Unique to Women
Fibroids (Leiomyomas, Myomas)
Fibroids are solid benign tumors that appear, sometimes in groups, on the outside, inside, or within the wall of the uterus, often changing the size and shape of it. About 30 percent of all women get fibroids by age thirty-five; black women are more likely to have them, and to get them at a younger age. The cause of fibroids is unknown, but these growths seem to be related to estrogen production. They may grow more quickly if you are pregnant, using oral contraceptives, or taking estrogen for hot flashes (all of which raise estrogen levels in the body).
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.
Often fibroids don’t cause symptoms. However, some fibroids may cause pain, bleeding between periods, or excessive menstrual flow.16 If you have fibroids and abnormal bleeding, be sure to get carefully checked for other possible causes of the bleeding (see p. 618). Depending on their size and location, fibroids can also cause abdominal or back pain, urinary problems, and constipation, and your belly may look bigger. Large fibroids sometimes make it difficult to conceive or to sustain a full-term pregnancy.
If you are taking estrogen in any form, you may be able to reduce large fibroids by not taking it anymore. Some women try to prevent or reduce fibroids by avoiding processed foods and the hormones usually found in commercial meat, dairy, and egg products. If your fibroids cause heavy bleeding, see the self-help treatments in “Abnormal Uterine Bleeding” (p. 618). Yoga exercises may ease the feelings of heaviness and pressure; some women find visualization techniques helpful, too.
In many cases, no treatment is necessary for fibroids; this is called watchful waiting. If you have excessive bleeding, pain, urinary difficulties, or problems with pregnancy, you may want to have an operation to remove the fibroids (myomectomy). This usually requires an abdominal incision, but sometimes it can be done with less invasive techniques (laparoscopy or hysteroscopy), which also means less anesthesia and therefore less risk. Even large, multiple fibroids can be removed with a myomectomy. Depending on where the fibroids were growing, myomectomy may make it harder or easier for you to get pregnant. In at least 10 to 25 percent of cases, new fibroids grow. Given enough time and continued hormone stimulation, most women with fibroids are likely to develop new ones.
Embolization of the uterine arteries is a newer, less invasive technique that cuts off blood supply to the fibroids and makes them shrink. It reduces bleeding, other symptoms, and tumor or uterus size in most women who have it done, and the complication rate is low.17 This procedure is done by radiologists. The recovery time is shorter, and for women close to menopause, it is probably safer. For women still intending to have children, the effects on pregnancy and childbirth are not yet known.
Many physicians recommend hysterectomy (removal of the uterus) as a treatment for fibroids in women who are past childbearing age or who do not want more children. This surgery may be unnecessary, particularly if you are nearing menopause, when the natural decline in estrogen levels usually shrinks fibroids. Moreover, hysterectomy, like any major surgery, carries some risks. (For more information, see p. 637.) Embolization or myomectomy--done by a skilled practitioner--avoids some of the problems associated with hysterectomy and poses no greater risks. New laser techniques for dissolving fibroids are also being investigated.
Sometimes the drug Lupron is recommended to women approaching menopause or planning to have surgery, to help shrink fibroids. Many practitioners now consider Lupron inappropriate to use for longer than six months, because its negative side effects include menopausal symptoms and bone thinning.
The newest treatment, having a medicated IUD (intra-uterine device) put into the uterus, can reduce bleeding and may shrink fibroids, possibly enabling you to avoid surgery.18
Excerpted from the 2005 edition of Our Bodies, Ourselves, © 2005, Boston Women's Health Book Collective.
16. S. A. Lippman et al., Uterine Fibroids and Gynecologic Pain Symptoms in a Population-Based Study, Fertility and Sterility 80, no. 6 (December 2003): 1488.
17. J. Golzarian, S. Murgo, M. Laureys, et al., Uterine Fibroids Embolization: A Review, Journal Belge de Radiologie 85, no. 1 (2002): 7-13. See also S. Murgo, P. Simon, J. Golzarian, Embolization of Uterine Fibroids, Revue Medicale Bruxelles 23, no. 5 (October 2002): 435-42; and J. B. Spies, A. Spector, A. R. Roth, et al., Complications After Uterine Artery Embolization for Leiomyomas, Obstetrics and Gynecology 100, no. 5 (part 1) (November 2002): 873-80.
18. V. Grigorieva et al., Use of a Levonorgestrel-Releasing Intrauterine System to Treat Bleeding Related to Uterine Leiomyomas, Fertility and Sterility 79, no. 5 (May 2003): 1194-98. See also A. E. Lethaby, I. Cooke, M. Rees, Progesterone/Progestogen Releasing Intrauterine Systems for Heavy Menstrual Bleeding, Cochrane Review no. 4 (2004); and R. Nagrani et al., Can the Levonorgestrel Intrauterine System Replace Surgical Treatment for the Management of Menorrhagia? British Journal of Obstetrics and Gynecology 109, no. 3 (March 2002): 345-47.
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