Surprising facts about fibroids

June 30, 2016 Providence Health Team

Uterine fibroids are more common than you think. But many women who have them don’t find out until their annual pelvic exam or prenatal ultrasound. Fibroids aren’t associated with an increased risk of uterine cancerous, but they can become quite large and cause severe pain and heavy periods.

Luckily, there are a number of minimally invasive treatments available.

“Fibroids are common and don’t need to be treated unless they cause bothersome symptoms. If treatment is necessary, several options are available”, says Ingrid Cherrytree, M.D., a Providence gynecologist who specializes in minimally invasive pelvic surgery in Portland, Ore.

How fibroids form

No one knows what causes fibroids, but we do know they develop from the muscular tissue of the uterus, called the myometrium. Here, a single cell of that tissue reproduces until it becomes a pale, firm rubbery mass. You can have one to several fibroids at once—from the microscopic to basketball-sized—some growing slowly, or not at all.

“Fibroids tend to cause the most symptoms when women reach their 40s. This is when hormone levels fluctuate and may lead to the growth of pre-existing fibroids that previously did not cause any symptoms,” says Dr. Cherrytree.

There are four types of fibroids:

  1. Submucosal fibroids: Grows directly under the uterine lining and projects into the inner cavity
  2. Intramural fibroids: Embeds within the uterine walls
  3. Subserosal fibroids: Bulges outward from the uterine wall, just beneath the outer coating of the uterus.
  4. Pendunculated fibroids: Hangs from a stalk inside or outside the uterus, and causes symptoms if they twist. (This is the rarest type of fibroid.)

Who gets fibroids?

  • 12-25 percent of reproductive-age women have fibroids.
  • Most women with fibroids don’t experience symptoms.
  • Fibroids are most common in women over age 40, given age-related changes in estrogen and progesterone levels.

You’re more likely to get fibroids if:

  • Your mother or sister had them.
  • You’re African American.
  • You’ve never been pregnant.

Symptoms of fibroids

Depending on the size and location of your fibroids, you may experience:

  • Heavy and prolonged menstrual bleeding
  • Bleeding between periods
  • Cramping 
  • Urinary problems
  • Sharp, sudden and severe pain in the lower abdomen
  • Bloated feeling

Detecting fibroids

During your annual pelvic exam, your doctor will feel your uterus. If it is larger or more irregular in shape than what is normal for you, your doctor may want to take further action. There are several procedure options available that allow your doctor to get a better look at your pelvic area.

  • Ultrasound. This procedure is the most common and reliable way to detect most fibroids. Sound waves generate images of the uterus and fibroids, if they exist. After an abdominal ultrasound, you may also have a transvaginal ultrasound where a “wand” is inserted into the vagina. Looking at a screen, the ultrasound technician or doctor can get a closer look at the pelvic organs.
  • X-ray with dyes or saline (hysterosalpingography). Fibroids growing in the lining of the uterus are detected by using a dye to highlight the uterine cavity and fallopian tubes on X-ray images.
  • MRI (magnetic resonance imaging). This procedure may be recommended to gain a more detailed understanding of your fibroids, if a surgical procedure is planned.

Treating fibroids

A hysterectomy once was a woman’s only choice to treat fibroids. “Certainly, taking out the uterus totally eliminates uterine fibroids and the chance of them ever growing again,” says Dr. Cherrytree. But it’s also major surgery.

Now, there are several minimally invasive treatment options. What method is right for you? That depends on the size and type of fibroids, your symptoms, your childbearing plans, and how soon you’ll hit menopause. You may also want to consider the treatment pros and cons.

  • Birth control pills or progesterone-based IUD. Hormones may help treat symptoms of heavy bleeding or reduce cramping during your period. They work best when your fibroids are smaller and not inside the uterine cavity.
  • Depot Lupron. This synthetic hormone shrinks large fibroids. If you’re having surgery to remove them, your doctor may recommend this method. That’s because it may result in less blood loss and create a better surgical outcome.

Myomectomy is the only surgical procedure that preserves a woman’s ability to get pregnant. Unlike a hysterectomy, which removes the entire uterus, a myomectomy removes only the fibroids (one or more) and leaves the uterus intact.

Depending on the size, number and location of the fibroids, the surgeon may choose one of these three types of minimally invasive surgery:

  1. Laparoscopic myomectomy: For fibroids outside the uterus or on the wall, two or more tiny incisions in the lower abdomen make way to insert a telescope and surgical instruments.
  2. Hysteroscopic myomectomy: For fibroids in the lining of the uterus, a camera and instruments are inserted directly through the cervix into the uterus.
  3. Abdominal myomectomy: For large fibroids and large uteruses, an incision is made similar to a Caesarian section.

Uterine artery embolization is a good option for women who may not be able to withstand the stress of surgery. This procedure cuts off blood supply to the fibroids, causing their eventual shrinkage. Through an incision in the groin, sand-sized plastic particles are injected into the uterine artery.

If you’re considering having your fibroids removed, get a second or third opinion from gynecologists who regularly deal with the kind of fibroids you have.

Do you think you might have fibroids?

See your doctor if you answer “yes” to any of these questions:

  • Have you noticed an increase in your bleeding during menstruation?
  • Are menstrual cramps becoming more frequent and/or painful?
  • Is your abdomen really distended?
  • Are you having difficulty with conception or fertility?

Don’t have a doctor? You can find a Providence provider here.

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