Uterine fibroids are very common, becoming more common as women age into their 30s and 40s. Fibroids are benign muscle knots or muscle tumors in the uterus, and they may or may not cause any symptoms depending on their size and their location. By age 50, between 20 to 80 percent of women will have developed fibroids, according to the U.S. Office on Women’s Health.
In this Q&A, Anne Hardart, MD, Co-Director of Urogynecology at Mount Sinai West, answers frequently asked questions about fibroids and treatment options.
Q: What are the symptoms?
The symptoms of fibroids depend on their size and their location. Very small fibroids in the muscle or on the outside of the uterus may never cause any symptoms. Fibroids that are large— they can get up to the size of a melon or even more—may cause pressure symptoms. Fibroids that are inside the uterus can cause heavy periods, irregular bleeding, and cramping. As fibroids grow, they can be uncomfortable or make a person urinate more frequently. However, if fibroids are not causing symptoms, they may not require any treatment, and they are very common, probably present in about 50 percent of women.
Q: Can fibroids cause fertility issues?
While fibroids often are not cause for concern, fibroids can make it difficult to become pregnant for women who are trying to conceive. Not all fibroids cause infertility, but for fibroids that affect the inside cavity of the uterus, it is often recommended that the fibroids be removed if someone is experiencing infertility. Fibroids also can cause difficulties during pregnancy, such as significant pain and increasing the risk of preterm delivery or miscarriage in some cases.
Q: How are uterine fibroids diagnosed?
You may not even know you have fibroids, and that is okay because they are not dangerous or cause for concern if they are not causing any symptoms. However, if you are having symptoms such as abnormal bleeding or pain and you think it may be related to fibroids, your doctor will probably do a pelvic exam and may order an ultrasound or an MRI.
Q: What are the treatment options?
There are many types of treatments for fibroids, and your doctor will work with you to determine the best treatment plan for your situation. Treatment options depend partly on the symptoms.
- If the symptoms are abnormal bleeding, that may mean hormonal treatment with low-dose birth control pills, a progesterone IUD, or other medications to help manage heavy bleeding and reduce cramping as well as slowing the growth of fibroids.
- For symptoms that are moderate to severe, treatment may mean a surgical procedure, such as removing fibroids (myomectomy) or even the uterus (hysterectomy), often in a minimally invasive way. Minimally invasive surgical approaches include hysteroscopy, which involves inserting a camera into the uterus through the cervix, and laparoscopy, which involves inserting a camera into the abdomen through the belly button.
- Symptoms related to pressure, or the bulk of large fibroids, can be managed with medications, a radiologic procedure called embolization, and surgery. Medications that shrink fibroids, such as gonadotropin releasing hormone agonists (GnRHa), are typically given by injection, but newer oral medications are also available. These medications also may be used prior to surgery to make fibroid removal easier. The surgical options for large fibroids are myomectomy and hysterectomy.
If you know you have fibroids, you should probably see your doctor every year, or more frequently if you are having symptoms such as heavy bleeding or pressure symptoms.