Fibroids

Fibroids are non-cancerous growths in the uterus (womb).  These have no relationship to fibrocystic disease of the breasts.  When examined under a microscope, fibroids are made up of muscle that is swirled into the shape of a small ball. Other names for fibroids include:

  • fibroid tumors,
  • myomas, and
  • leiomyomas.
Also, you may have heard fibroids called fire-balls. At least 25% of all women, if not more, will have fibroids at one time or another; and fibroids occur more frequently in African-American  women than in Caucasian women.
Most women do not know they have uterine fibroids because they are small and cause no problems. It is suspected that genetic factors play a role in fibroids since they seem to run in families. Click on the drawing to see a larger view.

fibroids

Types of Fibroids

Fibroids can vary in size, shape, and location; symptoms may also vary. Additionally, a woman may have a single fibroid or multiple fibroids (I have removed as many as 33 fibroids from one patient at the time of surgery). The size of fibroids can vary from something so small that it can only be seen with a microscope to a mass as large as a softball. Small fibroids are frequently undetected on pelvic examination, whereas multiple large fibroids may occupy the space of a full-term pregnancy. Fibroids are usually symmetrical like a ball, but occasionally are irregular in shape. 
They can be found within the cavity of the uterus (womb), in the wall of the uterus or on the outside surface. Fibroids are sometimes found adjacent to the uterus, especially on ligaments (strong bands of tissue) that support the uterus. When the fibroids are within the cavity of the uterus or are located outside of the uterus, they are sometimes attached with a stalk, like an apple on a stem, a so-called pedunculated fibroid. As noted above, most women do not know they have fibroid tumors.

Symptoms from Fibroids

There are a number of possible problems that can result from fibroids. If you have any of the symptoms listed below, you should contact your doctor since other, potentially more serious causes may be present.

  • Abnormal uterine bleeding, either with heavy menstrual periods or with bleeding in between menstrual cycles – the bleeding itself may only be an annoyance, or it can result in enough blood loss to cause anemia (low iron levels in the blood). A major concern is to make sure the bleeding is not due to something else that could be more serious.
  • Pain in the pelvis, lower abdomen or low back which is usually a dull pain but can also be sharp in nature – The pain may be constant, or it may occur with your menstrual cycle or during sex.
  • Pressure on the bladder which may cause difficulty or frequency of urination and pressure on the rectum may make bowel movements painful or difficult.
  • Miscarriages or obstructed labor – Fibroids usually do not prevent you from becoming pregnant unless the fibroids block both fallopian tubes (the passageway for the egg to move into the uterus after conception has occurred). But a fibroid does not provide a good place for growth of a new pregnancy just like a large rock is not good place for a corn stalk or tomato plant to grow. Once you become pregnant, a large fibroid tumor could block the birth canal making it necessary to be delivered by C-section. But many women go to full term and have a normal vaginal delivery even with large fibroid tumors.

Finding Fibroids

How do I know if I have fibroids? Pelvic examination may be the first indication you have fibroids. Sometimes fibroids are not detected because they are too small or because the patient is too large to allow an accurate exam. Also, it may be difficult to determine whether a mass is a fibroid or an enlargement of an ovary. Ultrasound is a painless test performed in your doctor’s office or x-ray facility that uses sound waves to diagnose fibroids.  A fluid-contrast ultrasound was developed a few years ago in which fluid is gently instilled into the cavity of the uterus – this makes it much easier especially to see fibroids that may be causing abnormal bleeding. 
Hysteroscopy uses a skinny telescope-like instrument so your doctor can look inside the uterine cavity (or cavity inside the womb). The small instrument is inserted vaginally through the cervix and requires no incision. Some hysteroscopies are performed in the doctor’s office and some in the operating room with you asleep. Fibroids inside the uterine cavity can be seen and removed with hysteroscopy. Laparoscopy also uses a telescope-like instrument but requires an incision in the navel and is usually performed in the operating room. Fibroids on the outside and some within the wall of the uterus can be seen and sometimes removed.. Other imaging tests such as MRI (magnetic resonance imaging) and CT (computed tomagraphy) can detect fibroids but are rarely used since less expensive methods such as ultrasound give similar information.

Should I Worry If I Have Fibroids?

What happens to fibroids? Most fibroids go undetected and cause no problems. Estrogen (the main female hormone) can cause fibroid tumors to grow. Sometimes, fibroids will enlarge rapidly during pregnancy when there are high levels of estrogen and shrink after the menopause when estrogen levels decline. Estrogen in birth control pills or that found in hormones given for the menopause may also cause fibroids to grow. Many times the growth of fibroids is not related to pregnancy or hormone treatment. It just happens for unknown reasons. 
Rapid growth of a fibroid may signal a cancerous change in the tumor. But remember that much less than 1% of all fibroids ever show such change. If the fibroid is pedunculated (attached on a stem or stalk), it may twist and cut off the blood supply, resulting in severe pain. A fibroid may simply outgrow its bloody supply which causes it to degenerate, again frequently causing pain. Rarely, a fibroid may become infected.

Treatment of Fibroids

How are fibroids treated? Fibroids that are not large and/or are not growing rapidly and that cause no symptoms require no treatment. After the menopause, the fibroids frequently become smaller. If the fibroids cause symptoms or if they are growing rapidly, several options are available for treatment. The ultimate decision lies with you and your doctor.

  • Medication (called GnRH analogues) have been shown to shrink many fibroids by approximately 1/3 their size. This may also help diminish pain, pressure, or bleeding associated with the fibroids. Several problems exist with this treatment. The medications are expensive, the fibroids usually return to their pretreatment size when the medicine is stopped (usually after 3-6 months), and the medications can have side effects. Medication is sometimes recommended if myomectomy is chosen (see below) or if you are near the menopause.
  • Uterine artery embolization (UAE) has been performed in recent years to treat fibroids. A radiologist carefully directs a small plastic tube to the blood supply that feeds the fibroids and injects an inert substance to block the blood supply to the fibroids. UAE may be used to try to buy time until the fibroids shrink on their own.  In certain cases, UAE may prevent the need for surgery. Certain risks and complications may occur. You should discuss the possibility of UAE in detail with your physician.
  • Conservative surgery or myomectomy can be done to remove just the tumors. Depending on the size, number and location of the fibroids, they may be removed at hysteroscopy or laparoscopy, or a major abdominal incision may be necessary to remove the fibroids. A major concern with this approach is the fibroids may return. If you want to retain fertility potential, myomectomy is the procedure of choice.
  • Hysterectomy or removal of the uterus assures all fibroids within the uterus are removed. Again depending on the circumstances, the surgery may be completed with laparoscopic assistance, vaginally or with an abdominal incision.. Abnormal bleeding, pelvic pain and pressure, difficulty urinating or having a bowel movement, or difficulty carrying a pregnancy may be caused by a number of problems. You should consult your doctor in order to determine the cause of your problem and discuss the best treatment for your situation – whether you have fibroids or not.

 

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for in

 Advanced Healthcare for Women
5354 Reynolds Street, Suite 518
Candler Professional Building
Savannah, Georgia 31405
 
Telephone 912-355-7717
Fax 912-355-0979
gyndoc@bellsouth.net

dividual needs and care.