Uterine fibroids: Symptoms, causes and treatment

What Are Uterine Fibroids?

Uterine fibroids are lumps or masses of muscular tissue that grow in or on the uterus, the place a baby grows when a woman is pregnant. These are usually benign (noncancerous), do not increase your chances of developing cancer and do not mean you are at higher risk for uterine cancer or other types of cancer. Uterine fibroids can be as small as a seed or as large as a watermelon. They can occur in nodules (small lumps) or clusters. Anyone with a uterus can develop uterine fibroids.

Types of uterine fibroids:

Intramural fibroids: Grow within the muscular wall of the uterus.
Submucosal fibroids: Grow just beneath the lining of the uterus and extend into the uterine cavity.
Subserosal fibroids: Grow on the outside of the uterus.

Pedunculated fibroids: Grow on a stalk attached to the inside or outside of the uterus.

Uterine Fibroid Symptoms

Symptoms depend on where the fibroid is and its size. Some uterine fibroids have no symptoms and are discovered accidentally.

Symptoms may include:

Heavy bleeding: Periods that last longer than seven days, soak through pads quickly or include large blood clots
Bleeding between periods: Spotting or unexpected bleeding cycles
Pain: Debilitating menstrual cramps, pelvic pain or pain during intercourse
Fertility issues: Inability to get pregnant, multiple miscarriages or early labor

Bulk and pressure symptoms (usually from large fibroids)

Abdominal distention: Growing stomach area or bloating that causes the abdomen to look enlarged or even pregnant
Pelvic and back pain: A constant, heavy feeling in the lower belly, lower back pain or leg aches
Frequent urination: Pressure on the bladder, resulting in a sudden, frequent or uncontrollable need to pee
Difficulty emptying the bladder: Inability to completely pee, or the inability to pee at all
Constipation: Fibroids pushing against the rectum can cause difficult bowel movements, rectal pain or bloating

Causes and Risk Factors for Uterine Fibroids

The exact cause of uterine fibroids isn’t known, but researchers believe hormones, genetics and other factors play a role.

Risk factors include:

Higher estrogen and progesterone levels during reproductive years
Family history of fibroids
Black race, with fibroids often developing earlier and causing more severe symptoms
Obesity
Diets high in red meat and low in fruits and vegetables

Diagnosing Uterine Fibroids

Your healthcare provider may diagnose uterine fibroids during a pelvic exam or recommend imaging tests to confirm the diagnosis and determine the size and location of the fibroids.

Pelvic exam: During a pelvic exam, your healthcare provider gently presses on your uterus to feel for lumps, tenderness or any unusual masses.
Ultrasound: This type of imaging (transabdominal and transvaginal) shows an image of your lower abdomen and pelvis.
MRI: This is used for detailed fibroid mapping, especially before surgery.
Sonohysterography: Sterile saline is injected into the uterus, which expands it and allows a highly detailed look at the uterus.
Hysteroscopy: A thin, flexible camera is guided into the uterus and gives a direct visualization of the uterine cavity (inside of the uterus).

These tests are noninvasive, take about 15 to 60 minutes and often can be performed in your doctor’s office, except an MRI.

Uterine Fibroids and Fertility

Uterine fibroids can affect the ability to conceive, depending on the type and location of the fibroids. Submucosal fibroids — those that grow into the uterine cavity — have the most significant effect on fertility because they can interfere with implantation and affect the uterus’ lining. Other types, such as intramural or subserosal fibroids, may have less effect on conception but can still pose risks during pregnancy, including preterm labor, placental abruption (a serious complication in which the placenta separates from the uterus before delivery), the need for cesarean delivery and bleeding after delivery.

For someone planning a pregnancy, a myomectomy — a surgical procedure that removes fibroids while preserving the uterus — may be recommended before conception, depending on the size, number and location of the fibroids. At Norton Women’s Care, gynecologic surgeons offer fertility-preserving surgical approaches designed to address fibroids with the goal of supporting a healthy pregnancy. If you are experiencing symptoms or have been diagnosed with fibroids and are considering starting or growing your family, talking with a specialist can help you understand your options.

Uterine Fibroid Treatment Options

Treatment for fibroids depends on how severe your symptoms are, the size and location of the fibroids and your desire to preserve fertility or the uterus.

Watchful Waiting

This “wait and see” approach is usually best for asymptomatic uterine fibroids. Your provider will develop a schedule to monitor and test your fibroids so you can make informed choices about fertility and other treatment.

Treatment Options

Hormone therapy – Because fibroids rely on hormones to grow, your health care provider may prescribe birth control pills or other hormones that may help control heavy bleeding. This provides only temporary treatment and will not get rid of fibroids. In women who’ve reached menopause, the fibroid may decrease in size naturally because the body has stopped producing hormones.
Uterine fibroid embolization – Also known as UFE, this minimally invasive fibroid treatment option preserves the uterus and allows most patients to go home the same day. Using imaging technology, an interventional radiologist inserts a small catheter through the groin into the artery that supplies blood to the fibroid. Tiny particles — smaller than a grain of sand — are injected through the catheter to block blood flow to the fibroids, causing them to shrink. To be a candidate for UFE, patients generally have heavy bleeding, pain and/or symptoms caused by the fibroid pressing on other organs, such as the bladder or bowel. You will need a referral to the Pelvic Health Program from your provider if you are interested in UFE.
Myomectomy – The fibroids are removed while keeping the reproductive organs. Depending on the size of the fibroids, this can be performed through a few small incisions (laparoscopically), with robotic-assisted equipment or through a traditional open abdominal surgery.
Hysterectomy – This is a major surgery to remove the uterus and fibroids. Depending on the size of the fibroids, this can be performed laparoscopically, with robotic-assisted equipment, through the vagina, or through a traditional open abdominal surgery. This fibroid treatment option is the only sure way fibroids cannot come back.