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Uterine fibroids

Leiomyoma; Fibromyoma; Myoma; Fibroids; Uterine bleeding - fibroids; Vaginal bleeding - fibroids

 

Uterine fibroids are tumors that grow in a woman's womb (uterus). These growths are typically not cancerous (benign).

Causes

 

Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.

Fibroids are rare in women under age 20. They are more common in African-Americans than White people.

No one knows exactly what causes fibroids. They are thought to be caused by:

  • Hormones in the body
  • Genes (may run in families)

Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds or kilograms. Although it is possible for just one fibroid to develop, most often there is more than one.

Fibroids can grow:

  • In the muscle wall of the uterus (myometrial)
  • Just under the surface of the uterine lining (submucosal)
  • Just under the outside lining of the uterus (subserosal)
  • On a long stalk on the outside the uterus or inside the uterus (pedunculated)

 

Symptoms

 

Common symptoms of uterine fibroids are:

  • Bleeding between periods
  • Heavy bleeding during your period, sometimes with blood clots
  • Periods that may last longer than normal
  • Needing to urinate more often
  • Pelvic cramping or pain with periods
  • Feeling fullness or pressure in your lower belly
  • Pain during intercourse

Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.

 

Exams and Tests

 

Your provider will perform a pelvic exam. This may show that you have a change in the shape of your womb.

Fibroids are not always easy to diagnose. Being obese may make fibroids harder to detect. You may need these tests to look for fibroids:

  • Ultrasound uses sound waves to create a picture of the uterus.
  • MRI uses powerful magnets and radio waves to create a picture.
  • Saline infusion sonogram (hysterosonography). Saline is injected into the uterus to make it easier to see the uterus using ultrasound.
  • Hysteroscopy uses a long, thin tube inserted through the vagina and into the uterus to examine the inside of the uterus.
  • Endometrial biopsy removes a small piece of the lining of the uterus to check for cancer if you have unusual bleeding.

 

Treatment

 

What type of treatment you have depends on:

  • Your age
  • Your general health
  • Your symptoms
  • Type of fibroids
  • If you are pregnant
  • If you want children in the future

Treatment for the symptoms of fibroids may include:

  • Birth control pills to help control heavy periods
  • Intrauterine devices (IUDs) that release hormones to help reduce heavy bleeding and pain
  • Tranexamic acid to reduce the amount of blood flow
  • Iron supplements to prevent or treat anemia due to heavy periods
  • Pain relievers such as ibuprofen or naproxen for cramps or pain
  • Hormone therapy shots to help shrink fibroids (done only for a short time)
  • Watchful waiting. You may have pelvic exams or ultrasounds every once in a while to check the fibroid's growth

Surgery and procedures used to treat fibroids include:

  • Hysteroscopy. This procedure can remove fibroids growing inside the uterus.
  • Uterine artery embolization. This procedure stops the blood supply to the fibroid, causing it to shrink and die. This may be a good option if you want to have children in the future.
  • Myomectomy. This surgery removes the fibroids from the uterus. This also may be a good choice if you want to have children. It will not prevent fibroids from growing again.
  • Hysterectomy. This surgery removes the uterus completely. It may be an option if you do not want children, medicines do not work, and you cannot have any other procedures.

 

Support Groups

 

National Uterine Fibroid Foundation -- www.nuff.org

 

Outlook (Prognosis)

 

If you have fibroids without symptoms, you may not need treatment.

If you have fibroids, they may grow if you become pregnant. This is due to the increased blood flow and higher estrogen levels. The fibroids usually return to their original size after your baby is born.

 

Possible Complications

 

Complications of fibroids include:

  • Severe pain or very heavy bleeding that needs emergency surgery.
  • Twisting of the fibroid. This can cause blocked blood vessels that feed the tumor. You may need surgery if this happens.
  • Anemia (not having enough red blood cells) from heavy bleeding.
  • Urinary tract infections: If the fibroid presses on the bladder, it can be hard to empty your bladder completely.
  • Infertility, in rare cases.

