What Are Uterine Fibroids?

If you consistently have heavy or painful periods, one of the causes may be uterine fibroids. Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Here is what you need to know about uterine fibroid causes, symptoms and treatment options.

What causes uterine fibroids?

It is not entirely clear why fibroids grow, but certain factors are believed to contribute, including:

• Hormone levels – The ovaries produce the hormones estrogen and progesterone. Estrogen plays a role in ovulation (when your ovaries release an egg) and thickens the lining of your uterus. Progesterone helps regulate your cycle. If estrogen levels are too high, it can lead to fibroid development, and if you don't have enough progesterone, the body can't stop the growth.
• Family history – There may be a link to genetics with uterine fibroids. If your mother or sister has uterine fibroids, you are more like to develop them.
• Pregnancy – Because pregnancy changes your estrogen and progesterone hormone levels, they can grow rapidly during pregnancy.

Where can uterine fibroids grow?

Uterine fibroids are noncancerous growths found in the uterus. They can grow in various shapes and sizes, and based on their location within the uterus, they are classified into four types:

• Intramural fibroids – The most common type of uterine fibroid, intramural fibroids grow within the uterus’ muscle wall. They can grow large and stretch the womb.
• Subserosal fibroids – This fibroid grows outside the uterus into the uterine cavity, called the serosa. Because of their location, they can cause your womb to look bigger on one side.
• Submucosal fibroids – Submucosal fibroids grow into the uterine cavity in the middle muscle layer. They are not as common as the other types of uterine fibroids.
• Pedunculated fibroids – Occasionally, subserosal fibroids will grow on stalks inside and outside the uterus, almost resembling a mushroom. When this happens, they are referred to as pedunculated fibroids.

Who is at risk for uterine fibroids?

Uterine fibroids are the most common benign (noncancerous) gynecologic tumors. Fibroids are most common in women in their 40s and early 50s, with more than 80% of African American women and approximately 70% of white women having uterine fibroids by age 50.

What are the symptoms of uterine fibroids?

Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Symptoms can include:

• Heavy or irregular menstrual cycles
• Painful menstrual cycles
• Pelvic pressure or heaviness from the weight of the uterus
• Frequent urination, caused by the pressure put on the bladder by fibroids
• Pain during sex

How are uterine fibroids diagnosed?

If you have symptoms of uterine fibroids, your OB/GYN will first perform a pelvic exam. If the fibroids are large enough, your doctor will be able to feel the fibroids. Your doctor may perform additional tests to see the fibroids internally, such as an ultrasound or magnetic resonance imaging (MRI).

Can I get pregnant if I have uterine fibroids?

Most women with fibroids can have normal pregnancies. However, fibroids can increase your risk of certain complications during pregnancy, such as:

• Cesarean sections – Women with fibroids are six times more likely to need a c-section
• Preterm delivery – A birth that occurs before the 37th week of pregnancy.
• Breeched baby – Occurs when the baby is not positioned correctly for a vaginal delivery
• Placental abruption – Occurs when the placenta separates from the inner wall of the uterus before birth

Medical treatment options for uterine fibroids

Depending on your symptoms, medical management may be the best way to treat your fibroids. Some treatments can control heavy menstrual cycles, while others can also control symptoms related to the size of the fibroids.

• Oral contraceptive pills - Oral contraceptive pills can control some of the symptoms associated with uterine fibroids. Oral contraceptives can make menstrual cycles more predictable, shorter and lighter. Menstrual pain is often improved with the use of oral contraceptive pills.
• Levonorgestrel Intrauterine Device (IUD) - An IUD that contains progestin can be used to treat heavy menstrual cycles. In fact, most women have little to no menstrual cycle after three months of use. IUDs are not recommended for the treatment of all types of fibroids. Submucosal fibroids can increase the rate of expulsion of the IUD.
• GnRH antagonists with add-back therapy - There are two types of oral medications that can treat heavy menstrual bleeding associated with fibroids. Both medications work to decrease your estrogen and progestin production, the two hormones that feed the fibroids. Both medications work quickly and effectively.
• Tranexamic acid - Tranexamic acid (TXA) is an oral medication that reduces heavy periods. It does not have hormones. It works with your clotting system to decrease bleeding. While TXA doesn’t treat fibroids directly, it does work well in decreasing bleeding.
• GnRH agonists - GnRH agonists are injection medications given to decrease the production of estrogen. These are used as short-term treatments before surgery to help shrink the size of uterine fibroids.

