Uterine Fibroids Causes, Symptoms, Diagnosis, Treatment and FAQs

A uterine fibroid is the most common benign (not cancerous) tumor of a woman’s uterus (womb). It is also called uterine myoma. Fibroids are tumors of the smooth muscle found in the wall of the uterus.

They can develop within the uterine wall itself or attach to it. They may grow as a single tumor or in clusters. Uterine fibroids can cause excessive menstrual bleeding, pelvic pain, and frequent urination.

• These growths occur in up to 50% of all women and are one leading cause of hysterectomy (removal of the uterus) in the United States. An estimated 600,000 hysterectomies are performed in the US annually, and at least one-third of these procedures are for fibroids. Medications and newer, less invasive surgical treatments are now available to help control the growth of fibroids.
• Fibroids start in the muscle tissues of the uterus. They can grow into the uterine cavity (submucosal), into the thickness of the uterine wall (intramuscular), or on the surface of the uterus (subserosal) into the abdominal cavity. Some may occur as pedunculated masses (fibroids growing on a stalk off of the uterus).
• Although these tumors are called fibroids, this term is misleading because they consist of muscle tissue, not fibrous tissue. The medical term for a fibroid is leiomyoma, a type of myoma or mesenchymal tumor.

The exact reasons why some women develop fibroids are unknown. Fibroids tend to run in families, and affected women often have a family history of fibroids. Women of African descent are two to three times more likely to develop fibroids than women of other races.

Fibroids grow in response to stimulation by the hormone estrogen, produced naturally in the body. These growths can show up as early as age 20 but tend to shrink after menopause when the body stops producing large amounts of estrogen.

Fibroids can be tiny and cause no problems, or they also can grow to weigh several pounds. Fibroids generally tend to grow slowly.

The following factors have been associated with the presence of fibroids:

• Being overweight, obesity
• Never having given birth to a child (called nulliparity)
• The onset of the menstrual period before age 10
• African American heritage (occurring 3-9 times more often than in Caucasian women)

Are fibroids serious? Can fibroids disappear on their own?

For the most part, uterine fibroids that do not cause a problem for the woman can be left untreated. In some cases, even fibroids that are not causing symptoms require removal or at least close observation. Rapid growth is a reason to watch more carefully, since a rare cancerous form of fibroid (referred to as a leiomyosarcoma) can be a fast-growing tumor, and it cannot be differentiated from a benign fibroid by ultrasound, MRI, or other imaging studies. However, this type of tumor occurs in less than 1% of uterine fibroids. It is also important to note that these rare cancerous tumors are not thought to begin in a benign fibroid.

Another risk of leaving these tumors alone is that they sometimes grow to a size that eventually causes significant symptoms, thus requiring removal. If fibroids grow large enough, the surgery to remove them can become more difficult and risky.

Uterine Fibroids Diagnosis

Uterine fibroids are frequently found incidentally during a routine pelvic exam. Your doctor may feel irregularities in the shape of your uterus, suggesting the presence of fibroids.

If you have symptoms of uterine fibroids, your doctor may order these tests:

• Ultrasound. If confirmation is needed, your doctor may order an ultrasound. It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. A doctor or technician moves the ultrasound device (transducer) over your abdomen (transabdominal) or places it inside your vagina (transvaginal) to get images of your uterus.
• Lab tests. If you have abnormal menstrual bleeding, your doctor may order other tests to investigate potential causes. These might include a complete blood count (CBC) to determine if you have anemia because of chronic blood loss and other blood tests to rule out bleeding disorders or thyroid problems.

Other imaging tests

• Magnetic resonance imaging (MRI). This imaging test can show in more detail the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options. MRI is most often used in women with a larger uterus or women approaching menopause (perimenopause).
• Hysterosonography. Hysterosonography also called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of submucosal fibroids and the lining of the uterus in women attempting pregnancy or who have heavy menstrual bleeding.
• Hysterosalpingography. Hysterosalpingography uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. This test can help your doctor determine if your fallopian tubes are open or are blocked and can show some submucosal fibroids.
• Hysteroscopy. For this, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus. Your doctor then injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.