If you are pregnant, there's a small risk that fibroids may cause complications:

  • You may deliver your baby early because there is not enough room in your womb.
  • If the fibroid blocks the birth canal or puts the baby in a dangerous position, you may need to have a C-section.
  • You may have heavy bleeding right after giving birth.

 

When to Contact a Medical Professional

 

Call your provider if you have:

  • Heavy bleeding, increased cramping, or bleeding between periods
  • Fullness or heaviness in your lower belly area

 

 

References

Dolan MS, Hill C, Valea FA. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 18.

Ferri FF. Uterine fibroids. In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier Mosby; 2017:1322-1323.

Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;(12):CD005073. PMID: 25541260 www.ncbi.nlm.nih.gov/pubmed/25541260.

Moravk MB, Bulun SE. Uterine fibroids. In: Jameson JL, De Groot LJ, de Krester DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 131.

Panagiotopoulou N, Nethra S, Karavolos S, Ahmad G, Karabis A, Burls A. Uterine-sparing minimally invasive interventions in women with uterine fibroids: a systematic review and indirect treatment comparison meta-analysis. Acta Obstet Gynecol Scand. 2014;93(9):858-867. PMID: 24909191 www.ncbi.nlm.nih.gov/pubmed/24909191.

Rodriguez MI, Warden M, Darney PD. Intrauterine progestins, progesterone antagonists, and receptor modulators: a review of gynecologic applications. Am J Obstet Gynecol. 2010;202(5):420-428. PMID: 20031112 www.ncbi.nlm.nih.gov/pubmed/20031112.

 
  • Uterine fibroids

    Uterine fibroids

    Animation

  •  

    Uterine fibroids - Animation

    Uterine fibroids are common, non-cancerous or benign tumors that can grow in a woman's womb, or uterus. You might be surprised to learn that one in five women may have this sometimes painful problem during their childbearing years and half of all women will probably have them by age 50. So, let's talk about uterine fibroids. Fibroids are abnormal growths made of smooth muscle cells. The cause of uterine fibroids is unknown, but their growth has been linked to estrogen, a hormone that plays a vital role in pregnancy and how your body uses calcium and maintains healthy cholesterol levels. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. As many as 40% though will shrink on their own. Fibroids can be tiny, detectable only by microscope, or they may grow very large, even filling the entire uterus. Most fibroids are small and cause no symptoms at all. If you do have symptoms, the most common symptoms of fibroids is heavy or prolonged periods. Bleeding between periods is not typical of fibroids. Fibroids can also cause fullness, pressure, or pain. For instance, a fibroid pressing on the bladder can make the bladder seem smaller, or more difficult to empty. A fibroid pressing on the rectum, can cause constipation. Particularly painful periods are often reported by many women with fibroids, especially those who pass blood clots or who have very heavy flow. Fibroids that change the shape of the inside of the uterus can make it difficult to conceive, or to carry a baby to term. To treat uterine fibroids, your doctor will first perform a pelvic exam to see if you have a change in the shape of your uterus. You may need an ultrasound or a pelvic MRI to confirm the diagnosis of fibroids. Your doctor may take a sample of tissue called a biopsy to rule out cancer. Once your doctor diagnoses fibroids, treatments may include birth control pills to manage heavy periods, intrauterine devices that release the hormone progestin to help reduce heavy bleeding and pain, or iron supplements to prevent or treat anemia due to heavy periods. Women who have fibroids growing inside the uterine cavity may need an outpatient procedure to remove the tumors. A procedure called uterine artery embolization can stop the blood supply to a fibroid, causing it to shrink and die. Surgery called myomectomy removes fibroids, especially for women who want to have children. Finally, some women may need a hysterectomy, or the removal of the uterus, if medicines do not work and other surgeries and procedures are not an option. Most women with fibroids may have no symptoms at all and may need no treatment at all. During pregnancy, existing fibroids may grow due to increased blood flow and estrogen levels. But they usually return to their original size after the baby is born. Call your health care provider if you have changes in your periods, including heavier bleeding, increased cramping, or a feeling of fullness or heaviness in your lower belly area.

