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.
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.
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)
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.
The Facts About Fibroids
Myoma. Leiomyoma. Fibroids. These are names for a common medical condition that affects many women. Fibroid tumors may sound like a serious condition, but for many women who have them, they're just a fact of life.
Fibroids are noncancerous growths that develop in the walls of the uterus. Each fibroid grows when a single cell in the uterine wall becomes supersensitive to estrogen. The more estrogen that is around, the bigger the fibroid may grow. Fibroids sometimes grow quite large during pregnancy, but shrink afterward. They also often shrink or disappear after menopause, when estrogen levels drop.
Many women have questions about fibroids. Here are the facts.
What are my chances of developing fibroid tumors?
Up to 80 percent of women develop fibroids by the time they reach age 50. You are more likely to get fibroids if a close relative has fibroids. Your chances are also higher if you are African American.
How can I tell if I have fibroids?
Many women have fibroids and don't know it. Often, a health care provider will discover them during a routine pelvic exam. Some women notice symptoms. These vary depending on the location, size and number of growths. Most women who develop fibroids have more than one tumor. Because the vast majority of the time fibroids do not become cancerous, unless you are having problems from your fibroids, there is no reason to do anything about them.
These are some of the symptoms fibroids may cause:
Heavy or longer menstrual bleeding
Bleeding between periods
Low abdominal or low back pain
Frequent urination (if a tumor presses on the bladder)
Constipation (if a tumor presses on the rectum)
Pregnancy losses and possibly infertility
Your health care provider will perform an examination of your abdomen and pelvis and may do an ultrasound to determine the cause of your symptoms. This painless procedure can help locate a growth and determine if it is a fibroid.
If I develop fibroids, what are my options for treatment?
Treatments vary depending on the size of the tumors and the severity of your symptoms:
Watchful waiting. If fibroids aren't causing you problems, your health care provider may decide to monitor their growth at your annual exam. This is the most common approach because most fibroids don't cause any problems. Sometimes they shrink or disappear on their own.
Medication. Certain medications can help control bleeding by blocking estrogen production. Blocking production of estrogen may temporarily help shrink fibroids. Often this type of medication is used to shrink tumors before surgery.
Surgery. Surgery may be necessary if you have severe symptoms. One type of surgery removes only the tumor (myomectomy). New treatments include uterine artery embolization, in which the blood vessels that feed the fibroid are blocked; and destruction of the fibroids with an extremely hot or cold instrument, using laparoscopy through the abdomen or the cervix. These treatments are possibilities depending on the location and size of the fibroid. If the main problem is bleeding, sometimes combining removal of the fibroids through the cervix with removal of the uterine lining by coagulation, laser, or heat will stop the bleeding. In some cases, a hysterectomy may be preferred if a woman does not want to have children anymore, has heavy bleeding or is postmenopausal. Most women who develop fibroids do not need a hysterectomy.
All treatments for fibroids have pros and cons. Be sure to talk with your health care provider and weigh your options before deciding on a course of action.
If I have fibroids, am I at higher risk for cancer?
No. Having fibroids does not increase your risk for cancer. Only in very rare cases does a fibroid growth become cancerous. Fear of cancer in the fibroids is generally not a good reason for hysterectomy, unless your health care provider suspects that problem for other reasons.
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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:
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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.
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Centerville, Utah 84014
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St. George, UT 84770
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Ogden, UT 84403
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Provo, Utah 84604
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