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Uterine fibroids are non-cancerous growths that develop in the wall of the uterus. They are also known as leiomyomas or myomas. Fibroids can range in size from small, pea-sized growths to larger ones that can distort the shape of the uterus.
Uterine fibroids are very common, with up to 80% of women experiencing them at some point in their lives. They are more common in women who are in their 30s and 40s, and African American women are more likely to develop them.
The cause of uterine fibroids is not well understood, but hormones, especially estrogen, and progesterone, are thought to play a role in their growth. Risk factors for developing uterine fibroids include a family history of fibroids, obesity, and early onset of menstruation.
Symptoms of uterine fibroids can include heavy menstrual bleeding, pelvic pain or pressure, frequent urination, constipation, and lower back pain. Some women with fibroids may not experience any symptoms at all.
Diagnosis of uterine fibroids typically involves a pelvic exam, ultrasound, or other imaging tests such as an MRI. Treatment options for fibroids can vary depending on the size and location of the growths, as well as the severity of symptoms. Treatment options may include medications to control symptoms, such as pain or heavy bleeding, or surgical options such as myomectomy, which involves removing the fibroids while leaving the uterus intact, or hysterectomy, which involves removing the uterus.
The prognosis for uterine fibroids is generally good, as they are not cancerous and do not increase the risk of developing uterine cancer. However, if fibroids are causing severe symptoms or affecting a woman's quality of life, it is important to discuss treatment options with a healthcare provider.
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:
Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.
The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own.
Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to its usual size.
Although researchers continue to study the causes of fibroid tumors, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible, but only a small percentage of these tumors require treatment.
But, by making healthy lifestyle choices, such as maintaining a healthy weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.
Also, some research suggests that using hormonal contraceptives may be associated with a lower risk of fibroids.
There's no single best approach to uterine fibroid treatment — many treatment options exist. If you have symptoms, talk with your doctor about options for symptom relief.
Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that's the case for you, watchful waiting could be the best option.
Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:
MRI-guided focused ultrasound surgery (FUS) is:
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
With any procedure that doesn't remove the uterus, there's a risk that new fibroids could grow and cause symptoms.
Options for traditional surgical procedures include:
Morcellation — a process of breaking fibroids into smaller pieces — may increase the risk of spreading cancer if a previously undiagnosed cancerous mass undergoes morcellation during myomectomy. There are several ways to reduce that risk, such as evaluating risk factors before surgery, morcellating the fibroid in a bag or expanding an incision to avoid morcellation.
All myomectomies carry the risk of cutting into an undiagnosed cancer, but younger, premenopausal women generally have a lower risk of undiagnosed cancer than do older women.
Also, complications during open surgery are more common than the chance of spreading an undiagnosed cancer in a fibroid during a minimally invasive procedure. If your doctor is planning to use morcellation, discuss your individual risks before treatment.
The Food and Drug Administration (FDA) advises against the use of a device to morcellate the tissue (power morcellator) for most women having fibroids removed through myomectomy or hysterectomy. In particular, the FDA recommends that women who are approaching menopause or who have reached menopause avoid power morcellation. Older women in or entering menopause may have a higher cancer risk, and women who are no longer concerned about preserving their fertility have additional treatment options for fibroids.
Hysterectomy and endometrial ablation won't allow you to have a future pregnancy. Also, uterine artery embolization and radiofrequency ablation may not be the best options if you're trying to optimize future fertility.
Have a full discussion of the risks and benefits of these procedures with your doctor if you want to preserve the ability to become pregnant. Before deciding on a treatment plan for fibroids, a complete fertility evaluation is recommended if you're actively trying to get pregnant.
If fibroid treatment is needed — and you want to preserve your fertility — myomectomy is generally the treatment of choice. However, all treatments have risks and benefits. Discuss these with your doctor.
For all procedures except hysterectomy, seedlings — tiny tumors that your doctor doesn't detect during surgery — could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. New fibroids, which may or may not require treatment, also can develop.
Also, some procedures — such as laparoscopic or robotic myomectomy, radiofrequency ablation, or MRI-guided focused ultrasound surgery (FUS) — may only treat some of the fibroids present at the time of treatment.