What are fibroids?

Fibroid tumors, also called myomas or leiomyomas, are tumors that arise in the muscle wall of the uterus. Fibroids are almost always benign. They are very common, 70-80% of women develop fibroids in their lifetime.  The normal uterine muscle tissue looks pink, while most fibroids are white in appearance. They were originally thought to be fibrous tumors until modern medical techniques identified them as muscle tumors.

What causes fibroids?

We do not know why a uterine muscle cell turns into a fibroid tumor, nor do we know why one woman will develop one fibroid and another might have 50. Fibroid growth may be linked to fluctuations in the levels of estrogen and progesterone in your body. We know that they shrink after menopause, or when medications are given that blow or slow the production of these two hormones. Fibroids are more common in black women than in white, Latina or Asian women.

What types of fibroids are there?

There are three basic types of fibroids: 

• Submucosal Myoma: This kind of fibroid arises close to the uterine cavity and grows into the cavity. This causes heavy or prolonged flow, bleeding between periods, and worsening cramps. Submucosal fibroids may create symptoms even when small. Ultrasound is the best way to diagnose the submucosal fibroid.
• Interstitial (or Intramural) Myoma: Fibroids that arise in the middle of the uterine muscle wall are called interstitial, or intramural fibroid. If an interstitial fibroid grows , it may be called a transmural myoma. As these interstitial fibroids grow they distort the cavity, causing abnormal bleeding and bulk pressure symptoms.
• Subserosal Myoma: This fibroid grows from the uterine muscle wall outwardly into the abdominal cavity. They can grow on stalks, which would be known as a pedunculated myoma. This type of fibroid does not cause bleeding issues generally, but might be the cause of frequent urination, rectal pressure or an abdominal mass.

Are fibroid tumors common in women? 

By age 40, between 30 and 40% of women will have fibroid tumors. The percentages rise between the ages of 40 and 50. Approximately 50% of women with fibroids will require surgery. Just because a woman has a fibroid does not automatically necessitate an operation.

Is there a concern that they could be cancerous?

The American College of OB/GYN (ACOG) recommends treating fibroids as benign. The incidence of cancer in fibroid tumors is 1/1000 cases in premenopausal women. Neither rapid growth nor degeneration has been shown to predict cancer preoperatively. If your fibroids are small and you’ve been experiencing minimal problems, we encourage you to wait before intervening without any worry.

What are the most common symptoms of fibroids?

Some of the most common fibroid symptoms we see at the Advanced Women’s Health Institute include:

• Abnormal uterine bleeding: As fibroids grow, they can cause heavy or abnormal bleeding as they distort the cavity. Several of our patients reported going through super products in 30 minutes or less during the worst part of their period, sometimes for as many as 2-4 days.
• Increased cramping: The normal uterine muscle contracts against the fibroid tumor, which may cause more painful cramps.
• Infertility: Submucosal and larger intramural/interstitial fibroids that distort the uterine cavity have been shown to affect pregnancy rates. Not all fibroids need to be removed before a woman tries to conceive, but it is important to talk to your physician about your risk factors when considering pregnancy.
• Bladder pressure: The bladder is located between the pubic bone and the uterus. As uterine fibroids grow, there is less room for the bladder to expand. This causes more frequent urination. Fibroid enlargement has been known to cause urinary retention, during which you may need a catheter.
• Rectal pressure: The rectum is located behind the uterus, and as the fibroids grow and expand, this may create the sensation of constipation and make bowel movements uncomfortable.
• Pain during intercourse: Some fibroids are dense and firm and act as brick walls to the normally flexible and soft vagina. This causes pain during sex.
• Feeling an abdominal mass: As fibroids grow, they can be felt in the tummy area as a hard spot. You may have difficulty buckling your jeans, or even appear pregnant.
• Pelvic and abdominal pain: Some women with fibroids may also have adenomyosis, which can cause the uterus to be painful to the touch.

What is the best way to diagnose fibroid tumors?

A pelvic examination alone is not adequate to diagnose fibroids. When the uterus is enlarged fibroids are frequently the cause, but not all uterine enlargement is caused by fibroids. The uterus is not usually enlarged when submucosal fibroids are present. Transvaginal ultrasound is the most cost-effective technique to diagnose fibroids. The american College of Obstetricians and Gynecologists states CT- scans or MRI should not be used as the first step for fibroid diagnosis.

After my fibroids have been removed, will they ever come back?

Approximately 30-50% of women are likely to develop new fibroids within 5 years of their operation. Some women will have to undergo a second operation. The younger a woman is when diagnosed, the more likely she will require another procedure. Women who have more than 3 fibroids at the time of surgery are more likely to have recurrence than women who have less than 3.

What is the best treatment for fibroids?

There are several options available depending upon your circumstances, including medications and minimally-invasive surgical procedures. After providing you with an accurate diagnosis, we will discuss the most common options, then the procedure and recovery.