Fibroids (Uterine Leiomyoma)

Definition

Uterine fibroids are tumors or lumps made of muscle cells and other tissue that grow within the wall of the uterus. Fibroids may grow as a single tumor or in clusters. A single fibroid can be less than one inch in size or can grow to eight inches across or more. A bunch or cluster of fibroids can also vary in size.

According to Michigan Medicine, Black women are three times more likely to be diagnosed with fibroids than white women, develop them earlier in life and it can cause more severe symptoms. An astounding 80 percent of women will develop them by their late 40s, according to the National Institute of Environmental Health Services. Researchers have pinpointed new clues as to why more Black women experience uterine fibroids.

Nearly a quarter of Black women between 18 and 30 have fibroids compared to about 6% of white women, according to some national estimates. By age 35, that number increases to 60%. Black women are also two to three times more likely to have recurring fibroids or suffer from complications.

Black women are also at least twice as likely as white women to remove their uterus through a hysterectomy. A third of hysterectomies are done during peak childbearing years between ages 18 and 44.

Alternative Names

Uterine Leiomyoma (pronounced YOU­ter­in lee­oh­my­OH­mah)

Causes

Currently, we know little about what causes uterine fibroids. Scientists have a number of theories, but none of these ideas explains fibroids completely. Most likely, fibroids are the end result of many factors interacting with each other. These factors could be genetic, hormonal, environmental, or a combination of all three. Once we know the cause or causes of fibroids, our efforts to find a cure or even prevent fibroids will move ahead more quickly.

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Symptoms

Many women with uterine fibroids have no symptoms.  Symptoms of uterine fibroids can include:

•    Heavy or painful periods, or bleeding between periods
•    Feeling “full” in the lower abdomen
•    Urinating often
•    Pain during sex
•    Lower back pain
•    Reproductive problems, such as infertility, multiple miscarriages, or early labor

Most women with fibroids do no have problems with fertility and can get pregnant. Some women with fibroids may not be able to get pregnant naturally.  But advances in treatments for infertility may help some of these women get pregnant.

Exams and Tests

Unless you start to have symptoms, you probably won’t know that you have uterine fibroids. Sometimes, health care providers find fibroids during a routine gynecological exam.

• During this exam, the health care provider checks out the size of your uterus by putting two fingers of one hand into the vagina, while applying light pressure to your abdomen with the other hand.
• If you have fibroids, your uterus may feel larger­than­normal; or, if you have fibroids, your uterus may extend into places that it should not.

If your health care provider thinks that you have fibroids, he or she may use imaging technology —machines that create a “picture” of the inside of your body without surgery—to confirm the diagnosis. Some common types of imaging technology include:

• Ultrasound, which uses sound waves to form the picture;
• Magnetic resonance imaging or MRI, which uses magnets and radio waves to build the picture;
• X­rays, which use a form of electromagnetic radiation to “see” into the body; and
• CT or “cat”­scan, which takes x­rays of the body from many angles to provide a more complete image.

Sometimes, health care providers use a combination of these technologies. Sometimes, however, the only way to confirm the presence of

uterine fibroids is through surgery.

• Laparoscopy (pronounced lapp­are­ah­skoe­ pee)—In this procedure, the surgeon makes a small cut into the abdomen, after inflating it with a harmless gas; then, using a small viewing instrument with a light in it, the doctor can look for fibroids.
• Your health care provider may suggest a procedure called a hysteroscopy (pronounced hiss­tur­ah­skoe­pee), which involves inserting a camera on a long tube through the vagina directly into the uterus to see the fibroids.

Keep in mind that because these are surgical procedures, you will need time to recover from them. However, the amount of recovery time you’ll need may vary.

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Treatments

If you have uterine fibroids, but show no symptoms, you many not need any treatment. Women who have pain and other symptoms might benefit If you have uterine fibroids, but show no symptoms or problems, you may not need any treatment. Your health care provider will check the fibroids at your routine gynecological exam to see if they have grown. Also, because fibroids rely on hormones to grow, your fibroids may decrease in size during/after menopause.

If you have pain now­ and ­then or feel mild symptoms, your health care provider may suggest pain medication, ranging from over­ the­ counter remedies to stronger prescription drugs. Treatments include:

• Medications can offer relief from the symptoms of fibroids and even slow or stop their growth.  But, once you stop taking the medicine, the fibroids often grow back.
• There are several types of fibroid surgery:
  • Myomectomy – Removes only the fibroids and leaves the healthy areas of the uterus in place
  • Uterine Artery Embolization (UAE) – Cuts off the blood supply to the uterus and fibroids, making them shrink
  • Hysterectomy – A more major procedure that removes the uterus; this type of surgery is the only sure way to cure fibroids.

Possible Complications

If you have many symptoms or feel pain often, you may benefit from medical therapy—that is, therapy using certain medications rather than surgery. Keep in mind that many medications have side effects, some of them serious.

If you have moderate symptoms of fibroids, surgery may be the best form of treatment. Surgery can be a major or a minor procedure. Talk to your health care provider about the different types of surgery, the possible risks of the procedure, and the side effects.

When to Contact a Medical Professional

Call to make an appointment if you have possible symptoms of a problem from a uterine fibroid, including:

• Heavy bleeding or painful periods
• Bleeding between periods
• Feeling “full” in the lower abdomen— sometimes called “pelvic pressure”
• Urinating often (results from a fibroid pressing on the bladder)
• Pain during sex
• Lower back pain
• Reproductive problems, such as infertility, multiple miscarriages, and early onset of labor during pregnancy

Preventions

Because we don’t know what causes fibroids, we also don’t know what increases or decreases the risk. Once we know the cause or causes of fibroids, our efforts to find a cure or even prevent fibroids will move ahead more quickly.