Lesli complained to her gynecologist that her lower back hurt. She was told that she had probably lifted something incorrectly. She sought a second opinion and an ultrasound examination. Fibroids were discovered in Lesli's uterus and were removed by laparoscopy. Over 10 years later, Lesli began experiencing problems again. This time, the culprit was a tennis ball-sized fibroid above her uterus.
Fibroids are benign tumors composed of smooth muscle cells wrapped in a fibrous covering. They are found in the wall of the uterus and sometimes on the cervix. They are also known as myomas, leiomyomas, or fibromyomas.
Fibroids are more common in women in their 30s and 40s. Other risk factors for fibroids include family history, ethnicity (African-American women are more likely to have fibroids than Caucasian women), and obesity.
In many women, fibroids go unnoticed and do not produce symptoms. In others, symptoms may include:
Fibroids can form inside or outside the uterus, or within the uterine wall. They can grow larger than a grapefruit or remain as tiny as a pea. It is possible to have more than one fibroid, and have them in different sizes.
Although an exact cause is not known, it appears that estrogen affects the growth of fibroids. Many fibroids are discovered during pregnancy because they tend to become larger as pregnancy causes an increase in estrogen. Conversely, as estrogen production tapers off during menopause, fibroids may shrink or even disappear.
Fibroids are often discovered during a gynecologic exam. An ultrasound, MRI scan, or sonohysterography may be used to confirm the diagnosis. If the fibroid is large enough, you may be able to feel it yourself by placing your hand on top of it.
If you are found to have fibroids, you will probably be monitored for a period of time to determine their growth rate. If they are not especially large or problematic and are not suspected as a cause of infertility, continued monitoring may be the right treatment for you.
There are a number of treatment options available, including medications and surgical procedures. Again, small fibroids may just be monitored, rather than treated.
There are several medications that treat symptoms of fibroids, while there are others that can be used to shrink the fibroids. Medication options include:
If drug therapies prove unsuccessful, surgery is an alternative. Individual fibroids can be removed using a procedure called myomectomy, which removes the fibroids, but retains the uterus. There are 3 approaches to this particular surgery:
Myomectomy does have risks, and some women have fibroids even after surgery.
In severe cases, a hysterectomy may be advised, which involves removing the uterus.
Less invasive procedures are available, though, such as:
Your doctor will consider a number of factors, such as your age, overall health, and fibroid symptoms before recommending a treatment approach. Get as much information as you can about fibroids and do not be afraid to ask your doctor questions. It is your responsibility to learn more about your condition and explore your options.
Center for Uterine Fibroids
The American Congress of Obstetricians and Gynecologists
The College of Canadian Family Physicians
Womens Health Matters
Committee on practice bulletins—gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206. Reaffirmed 2016.
Uterine fibroids. The American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20130912T1222293657. Updated May 2011. Accessed July 6, 2015.
Uterine fibroids fact sheet. Office on Women's Health website. Available at: https://www.womenshealth.gov/a-z-topics/uterine-fibroids. Updated January 15, 2015. Accessed July 6, 2015.
Uterine leiomyoma. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115612/Uterine-leiomyoma. Updated April 15, 2016. Accessed July 6, 2015.
Last reviewed May 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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