Uterine Fibroids

Are you experiencing pelvic discomfort, pain, or heavy periods? Many women face these challenges, and they could be linked to a condition like uterine fibroids. Understanding this condition and the available treatment options is crucial for taking control of your health and well-being.

What are uterine fibroids?

Uterine fibroids are noncancerous growths that develop in the uterus, commonly occurring during a woman's childbearing years. While the exact cause of fibroids remains unknown, it is believed that hormones such as estrogen and progesterone play a role in their growth.

These growths can take various forms—inside the uterus, within the muscle wall, or on the outer surface.

Many women with uterine fibroids experience mild symptoms or no symptoms at all. However, some women may face painful cramps, heavy menstrual bleeding, and discomfort. Fortunately, there are multiple treatment approaches to address these symptoms.

What are the symptoms of uterine fibroids?

The symptoms of uterine fibroids can vary in intensity and may include:

• Heavier, prolonged periods leading to anemia.
  
  
• Painful periods accompanied by cramping.
  
  
• Spotting before or after menstrual cycles.
  
  
• Bleeding between periods.
  
  
• Pelvic pain and pressure, often extending to the lower back.
  
  
• Pain during sexual intercourse.
  
  
• Frequent urination or urinary leakage.
  
  
• Bowel movement difficulties or pain.
  
  
• Infertility or pregnancy-related complications.

How are uterine fibroids diagnosed?

To diagnose uterine fibroids, your health care provider may perform a pelvic exam, review your medical history, and conduct additional tests. These tests may include pelvic ultrasounds or Hyster sonograms, which help visualize the size and location of fibroids. In some cases, laparoscopy or hysteroscopy may be used to provide a closer look inside the uterus.

If you experience severe pain, heavy bleeding, or other symptoms, your doctor may explore other possible causes, such as endometriosis or pelvic inflammatory disease.

How are uterine fibroids treated?

The treatment approach for uterine fibroids depends on factors like the severity of your symptoms, your fertility goals, and your overall health.

Treatment Options for Uterine Fibroids

For Mild Symptoms or When Nearing Menopause:

If you have uterine fibroids but have few or no symptoms, your doctor may recommend watchful waiting, with no further treatment needed.

This means you will have regular pelvic exams to check on fibroid growth and other symptoms that may arise.

If you are nearing menopause, watchful waiting may also be recommended for you, depending on the severity of your symptoms. After menopause, your estrogen and progesterone levels will drop, causing most fibroids to shrink and symptoms to subside.

Heavy Menstrual Cycles or Pain

If you have heavy menstrual bleeding or pain, it may be from a bleeding uterine fibroid. Keep it mind, it could also be related to a simple menstrual cycle issue or a different issue completely.

Heavy, prolonged, and painful periods caused by uterine fibroids will stop on their own after you reach menopause. If you are nearing menopause and can tolerate your symptoms, you may opt to control your symptoms with home treatment and medicine until menopause.

Your doctor may recommend a medication to relieve heavy menstrual bleeding, anemia, or pain during menstruation.

The following are commonly recommended medications:

Nonsteroidal anti-inflammatory drugs: They relieve menstrual cramping and reduce bleeding for many women.

Hormonal birth control: Pill, patch, or ring. These options typically lighten menstrual bleeding and pain while also preventing pregnancy.

An intrauterine device (IUD): This device releases small amounts of the hormone progesterone into the uterus. It may reduce heavy menstrual bleeding.

A progestin shot (Depo-Provera): Administered every three months, this shot may lighten menstrual bleeding, while also preventing pregnancy. Based on various studies, progestin may either shrink fibroids or make them grow, which can vary depending on the patient.

Iron supplements: These are available without a prescription and are an important part of correcting anemia, caused by fibroid blood loss.

Infertility and Pregnancy Problems:

If you have fibroids and are having difficulty getting pregnant, there is no way to be certain they are the cause of infertility. Fibroids are the cause of infertility in only a small number of women, and most women with fibroids have no trouble getting pregnant.

If a fibroid distorts the wall of the uterus, it can make it difficult for a fertilized egg to implant in the uterus due to the distortion. This may make an in vitro fertilization less likely to be successful if the fertilized egg is unable to implant after being transferred to the uterus.

For women who have uterine fibroids and are unable to get pregnant, your doctor may recommend a myomectomy, which is surgery to remove the fibroid. Because fibroids often grow again, it’s best to try to become pregnant as soon as you can after a myomectomy.

For Severe Fibroid Symptoms:

If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, your doctor may recommend shrinking or removing the fibroid, or in some cases removing the entire uterus with a procedure called a hysterectomy.

It is important to be aware that in all treatment options besides hysterectomy, uterine fibroids may grow back. Removing the fibroids or treating them with medication is recommended for women who plan to become pregnant.

Temporarily Shrinking the Fibroids:

Hormone therapy with a gonadotropin-releasing hormone analog, also known as GnRH-a, puts the body in a state like menopause. This shrinks both the uterus and the fibroids.

This therapy can help to:

• Shrink a fibroid before it is surgically removed. This lowers your risk of heavy blood loss and scar tissue from the surgery.
  
  
• Provide short-term relief as a “bridge therapy” if you are nearing menopause, as fibroids naturally shrink after menopause.

GnRH-a is only used for a few months because it can weaken bones, and in some women, it can cause unpleasant menopausal symptoms. Fibroids grow back after this therapy has ended.

Shrinking or Destroying Fibroids Without Surgery:

• Uterine Fibroid Embolization: This procedure cuts off the blood supply to fibroids, causing them to shrink. While it preserves the uterus, it's not ideal for women planning to become pregnant.
  
  
• MRI-Guided Focused Ultrasound: This innovative treatment uses high-intensity ultrasound waves to break down fibroids, with promising results in symptom relief. This treatment may not be available everywhere, as more studies are needed to find out if it's successful in the long term.
  
  
• Endometrial Ablation: This procedure destroys the uterine lining by laser, heat, electricity, freezing, or microwaves. As the lining of the uterus heals and scars, it reduces or eliminates bleeding. It's not suitable for women who plan to become pregnant.
  
  
• Uterine Fibroid Embolization: This procedure cuts off the blood supply to fibroids, causing them to shrink. While it preserves the uterus, it's not ideal for women planning to become pregnant.

Surgically Removing Fibroids:

• Myomectomy: This surgery often be done through one or more small incisions using laparoscopy or through the vagina. Depending on the location of the fibroid, this surgery can be done using robotic tools, and sometimes a larger incision in the belly is needed. This procedure preserves the uterus, making pregnancy possible for some women.
  
  
• Hysterectomy: For severe cases or women who no longer desire pregnancy, the removal of the entire uterus might be considered.

Dealing with pelvic pain, heavy periods, and related discomfort can greatly impact your everyday life. If you suspect uterine fibroids might be causing your symptoms, seeking medical advice is crucial to get relief.

Your primary care provider may be able to provide a diagnosis or refer you to a urogynecologist. A urogynecologist is a subspecialty of gynecology that is specially trained in gynecology and urology to diagnose and treat medical issues related to the pelvic floor. Learn more about urogynecology.