What are Fibroids?
Fibroids, also known as uterine fibroids, myomas, or leiomyomas, are noncancerous tumors that develop in the uterus. These growths can alter the shape or size of the uterus and sometimes affect the cervix. Many women experience multiple fibroids, although it is possible to have just one. The symptoms and need for treatment depend on the fibroids' location, size, and number.
Types of Fibroids
Fibroids, also known as uterine fibroids, are classified into three main types based on their location within the uterus:
- Subserosal Fibroids: These are located in the outer wall of the uterus and account for about 55% of fibroids.
- Intramural Fibroids: Found in the muscular layers of the uterine wall, these make up approximately 40% of fibroids.
- Submucosal Fibroids: These protrude into the uterine cavity and represent about 5% of fibroids.
Fibroids can also be pedunculated, meaning they are connected to the uterus by a stalk, or they can attach to nearby ligaments or organs, such as the bladder and bowel.
It is rare for fibroids to be found outside the pelvic cavity.
Common Symptoms of Fibroids
Abnormal Uterine Bleeding
Abnormal uterine bleeding is the most common symptom of fibroids, especially when they are located in or near the uterine lining. This symptom is often the primary reason women seek treatment for fibroids. However, abnormal bleeding can also be caused by other conditions, so it's crucial to undergo a thorough evaluation to identify the exact cause.
Pain and Cramping
Some women with fibroids experience pain. A rapidly enlarging fibroid may outgrow its blood supply, leading to degeneration, which causes pain and cramping. Fibroids attached to the uterus by a thin stalk can twist, resulting in severe pain. Large fibroids can also make sexual intercourse painful and cause painful menstrual cramps.
Pressure
Large fibroids may exert pressure on nearby pelvic organs such as the bladder, bowel, or rectum, leading to discomfort and other related symptoms.
Can Fibroids Affect My Fertility?
Impact on Fertility
Approximately 5% to 10% of infertile women have fibroids.
How Do Fibroids Cause Infertility?
Fibroids can reduce fertility in several ways:
- Cervical Changes: Fibroids can alter the shape of the cervix, affecting how sperm enter the uterus.
- Blockage of Fallopian Tubes: Fibroids can block the fallopian tubes, preventing sperm from reaching the egg.
- Uterine Lining Impact: Fibroids can affect the thickness of the uterine lining, where embryos implant and grow.
How are Fibroids Diagnosed?
Pelvic Exam. Uterine fibroids are often detected during a routine pelvic exam. Blood Tests. For women with irregular bleeding, a blood test can help determine if the bleeding is due to anovulation (not ovulating) or other medical conditions.
Ultrasound. Ultrasound is typically the first tool used to diagnose fibroids. It uses sound waves to create an image of the reproductive organs. Both transvaginal and transabdominal ultrasounds may be used to visualize fibroids, considering their varying sizes and locations.
Sonohysterography. Sonohysterography involves placing a small amount of fluid in the uterus through a thin plastic tube during an ultrasound. This fluid helps outline the uterine cavity, improving the visualization of fibroids that protrude into or distort the space and aiding in determining the best treatment approach.
Hysterosalpingography (HSG). HSG uses X-rays to produce images of the inside of the uterus and check if the fallopian tubes are open. It helps identify fibroids that protrude into or alter the shape of the uterine cavity or those blocking the fallopian tubes.
Magnetic Resonance Imaging (MRI). MRI uses high-frequency radio waves to produce detailed images, helping to determine the presence of fibroids. However, MRI is not routinely required for fibroid diagnosis.
Diagnostic Hysteroscopy. Diagnostic hysteroscopy involves inserting a telescope-like instrument (hysteroscope) through the vagina and cervix into the uterus. It helps identify submucosal fibroids and other abnormalities within the uterine cavity.
For more information:
How are Fibroids Treated?