Uterine Fibroids Risk factors

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Factors that can have an impact on fibroid development include:

• Race. Black women are more likely to have fibroids than are women of other racial groups. Also, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids, along with more severe symptoms.
• Heredity. If your mother or sister had fibroids, you’re at increased risk of developing them.
• Other factors. The onset of menstruation at an early age; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

Uterine Fibroids Complications

Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anemia), which causes fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss.

Pregnancy and fibroids

Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids — especially submucosal fibroids — could cause infertility or pregnancy loss.

Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction, and preterm delivery.

Uterine Fibroids Prevention

Although researchers continue to study the causes of fibroid tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment.

But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.

Also, some research suggests that using hormonal contraceptives may be associated with a lower risk of fibroids.

Uterine Fibroids Treatment

There’s no single best approach to uterine fibroid treatment — many treatment options exist. If you have symptoms, talk with your doctor about options for symptom relief.

Watchful waiting

Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option.

Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.

Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids but may shrink them. Medications include:

• Gonadotropin-releasing hormone (GnRH) agonists. Medications called GnRH agonists to treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. As a result, menstruation stops, fibroids shrink and anemia often improves.GnRH agonists include leuprolide (Lupron, Eligard, others), goserelin (Zoladex) and triptorelin (Trelstar, Triptodur Kit). Many women have significant hot flashes while using GnRH agonists. GnRH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.Your doctor may prescribe a GnRH agonist to shrink the size of your fibroids before planned surgery or to help transition you to menopause.
• Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear. It also prevents pregnancy.
• Tranexamic acid (Lysteda, Cyklokapron). This nonhormonal medication is taken to ease heavy menstrual periods. It’s taken only on heavy bleeding days.
• Other medications. Your doctor might recommend other medications. For example, oral contraceptives can help control menstrual bleeding, but they don’t reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don’t reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.

MRI-guided focused ultrasound surgery (FUS) is:

• A noninvasive treatment option for uterine fibroids that preserves your uterus, requires no incision and is done on an outpatient basis.
• Performed while you’re inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The images give your doctor the precise location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses on sound waves (sonications) into the fibroid to heat and destroy small areas of fibroid tissue.
• Newer technology, so researchers are learning more about the long-term safety and effectiveness. But so far data collected show that FUS for uterine fibroids is safe and effective.

Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

• Uterine artery embolization. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised. However, research shows that complications are similar to surgical fibroid treatments and the risk of transfusion is substantially reduced.
• Radiofrequency ablation. In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. This can be done during a laparoscopic or transcervical procedure. A similar procedure called cryomyolysis freezes the fibroids. With laparoscopic radiofrequency ablation, also called Lap-RFA, your doctor makes two small incisions in the abdomen to insert a slim viewing instrument (laparoscope) with a camera at the tip. Using the laparoscopic camera and a laparoscopic ultrasound tool, your doctor locates fibroids to be treated. After locating a fibroid, your doctor uses a specialized device to deploy several small needles into the fibroid. The needles heat the fibroid tissue, destroying it. The destroyed fibroid immediately changes consistency, for instance from being hard like a golf ball to be soft like a marshmallow. During the next three to 12 months, the fibroid continues to shrink, improving symptoms.Because there’s no cutting of uterine tissue, doctors consider Lap-RFA a less invasive alternative to hysterectomy and myomectomy. Most women who have the procedure get back to regular activities after 5 to 7 days of recovery.The transcervical — or through the cervix — approach to radiofrequency ablation also uses ultrasound guidance to locate fibroids.
• Laparoscopic or robotic myomectomy. In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place. If the fibroids are few, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Larger fibroids can be removed through smaller incisions by breaking them into pieces (morcellation), which can be done inside a surgical bag, or by extending one incision to remove the fibroids.Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Robotic myomectomy gives your surgeon a magnified, 3D view of your uterus, offering more precision, flexibility, and dexterity than is possible using some other techniques.
• Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
• Endometrial ablation. This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Typically, endometrial ablation is effective in stopping abnormal bleeding. Submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this doesn’t affect fibroids outside the interior lining of the uterus. Women aren’t likely to get pregnant following endometrial ablation, but birth control is needed to prevent a pregnancy from developing in a fallopian tube (ectopic pregnancy).

