Condition Basics

What are uterine fibroids?

Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside, on the outside, or in the wall of your uterus.

Your doctor may call them fibroid tumours, leiomyomas, or myomas. But fibroids aren't cancer. You don't need to do anything about them unless they are causing problems.

Fibroids are very common in women in their 30s and 40s. But fibroids usually don't cause problems. Many women never even know they have them.

What causes them?

Doctors aren't sure what causes fibroids. But the hormones estrogen and progesterone seem to make them grow. Your body makes the highest levels of these hormones during the years you have periods.

What are the symptoms?

Pain and heavy menstrual bleeding are the most common symptoms of uterine fibroids. But often fibroids don't cause any symptoms. Or symptoms may be mild, like periods that are a little heavier than normal. In some cases, having trouble getting pregnant is the first sign of fibroids.

How are they diagnosed?

To find out if you have fibroids, your doctor will ask about your symptoms. He or she will do a pelvic examination to check the size of your uterus. Your doctor may do an ultrasound or other tests to see inside your uterus. You may have blood tests to look for other problems.

How are uterine fibroids treated?

For mild symptoms of fibroids or if you're near menopause, you don't need to do anything. If you have pain and heavy bleeding, try a non-prescription medicine like ibuprofen, or ask about birth control pills. If you're near menopause, medicines can help treat symptoms. For severe problems, procedures can shrink or remove fibroids.

What Increases Your Risk

Things that increase a woman's risk for uterine fibroids include:

• Age. Fibroids become more common as women age, especially from the 30s and 40s through menopause. After menopause, fibroids usually shrink.
• Family history. Having a family member with fibroids increases your risk.
• Ethnic origin. Black women are more likely to develop fibroids than white women.
• Obesity.

Symptoms

Uterine fibroid symptoms can develop slowly over several years or quickly over several months. Most women with fibroids have mild symptoms or none at all. But for some women, the symptoms become a problem. The types of symptoms women have can depend on where the fibroid is found in the uterus.

Uterine fibroid symptoms and problems include:

Abnormal menstrual bleeding.

This includes:

• Heavier, prolonged periods that can cause anemia.
• Painful periods.
• Spotting before or after periods.
• Bleeding between periods.

Pelvic pain and pressure.

This includes:

• Pain in the belly, pelvis, or low back.
• Pain during sexual intercourse.
• Bloating and feelings of pressure in the belly.

Urinary problems.

These include:

• Frequent urination.
• Leaking urine.
• Kidney blockage following ureter blockage (rare).

Other symptoms.

These may include:

• Difficult or painful bowel movements.
• Difficulty getting pregnant.
• Problems with pregnancy, such as placental abruption and preterm labour.

What Happens

Uterine fibroids can grow on the inside wall of the uterus, within the muscle wall of the uterus, or on the outer wall of the uterus. They can alter the shape of the uterus as they grow. Over time, the size, shape, location, and symptoms of fibroids can change.

As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s through menopause (around age 50). Uterine fibroids can stay the same for years with few or no symptoms, or you can have a sudden, rapid growth of fibroids.

Fibroids do not grow before the start of menstrual periods (puberty). They sometimes grow larger during the first trimester of pregnancy, and they usually shrink for the rest of a pregnancy. After menopause, when a woman's hormone levels drop, fibroids usually shrink and don't come back.

Complications of uterine fibroids

Complications of uterine fibroids aren't common. Some of the problems that may happen are:

• Anemia from heavy bleeding.
• Problems with the urinary tract or bowels, if a fibroid presses on them.
• Infertility, especially if the fibroids grow inside the uterus and change the shape of the uterus.
• Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
• Infection or a breakdown of uterine fibroid tissue.

Fibroids can cause problems during pregnancy, such as:

• The need for a caesarean section delivery. This is the most common effect of fibroids on pregnancy.^{footnote 1}
• Preterm labour and delivery.
• Pain during the second and third trimesters.
• An abnormal fetal position, such as breech position, at birth.
• Placenta problems.

When to Call a Doctor

Call your doctor to make an appointment if you have:

• Heavy menstrual bleeding.
• Periods that have changed from relatively pain-free to painful over the past 3 to 6 months.
• Frequent painful urination, or you can't control the flow of urine.
• A change in the length of your menstrual cycle over 3 to 6 menstrual cycles.
• New persistent pain or heaviness in the lower belly or pelvis.

Watchful waiting

If you have uterine fibroids but you have few or no symptoms, you don't need treatment. Instead, your doctor will recommend watchful waiting. This means that you will have pelvic examinations to check on fibroid growth and symptoms. Talk with your doctor about how often you will need a checkup.

Examinations and Tests

To find out if you have fibroids, your doctor will ask you about your symptoms and your menstrual periods. Your doctor will do a pelvic examination to check the size of your uterus.

You may get an ultrasound or another type of test that shows pictures of your uterus. These help your doctor see how large your fibroids are and where they are growing.

Your doctor may also do blood tests to look for anemia or other problems. You may have a laparoscopy. This looks for fibroids on the outside of your uterus. Sometimes hysteroscopy is used. It lets the doctor check the inside of your uterus.

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Treatment Overview

If your fibroids aren't bothering you, you don't need to do anything about them. Your doctor may check them during your regular visits to see if they have gotten bigger.

But if you have a fibroid problem, there are several treatments to consider. What treatment you choose may depend on how bad your symptoms are, if you want to get pregnant, and how close you are to menopause.

