Uterine fibroids are noncancerous growths that develop in or on the uterus, and they are so common that many women have them and never know it. However, they can sometimes cause significant symptoms such as infertility, heavy bleeding, and pelvic pain or pressure.
In this article, Sukhkamal Campbell, M.D., a reproductive endocrinologist (fertility specialist) with UAB Medicine, discusses uterine fibroids and highlights the various treatment options.
The basics
Uterine fibroids are non-cancerous muscle tumors that grow in the cavity of the uterus (womb), within the muscle layer, or on the outer surface of the uterus. They usually occur in groups. They vary in size; some are as small as an apple seed and others as large as a grapefruit.
Uterine fibroids are extremely common, affecting about 70% of women during their reproductive years. Many women never experience symptoms and may go their entire lives without knowing they have fibroids.
Symptoms often depend on the size, number, and location of the fibroids. Common symptoms include:
- Heavy menstrual bleeding or longer cycles
- Frequent urination
- Discomfort around the rectum
- Infertility or pregnancy complications
- Swollen abdomen/bloating
- Pelvic pain/pressure
Uterine fibroids may be discovered during a pelvic examination, ultrasound, or evaluation for anemia caused by heavy bleeding. Doctors often begin with an ultrasound to assess the size and location of fibroids. In some cases, we use an MRI to create a more detailed map for treatment planning.
Don’t normalize symptoms
Uterine fibroids can affect quality of life in many ways, so it’s important to tell your primary care doctor or OB/GYN if you experience possible symptoms. For example:
- The heavy bleeding can cause anemia (too few red blood cells and a resulting lack of oxygen to the body) and iron deficiency. The bleeding can require a blood transfusion or iron infusion, and in rare cases, it can even be life-threatening.
- Depending on their location and size, fibroids can cause infertility or pregnancy complications.
- Large fibroids may cause “bulk symptoms” such as a firm abdomen to the touch, constipation, pain with intercourse, and frequent urination.
Dr. Campbell says many women may have normalized these symptoms because relatives or friends have experienced similar problems. Some live with heavy bleeding for years because they assume it is normal or unavoidable.
Women do not have to simply live with these symptoms – they should speak to their doctor. And you don’t have to wait until uterine fibroids become dangerous or you want to become pregnant.
Treatment options
The appropriate treatment for each patient will depend on the size, number, and location of the uterine fibroids, as well as the woman’s family-building goals. Imaging studies can help guide these decisions. Hysterectomy is the most widely known definitive treatment, but it’s just one of several options to consider with your healthcare team. Some of these options are highlighted below:
- Medications: For some women, medications may help control heavy bleeding or shrink the fibroids. These include birth control pills and injected medications.
- Minimally invasive procedures:
- Radiofrequency ablation is a procedure in which doctors use radiofrequency heat to shrink fibroids. It is a minimally invasive approach done through a few small incisions (cuts), so it has a shorter recovery time than open surgery.
- Uterine fibroid embolization (UFE) is another way to shrink fibroids and works by starving them of their blood supply. Using a small, pinprick incision, interventional radiology doctors inject clotting particles into arteries feeding the fibroid.
- Surgical removal:
- Myomectomy is a surgical option for removing fibroids, usually when they are more numerous or larger in size. Unlike hysterectomy, myomectomy allows the patient to maintain her fertility.
- Hysterectomy, or the removal of the uterus, is the only way to eliminate all possibility of fibroids from continuing to grow and cause symptoms. However, carrying a pregnancy will no longer be an option.
Treatment should fit your goals
Many women seek treatment because they are having difficulty becoming pregnant or have experienced pregnancy loss. Fibroids may interfere with implantation of an embryo or cause pregnancy complications. All treatment options except hysterectomy preserve the uterus, and they may be recommended depending on your fertility goals and the size, number, and location of your fibroids.
Not every fibroid requires treatment. Some women have fibroids that cause little or no symptoms and may only need monitoring. Mild cases may be managed with medication. Other times, hysterectomy may be the most logical choice for quality of life.
The right treatment for one woman may not be the right treatment for another. Women today have more choices than they may realize, including options that preserve the uterus and fertility. At UAB Medicine, OB/GYNs, interventional radiologists, and reproductive endocrinologists like Dr. Campbell work with patients to develop personalized treatment plans based on their symptoms and goals.
Learn more about uterine fibroids or to schedule an appointment with a UAB Medicine expert.