Women's health: Uterine fibroids are a common problem

Uterine fibroids, or myomas, are abnormal growths of muscular tissue in a woman’s uterus, and can grow inside or outside the uterus or inside the wall of the uterus. Fibroids are sometimes called tumors, but they are not cancerous. Doctor’s don’t know exactly what causes fibroids, but estrogen levels are believed to affect their growth. About one in four women develop fibroids, especially during childbearing years. They tend to be more prevalent in African-American women and women who have not had children.

In some women, fibroids have no symptoms at all, usually if the growths are small. But other women can experience moderate to severe problems from larger fibroids, including:

• Very heavy menstrual periods, and associated fatigue due to iron deficiency
• Pelvic pressure or pain
• Feeling bloated often, especially after meals
• Problems urinating, such as an inability to pee or fully empty the bladder or increased frequency
• Pain or pressure when having bowel movements
• Distended stomach, resembling pregnancy

Problems tend to increase as the size of fibroids increase. Fibroids can range in size from smaller than a pea to a grapefruit or larger. Most doctors suggest watchful waiting before treatments are discussed, especially if fibroids are small and not causing problems. This means more frequent exams (pelvic ultrasounds or MRIs) to determine the number, sizes and locations of fibroids.

Larger fibroids (depending on their location) tend to create pressure on organs near the uterus, such as the bladder, and become increasingly uncomfortable. Fibroids do not cause infertility, but depending on their size and location, they may affect a woman’s ability to carry a baby to full term.

Some doctors say there tend to be two types of occurrences of fibroids: women who have many small to moderate (and a few larger) size fibroids, and women who have a few fibroids, of any size. Fibroids almost always shrink after menopause, usually between the ages of 40 and 60, but doctors can’t predict when this will happen. Various procedures are available if a woman elects to have treatment, but each option has risks and can affect fertility.

• Nonsurgical procedures: Cutting off blood supply (uterine artery embolization (UAE)) to the fibroids or dissolving the fibroids (myolysis), but leaving the uterus in place. With UAE, a woman may still have children, but she may have complications with a pregnancy from the procedure. Myolysis is a newer ultrasound procedure and its affect on fertility is uncertain.
• Myomectomy: Surgery to remove the fibroids, but leaving the uterus in place and a woman can still have children, although a cesarean-section is usually needed
• Hysterectomy: Surgery to remove the entire uterus, meaning a woman can no longer have children

Unfortunately, unless a hysterectomy is performed, new fibroids can grow over time after a myomectomy or nonsurgical procedure is done. Doctor’s can’t predict how soon or how many new fibroids may grow, but this occurs in many women.

If you have bothersome fibroids, talk to a gynecologic specialist about treatment options and the risks associated with each.