  • Pelvic laparoscopy

    Pelvic laparoscopy - illustration

    Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

    Pelvic laparoscopy

    illustration

  • Female reproductive anatomy

    Female reproductive anatomy - illustration

    External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

    Female reproductive anatomy

    illustration

  • Fibroid tumors

    Fibroid tumors - illustration

    Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly.

    Fibroid tumors

    illustration

  • Uterus

    Uterus - illustration

    The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

    Uterus

    illustration

  • Uterine fibroids

    Animation

  •  

    Uterine fibroids - Animation

    Uterine fibroids are common, non-cancerous or benign tumors that can grow in a woman's womb, or uterus. You might be surprised to learn that one in five women may have this sometimes painful problem during their childbearing years and half of all women will probably have them by age 50. So, let's talk about uterine fibroids. Fibroids are abnormal growths made of smooth muscle cells. The cause of uterine fibroids is unknown, but their growth has been linked to estrogen, a hormone that plays a vital role in pregnancy and how your body uses calcium and maintains healthy cholesterol levels. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. As many as 40% though will shrink on their own. Fibroids can be tiny, detectable only by microscope, or they may grow very large, even filling the entire uterus. Most fibroids are small and cause no symptoms at all. If you do have symptoms, the most common symptoms of fibroids is heavy or prolonged periods. Bleeding between periods is not typical of fibroids. Fibroids can also cause fullness, pressure, or pain. For instance, a fibroid pressing on the bladder can make the bladder seem smaller, or more difficult to empty. A fibroid pressing on the rectum, can cause constipation. Particularly painful periods are often reported by many women with fibroids, especially those who pass blood clots or who have very heavy flow. Fibroids that change the shape of the inside of the uterus can make it difficult to conceive, or to carry a baby to term. To treat uterine fibroids, your doctor will first perform a pelvic exam to see if you have a change in the shape of your uterus. You may need an ultrasound or a pelvic MRI to confirm the diagnosis of fibroids. Your doctor may take a sample of tissue called a biopsy to rule out cancer. Once your doctor diagnoses fibroids, treatments may include birth control pills to manage heavy periods, intrauterine devices that release the hormone progestin to help reduce heavy bleeding and pain, or iron supplements to prevent or treat anemia due to heavy periods. Women who have fibroids growing inside the uterine cavity may need an outpatient procedure to remove the tumors. A procedure called uterine artery embolization can stop the blood supply to a fibroid, causing it to shrink and die. Surgery called myomectomy removes fibroids, especially for women who want to have children. Finally, some women may need a hysterectomy, or the removal of the uterus, if medicines do not work and other surgeries and procedures are not an option. Most women with fibroids may have no symptoms at all and may need no treatment at all. During pregnancy, existing fibroids may grow due to increased blood flow and estrogen levels. But they usually return to their original size after the baby is born. Call your health care provider if you have changes in your periods, including heavier bleeding, increased cramping, or a feeling of fullness or heaviness in your lower belly area.

  • Pelvic laparoscopy

    Pelvic laparoscopy - illustration

    Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

    Pelvic laparoscopy

    illustration

  • Female reproductive anatomy

    Female reproductive anatomy - illustration

    External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

    Female reproductive anatomy

    illustration

  • Fibroid tumors

    Fibroid tumors - illustration

    Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly.

    Fibroid tumors

    illustration

  • Uterus

    Uterus - illustration

    The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

    Uterus

    illustration

A Closer Look

 

    Self Care

     

    Tests for Uterine fibroids

     

       

      Review Date: 9/26/2015

      Reviewed By: Daniel N. Sacks MD, FACOG, obstetrics & gynecology in private practice, West Palm Beach, FL. Review Provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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