With any procedure that doesn’t remove the uterus, there’s a risk that new fibroids could grow and cause symptoms.

Traditional surgical procedures

Options for traditional surgical procedures include:

• Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead. However, scarring after surgery can affect future fertility.
• Hysterectomy. This surgery — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. Hysterectomy ends your ability to bear children. If you also elect to have your ovaries removed, the surgery brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women with uterine fibroids may be able to choose to keep their ovaries.

Morcellation during fibroid removal

Morcellation — a process of breaking fibroids into smaller pieces — may increase the risk of spreading cancer if a previously undiagnosed cancerous mass undergoes morcellation during myomectomy. There are several ways to reduce that risk, such as evaluating risk factors before surgery, morcellating the fibroid in a bag or expanding an incision to avoid morcellation.

All myomectomies carry the risk of cutting into undiagnosed cancer, but younger, premenopausal women generally have a lower risk of undiagnosed cancer than do older women.

Also, complications during open surgery are more common than the chance of spreading undiagnosed cancer in a fibroid during a minimally invasive procedure. If your doctor is planning to use morcellation, discuss your risks before treatment.

The Food and Drug Administration (FDA) advises against the use of a device to morcellate the tissue (power morcellator) for most women having fibroids removed through myomectomy or hysterectomy. In particular, the FDA recommends that women who are approaching menopause or who have reached menopause avoid power morcellation. Older women in or entering menopause may have a higher cancer risk, and women who are no longer concerned about preserving their fertility have additional treatment options for fibroids.

If you’re trying to get pregnant or might want to have children

Hysterectomy and endometrial ablation won’t allow you to have a future pregnancy. Also, uterine artery embolization and radiofrequency ablation may not be the best options if you’re trying to optimize future fertility.

Have a full discussion of the risks and benefits of these procedures with your doctor if you want to preserve the ability to become pregnant. Before deciding on a treatment plan for fibroids, a complete fertility evaluation is recommended if you’re actively trying to get pregnant.

If fibroid treatment is needed — and you want to preserve your fertility — myomectomy is generally the treatment of choice. However, all treatments have risks and benefits. Discuss these with your doctor.

Risk of developing new fibroids

For all procedures except hysterectomy, seedlings — tiny tumors that your doctor doesn’t detect during surgery — could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. New fibroids, which may or may not require treatment, also can develop.

Also, some procedures — such as laparoscopic or robotic myomectomy, radiofrequency ablation, or MRI-guided focused ultrasound surgery (FUS) — may only treat some of the fibroids present at the time of treatment.

Frequently Asked Questions About Uterine Fibroids

What does fibroid pain feel like?

Pelvic Discomfort Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.

What causes uterine fibroids to grow?

Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.

Hormones. Estrogen and progesterone, are two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids.

Are fibroids serious?

Fibroids do not normally result in complications, but if they occur, they can be serious and even life-threatening.

Do fibroids make you tired?

Tiredness or fatigue is one of the sneaky signs of fibroid. It is easy to miss as a symptom of fibroids because it’s not caused by overwork or a lack of sufficient sleep at night but is mainly due to the loss of blood from heavy periods. This blood loss leads to anemia and an iron deficiency from the lack of red blood cells.

What size of fibroids needs surgery?

A myomectomy can be performed through an open incision, or in some cases, laparoscopically. Most experts believe that about 9-10 centimeters (about 4 inches) diameter is the largest size fibroid that should be removed laparoscopically.