For heavy menstrual bleeding or pain

The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods. But they don't shrink fibroids. These include:

• Non-steroidal anti-inflammatory drugs (NSAIDs). They improve menstrual cramping and reduce bleeding for many women.
• Birth control hormones (pill, patch, or ring). They lighten menstrual bleeding and pain while preventing pregnancy.
• An intrauterine device (IUD) that releases small amounts of progestin into the uterus. It may reduce heavy menstrual bleeding.
• A progestin shot (Depo-Provera) every 3 months. It may lighten your bleeding.
• Iron supplements. They can help correct anemia caused by fibroid blood loss.

For infertility and pregnancy problems

Most women with fibroids have no trouble getting pregnant. But if a fibroid distorts the wall of the uterus, it can prevent a fertilized egg from implanting in the uterus. Surgery to remove the fibroid, called myomectomy, may improve your chances of having a baby.^{footnote 2}

For severe fibroid symptoms

If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, there are treatments you can try. After all treatments except hysterectomy, fibroids may grow back. If you plan to get pregnant, talk with your doctor about which treatment is right for you.

You can try:

Shrinking a fibroid for a short time.

Hormone therapy with a gonadotropin-releasing hormone analogue (GnRH-a) puts the body in a state like menopause. This shrinks both the uterus and the fibroids. Fibroids grow back after GnRH-a therapy has ended.

Shrinking or destroying fibroids without surgery.

• Uterine fibroid embolization stops the blood supply to the fibroid. The fibroid then shrinks and may break down.
• MRI-guided focused ultrasound uses high-intensity ultrasound waves to break down the fibroids.
• Endometrial ablation is a treatment that destroys the lining of the uterus. As the lining of the uterus heals, it will scar. This scarring reduces or prevents bleeding.

Surgery to remove fibroids.

This surgery is called myomectomy. It preserves the uterus, and it makes pregnancy possible for some women.

Surgery to remove the entire uterus.

This surgery is called hysterectomy. It is available to women with long-lasting or severe symptoms who have no future pregnancy plans.

When nearing menopause

If you are nearing menopause and can tolerate your symptoms, you can try to control them with home treatment and medicine. After menopause, your estrogen and progesterone levels will drop. This causes most fibroids to shrink and symptoms to subside.

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Self-Care

Try one or more of these tips to help relieve your menstrual pain.

• Take non-steroidal anti-inflammatory drugs (NSAIDs).

  NSAIDs help relieve menstrual cramps and pain. Examples include ibuprofen and naproxen.

• Put heat on your lower belly.

  Use a heating pad or hot water bottle, or take a warm bath. Heat improves blood flow and may ease pelvic pain.

• Elevate your legs.

  Lie down and prop up your legs by putting a pillow under your knees. This may help relieve pain.

• Lie on your side, and bring your knees up to your chest.

  This will help relieve back pressure.

• Use pads instead of tampons.
• Get exercise.

  Exercise improves blood flow and may reduce pain.

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Medicines

Medicine can be used to help relieve uterine fibroid problems. But when treatment is stopped, symptoms usually return.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) may help with menstrual cramping and heavy bleeding.
• Birth control hormones (pill, patch, or ring) reduce heavy menstrual periods and pain.
• An IUD that releases small amounts of a certain hormone (levonorgestrel) may reduce heavy menstrual bleeding.
• A progestin shot (Depo-Provera) may lighten your bleeding. Progestin may improve fibroids. But it may make them grow.^{footnote 3}.
• Iron supplements can help anemia.
• Gonadotropin-releasing hormone analogue (GnRH-a) therapy is used to shrink fibroids before surgery. This treatment is used for only a few months, because it can weaken the bones. It can also help with symptoms.

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Surgery

Surgery can be used to remove uterine fibroids only (myomectomy). Or it can be used to remove the entire uterus (hysterectomy).

Surgery is an option when:

• You still have heavy uterine bleeding or anemia after several months of treatment.
• Fibroids grow after menopause.
• Fibroid pain or pressure affects your quality of life.
• The fibroids cause urinary or bowel problems.
• There is a chance that you have cancer.
• Fibroids may be making it hard to get pregnant.

Surgery choices

Options include:

• Myomectomy. This is surgery to remove the fibroids. If you hope to get pregnant later, myomectomy is your one surgical option.
• Hysterectomy. This is surgery to remove the uterus. It's only recommended for women who have no future plans to get pregnant.

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Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) shrinks or destroys uterine fibroids. It does this by blocking the artery that supplies blood to them.

This procedure is also called uterine artery embolization.

During UFE, a radiologist places a thin, flexible tube called a catheter into the upper thigh. He or she guides it into the uterine artery that supplies blood to the fibroids. A liquid is then injected into the uterine artery through the catheter.

UFE is a non-surgical option to hysterectomy or myomectomy. It relieves fibroid symptoms for most women. But in rare cases it can lead to problems. These include a serious infection or early menopause.

UFE may be an option when:

• You don't wish to have children. It's possible to get pregnant after UFE. But there are risks.
• You still have heavy uterine bleeding or anemia after several months of treatment with birth control hormones and a non-steroidal anti-inflammatory drug (NSAID).
• You have fibroid pain or pelvic pressure that affects your quality of life.
• You have urinary or bowel problems from a fibroid that is pressing on your bladder, ureter, or bowel.
• You don't want to have a hysterectomy or myomectomy.
• You have a disease or disorder that makes surgery with general anesthesia dangerous.

You can still get pregnant after UFE. If you need to prevent pregnancy after UFE, use birth control.

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