This will sound frightening: As many as 80 percent of women will have a tumor called a leiomyoma in their uterus at some point in their lives.
Here’s the good news: Those tumors, more commonly known as fibroids, are not cancerous and may never cause symptoms. If they do, there are a variety of options for treatment.
“Fibroids are a really common type of growth in the muscular wall of the uterus, and most women have them,” says UNC Health gynecologic surgeon Gina Silverstein, MD. “When you hear that diagnosis, it’s scary, but once people understand how common they are and how unlikely they are to be dangerous, they’re more comfortable.”
It’s not clear why fibroids develop or grow, Dr. Silverstein says; there’s likely a genetic component, because fibroids sometimes run in families, and a hormonal component, as they tend to develop after puberty and often shrink after menopause.
While you can’t prevent fibroids from developing, you can get relief if symptoms develop. Dr. Silverstein explains what you need to know.
Symptoms of Fibroids
Fibroids vary in size—they can be as small as a pea or as large as a watermelon (though Dr. Silverstein says they rarely get that big). They can be in various places in and around the uterus: within the uterine walls, on the outside of the uterus or just under the lining, where a baby grows. Your symptoms will vary depending on the size, location and number of fibroids.
“You might have tiny fibroids, but depending on where they are, even small fibroids can cause a lot of bleeding,” Dr. Silverstein says. “Or you might have a fibroid the size of a grapefruit and never have any problems with it.”
Many women have no symptoms, and fibroids are diagnosed during a routine pelvic exam or during an ultrasound related to pregnancy or fertility concerns.
Fibroids—whether they’re causing symptoms or not—can sometimes affect your ability to get pregnant if they’re bulging into the center of the uterus or are close to the uterine lining. Fibroids may be the sole cause of infertility for 2 to 3 percent of women, but once you conceive, they typically don’t affect pregnancy or delivery.
Approximately 25 to 30 percent of women with fibroids experience symptoms, which can include: heavy periods, bleeding in between periods, back pain, abdominal pain, pelvic pain and pain during sex. Some women have urinary symptoms or constipation because the fibroid is pressing on those organs.
“Fibroids can cause what we call ‘bulk symptoms,’ or a feeling in the belly that something’s there that’s not supposed to be there, a pressure or a fullness,” Dr. Silverstein says.
Fibroids do not turn into cancer. Still, these symptoms significantly affect quality of life, and severe blood loss from heavy bleeding can lead to anemia, an iron deficiency that causes fatigue and weakness. If you’re concerned, talk to your provider.
“Some of these symptoms can be due to all sorts of things, but fibroids show up really well on ultrasounds, so they are typically easy to diagnose,” Dr. Silverstein says. “If you’re worried, it’s always worth asking.”
Treatment Options for Fibroids
If you’re not having symptoms, fibroids don’t require treatment.
“It’s OK to just monitor, but that’s when it’s helpful to stay in touch with your body and look for changes to your period or let your provider know if you start having pelvic pain,” Dr. Silverstein says.
Some symptoms can be managed with medications. Birth control pills can help control heavy bleeding (and the hormones in oral contraceptives don’t seem to worsen fibroids, Dr. Silverstein says).
There are medications that block the production of hormones, which can shrink fibroids and ease symptoms but also put the body in a menopause-like state, with no periods and symptoms such as hot flashes.
Your gynecologist may refer you to an interventional radiologist, who can perform a uterine fibroid embolization.
During this procedure, the radiologist makes a small incision to insert a catheter; they inject tiny particles to cut off blood flow to the fibroid. This usually decreases menstrual bleeding and causes the fibroids to stop growing and shrink over time, reducing symptoms. Uterine fibroid embolization has a quick recovery time but may impair your ability to get pregnant and doesn’t always completely resolve symptoms.
Radiofrequency ablation is another minimally invasive procedure in which radiofrequency energy, or heat, is directed at the fibroid to destroy it. This preserves uterine cells around the fibroid. Right now, access to this procedure can be limited depending on where you live.
You may also be a candidate for gynecologic surgery.
“With a hysterectomy, or removal of the uterus, the fibroids will be gone and they won’t come back,” Dr. Silverstein says. “If you’re interested in having children or don’t want to have a hysterectomy, the uterine-sparing option is a myomectomy.”
During a myomectomy, your doctor will remove the existing fibroids. The size and location of your fibroids will dictate how the surgery is performed. Some can be done vaginally so no incisions are needed. With a minimally invasive, or laparoscopic myomectomy, the surgeon will make a few small incisions. Some myomectomies do require opening the abdomen through a larger incision. A myomectomy is often the best choice if you want to have a baby in the future.
“With a myomectomy, we can’t guarantee that fibroids will never grow back, but if they do grow back, they’re typically smaller and not as bothersome,” Dr. Silverstein says. “Most people don’t need another surgery after a myomectomy.”
After menopause, your risk for symptoms related to fibroids is lower, in part because fibroids tend to stop growing, but also because you won’t have period-related symptoms if you’re not menstruating. If you have any abnormal bleeding or pelvic pain after menopause, it’s important to tell your provider.
Again, the approach that is best for you will vary, but Dr. Silverstein says you and your doctor can consider your symptoms and goals when making a decision.
“There’s a misconception that the only treatment is hysterectomy, but these days we have lots of options,” she says. “Not every option will be a good fit for every person, so this is where it can be beneficial to seek out providers who are familiar with fibroids, pelvic pain and abnormal bleeding and can help you decide what is best for you.”
Concerned about bleeding or pain? Talk to your doctor or find one near you.