What are fibroids and how are they treated?

DEAR DOCTOR K:

I saw my doctor because of pain in my pelvis and heavy menstrual bleeding. Tests showed that I have fibroids. What are fibroids and how are they treated?

DEAR READER:

A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea or as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus. The number of fibroids, their size and how fast they grow varies from one woman to another. (I’ve put an illustration of fibroids below.)

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Female hormones encourage fibroids to grow. Fibroids continue growing until menopause, when production of female hormones drops off.

Often, fibroids cause no symptoms. A woman may not realize that she has a fibroid until her gynecologist feels it during a pelvic exam. When symptoms do occur, they can include pain and heavy menstrual bleeding, abdominal swelling, infertility and repeated miscarriages.

If fibroids are small and are not causing any symptoms, they do not need to be treated. You may need regular pelvic exams to make sure your fibroids are not growing rapidly. If your doctor thinks a fibroid is growing so rapidly that it may soon cause symptoms, he or she may prescribe medications to temporarily shrink it. In addition, in rare cases, about one woman in every 50,000 will have a cancer in the uterus that at first is diagnosed as a fibroid.

Your fibroids may need to be removed if they cause significant symptoms, interfere with your fertility, or if your doctor cannot determine whether they are fibroids or cancer. There are several options for removing fibroids:

  • Myomectomy. In this surgical procedure, fibroids are cut out of the uterine wall. This surgery may be done through small incisions or a larger incision in the lower abdomen, depending on the number and size of the fibroids. Myomectomy allows a woman to keep her uterus in case she wants to have children.
  • Hysteroscopic resection. A viewing instrument called a hysteroscope is inserted into the uterus through the vagina. Surgical instruments attached to the hysteroscope remove fibroids from the uterus.
  • Uterine artery embolization. Material is injected into specific blood vessels to stop blood flow to a fibroid or fibroids. Without blood, the fibroids shrink.

    New fibroids can appear any time before you enter menopause after any of these procedures.

  • Hysterectomy. The uterus is removed, along with the fibroids within it. This procedure may be the best option if fibroids are numerous or large, and causing bothersome symptoms that are not responding to treatment. Obviously, a woman who still wants to be able to have children should not have a hysterectomy. Fibroids cannot grow back after a hysterectomy.

Fibroids are more likely to occur in women who are African-American; started menstruating before the age of 10; have had fewer than two pregnancies; eat lots of red meat; or who have vitamin D deficiency (as indicated by a blood test).