Treatment Options for Women Planning Pregnancy
If you plan to get pregnant in the future, consider these fibroid treatment options:
Drug Therapy
- Hormonal Treatments: Some fibroids respond to estrogen levels and can be managed with medications such as Gonadotropin-releasing hormone (GnRH) analog injections, birth control pills, and progestins.
Myomectomy Surgery
- Abdominal Myomectomy (Laparotomy): The surgeon makes a 3-5 inch (or larger) incision in the abdomen to remove fibroids on the outer surface of the uterus and surrounding organs.
- Laparoscopic Myomectomy: A lighted telescope (laparoscope) is inserted into the abdomen through a small incision near the belly button, and surgical instruments are used to remove the fibroids through additional small incisions.
- Hysteroscopic Myomectomy: This procedure removes fibroids inside the uterus using a lighted telescope (hysteroscope) inserted through the vagina. The uterus is inflated with fluid, and surgical instruments are inserted through the hysteroscope.
- Robotic-Assisted Myomectomy: A telescope is inserted into the abdomen at or above the navel, and up to five small incisions hold the instruments used to remove the fibroids, controlled by robotic instruments.
Treatment Options for Women Not Planning Pregnancy
If you do not plan to get pregnant in the future, consider these fibroid treatment options:
Myolysis
- A laparoscopic technique that burns fibroids using heat or cold energy via needles or lasers.
MRI-Guided Focused Ultrasound Surgery (MrgFUS)
- A non-invasive method that uses focused ultrasonic treatment guided by MRI. This newer technology has limited long-term outcome data.
Uterine Artery Embolization
- Performed by a radiologist, this procedure involves injecting small particles into the uterine blood vessels to block the blood supply to fibroids, causing them to shrink. Women typically experience several days of pain post-procedure, with fibroid volume shrinking by 40-50% and most experiencing symptom relief.
Hysterectomy
- About half of all hysterectomies (surgical removal of the uterus) are performed to treat fibroids. This option is most suitable for women with symptoms who do not wish to become pregnant. Hysterectomy can be done through the abdomen, vagina, or using a laparoscope.
For more information:
What can happen with Fibroids in Pregnancy?
Concerns with Fibroids During Pregnancy
Fibroids in pregnancy can pose several risks, including an increased chance of preterm birth or miscarriage. Some specific concerns include:
- Severe Pain: Fibroids can outgrow their blood supply, leading to significant pain.
- Baby's Position: Fibroids can change the baby's position in the uterus, increasing the risk of miscarriage, preterm delivery, and cesarean section.
Management of fibroids during pregnancy depends on your unique situation and your doctor’s recommendations. Surgery is rarely necessary or performed during pregnancy.
Pregnancy After Fibroid Surgery
The chances of getting pregnant after fibroid surgery are similar to those for women in the general population, with pregnancy rates between 40%-50% after a myomectomy. Removing fibroids, depending on their location, can also decrease the risk of miscarriage. It's important to discuss your personal clinical profile with your physician.
Delivery Considerations
If a woman conceives after fibroid removal, she should discuss her history with the obstetrician who will deliver the baby. A scheduled cesarean section may be recommended before labor begins to avoid complications. Strong labor contractions during a vaginal delivery may increase the risk of uterine rupture and complications for the baby.
Additional Resources
Find an Expert
Fibroids or Myomas or Leiomyomas
Fibroids and Fertility
Uterine fibroids are benign (noncancerous) tumors of muscle tissue in the uterus. They are also called myomas or leiomyomas. View the Fact Sheet
Treatment of uterine fibroids
Do all fibroids require treatment? Not usually, because most patients with fibroids do not have symptoms. View the fact sheet
What are fibroids?
Uterine fibroids (also called myomas or leiomyomas) are benign (noncancerous) tumors of muscle tissue found in the uterus. View the fact sheet
SART Fertility Experts - Fibroids and Fertility
Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi. Listen to the Episode
Fibroid Tumors
An educational video that answers patient questions about the causes, symptoms, diagnosis and management of uterine fibroids. Watch Video
Causes of Female Infertility
Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