Surgical treatment options for uterine fibroids

Medical management may not be the best treatment for all people with fibroids. Because of their symptoms, some may require surgery. There are surgical options that preserve the uterus for childbearing and others that will allow you to keep your uterus, but childbearing may be impacted.

A myomectomy is a procedure that removes the uterine fibroids while conserving the uterus for fertility. Fibroids may return after two to three years, but most people are symptom-free for many years. There are several types of myectomy procedures, and your doctor will help determine which is right for you.

• Hysterectomy myomectomy - For people who have small submucosal fibroids, a hysteroscopic myomectomy may be a treatment option. A hysteroscopic myomectomy is an outpatient procedure. Your surgeon will place a camera through the vagina and into the uterus through the cervix. The doctor can see the fibroids and remove them.
• Robotic myomectomy - With robotic surgery, your surgeon can perform a myomectomy by making four small incisions, each about 1 centimeter in length. This robotic system gives the doctor the visualization and precision of an abdominal myomectomy and gives the patient the benefits of laparoscopic surgery. Those benefits include less blood loss, less postoperative pain and less scarring. Your doctor can determine if this procedure is appropriate for you based on the number, size and location of your fibroids.
• Abdominal myomectomy - Patients with large or numerous fibroids may need an abdominal myomectomy. The surgeon makes a small incision above the pubic bone and surgically removes the fibroids from your uterus.
• Radiofrequency ablation - Radiofrequency ablation is a minimally invasive procedure that burns the fibroids. Under ultrasound guidance, this procedure can be accomplished through the cervix or laparoscopic depending on the location of fibroids. While the uterus is preserved, there is no long-term data about pregnancy after the procedure.

Those who are past their childbearing years have other surgical options for fibroid treatment:

• Uterine artery embolization - Interventional radiologists perform uterine artery embolization procedures. After you are mildly sedated, the radiologist uses a slender, flexible tube to inject small particles into the uterine arteries that supply blood to your fibroids and uterus. These small particles block the blood flow to the uterus and the fibroids. Blocking the blood flow causes the fibroids to shrink. While some successful pregnancies have been reported after this procedure, we recommend this procedure only for women who have completed childbearing.
• Endometrial ablation - Endometrial ablation is a treatment for heavy, prolonged vaginal bleeding. This procedure destroys the endometrial lining (the lining of the uterus).
• Hysterectomy - Hysterectomy is the definitive treatment for fibroids. During a hysterectomy, the surgeon removes your uterus and cervix. Depending on your age and your medical and family history, the surgeon may also remove your ovaries.

Can dietary choices help with uterine fibroids?

Several studies that show that diet can impact the growth of uterine fibroids. One study shows that not getting enough vitamin D or consuming too few fruits and vegetables may increase the risk of uterine fibroids. Also, excess weight can be a risk factor for uterine fibroids, so maintaining a balanced diet and exercising regularly is important.

Consider adding:

• Fruits, like apples, oranges and tomatoes
• High-fiber foods, including cruciferous veggies like broccoli, Brussels sprouts or cabbage
• Green leafy vegetables
• Food high in iron, such as grass-fed beef and legumes
• Whole grains, such as quinoa, barley or wheat

Limit consumption of:

• High-fat, processed meats
• Foods high in salt
• Refined sugar
• Alcohol
• Caffeine