Unique to Women
Fibroids (Leiomyomas, Myomas)
Fibroids are solid benign smooth-muscle tumors* that appear, often in groups, on the outside, inside, or within the wall of the uterus, possibly changing the size and shape of it. Many fibroids cause no problems at all, and many woman do not even know that they are present. Most women with fibroids can conceive and carry a pregnancy to term without any special treatment.
Some fibroids, depending on size and location, can cause heavy vaginal bleeding, abdominal or back pain, urinary problems, and constipation. Sometimes they may make a woman’s belly look bigger. Fibroids that bulge into the uterine cavity (submucous fibroids) may make it difficult to conceive or to sustain a full-term pregnancy. There are several way to remove fibroids—which one is best depends on the size and location of the fibroids, as well as the skills of your surgeon. In at least 10 to 50 percent of cases in which fibroids are removed, new fibroids grow. However, only about 20 percent of women will require more treatment.
About 30 percent of all women get fibroids by age thirty-five and almost 80 percent of women will have fibroids by age fifty. Black women are more likely to have them, and to get them at a younger age. The cause of fibroids is unknown. About 40 percent of fibroids will grow during pregnancy, usually within the first three months. Some researchers used to think that using oral contraceptives made fibroids grow, but this is not as clear with low-dose pills. Very rarely, taking estrogen after menopause might affect fibroids.
Fibroids may be discovered during a routine pelvic exam. Because fibroids can grow, they should be monitored. If they haven’t grown any more by the time you have your next monitoring exam several months later, a yearly checkup will be enough. Ultrasound can give more definite information about the number and size of fibroids, but this is not always necessary.
If you have fibroids and abnormal bleeding, be sure to get carefully checked for other possible causes of the bleeding.
Medical Treatments for Fibroids
In many cases, no treatment is necessary for fibroids; this is called watchful waiting. If you are nearing menopause, the natural decline in estrogen levels at that time usually shrinks fibroids. Although many physicians recommend hysterectomy—removal of the uterus—as a treatment for fibroids, this is usually not necessary.
Myomectomy. If you have excessive bleeding, pain, urinary difficulties, or problems with pregnancy, you may want to have an operation called a myomectomy to remove the fibroids. Done by a skilled practitioner, myomectomy avoids some of the problems associated with hysterectomy and poses no greater risks. Even large, multiple fibroids can be removed with a myomectomy. There are several approaches, depending on the size and location of the fibroids.
Embolization of the uterine arteries. This procedure, performed by an interventional radiologist, cuts off blood supply to the fibroids, making them shrink. It reduces bleeding and tumor or uterus size in most women who have it done. The recovery time is typically shorter than for surgical removal of fibroids, if the procedure goes smoothly. Complications may include severe pain and fever that might require an emergency hysterectomy, damage to the uterus or other organs, and loss of ovarian function due to a constricted blood supply (this leads to premature menopause). For these reasons, this may be a risky approach for a woman who still wants to get pregnant.
Focused ultrasound surgery. Also called focused ultrasound ablation, this is another less-invasive option, but it can be used only for smaller fibroids and is not widely available.
Other treatments. Sometimes the drug leuprolide acetate (Lupron) is recommended to help shrink fibroids in women approaching menopause or planning to have surgery. However, Lupron has many negative effects, some of which may last many months beyond use of the drug. These include hot flashes, vaginal dryness, trouble with memory and concentration, and bone thinning. Also, after the Lupron is stopped, the fibroids can grow back.
The newest treatment, a medicated intrauterine device (IUD) called Mirena put into the uterus, can reduce bleeding and possibly enable you to avoid surgery.
Some women try to prevent or reduce fibroids by avoiding processed foods and the hormones usually found in commercial meat, dairy, and egg products, but there is no evidence that this will work. If your fibroids cause heavy bleeding, see the self-help treatments on p. 613. Yoga exercises may ease the feelings of heaviness and pressure; some women find visualization techniques helpful, too.
* The word “tumor” used to be a euphemism for cancer, but in fact, tumors are just growths of cells that serve no purpose. Over 90 percent of all tumors are benign (not cancerous) and harmless.
Excerpted from the 2011 edition of Our Bodies, Ourselves. © 2011, Boston Women's Health Book Collective.
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