834

C. Matthew Peterson, M.D.

Matthew Peterson, M.D., is a Reproductive Endocrinologist in the University of Utah Department of Obstetrics and Gynecology. Dr. Peterson received his undergraduate degree, magna cum laude from Brigham Young University in 1977 and his M.D. from the University of Utah in 1981. His residency training in obstetrics... Read More

Specialties:

Adolescent Gynecology, Endometriosis, Gynecological Surgery, Gynecology, In Vitro Fertilization, Minimally Invasive Pelvic Surgery, Pediatric Gynecology, Polycystic Ovary Syndrome, Reproductive Endocrinology & Infertility, Tubal Ligation Reversal, Women's Genetic Counseling

Locations:

Centerville Health Center (801) 581-3834
Dixie Regional Medical Center
Parkway Health Center (801) 581-3834
South Jordan Health Center (801) 581-3834
University Hospital (801) 581-3834
Utah Center for Reproductive Medicine (801) 581-3834

Reproductive Medicine services are available at the Utah Center for Reproductive Medicine as well as multiple locations through out the state of Utah, including Centerville, Orem, South Jordan and Park City. Our reproductive endocrinologists offer a wide range of services including:

  • Infertility counseling
  • Infertility monitoring and treatment
  • IUD insertion and removal
  • Annual gynecological exams
  • Endocrinology
  • Diagnosis and treatment of polycystic ovary syndrome
  • In vitro fertilization
  • Treatment of endometriosis
  • Pediatric and adolescent gynecology services

Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

Utah Center for Reproductive Medicine 675 Arapeen Way, Suite 205
Salt Lake City, Utah 84108-1237
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University of Utah Health Care
Centerville Health Center
26 South Main
Centerville, Utah 84014
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Dixie Regional Medical Center 544 South 300 East
St. George, UT 84770
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McKay Dee Hospital 4401 Harrison Blvd.
Ogden, UT 84403
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University of Utah Health Care
Redstone Health Center
1743 W. Redstone Center Drive, #115
Park City, Utah 84098
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University of Utah Health Care
South Jordan Health Center
5126 W. Daybreak Parkway
South Jordan, 84095
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Utah Valley Regional Medical Center
Woman’s and Children’s Clinic
1034 N 500 W
Provo, Utah 84604
  • FAZST
    Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility
    Status: Recruiting
  • MORENDO
    Keywords: Endometriosis
    Status: Active, not recruiting
  • Healthy Conceptions for Couples Intervention Pilot Study
    Keywords: Infertility, Obesity, polycystic ovarian syndrome, emotionally focused therapy, weight loss
    Status: Recruiting