Uterine fibroids are often misunderstood–which is understandable because we still don’t fully know how or why they develop! For many people, fibroids will be an inconsequential part of their lives. For others, fibroids can be disruptive with painful symptoms that require treatment. Here are some of the most common questions about fibroids–along with reasons for seeking treatment and what you might expect.
What are fibroids?
Fibroids, also called leiomyomas or myomas, are non-cancerous tumors that develop from the muscle tissue in the uterus. Uterine fibroids can grow, shrink or stay the same over time. We don’t fully understand what causes them, but their growth has been linked to the hormone estrogen. The most common fibroid locations include:
- Intramural, within the muscle wall of the uterus (most common).
- Subserosal, growing outward from the uterus into the pelvic cavity.
- Submucosal, growing into the uterus.
Are fibroids common?
Uterine fibroids are quite common and most often develop in middle age. While people of any race can develop fibroids, they occur in Black women at three times the rate of white women. The research into this disparity is not definitive, but some studies have suggested overall lifetime stress, environmental factors, vitamin D deficiency or genetics. Fibroids also tend to occur at a younger age in Black women and become larger and more numerous–and therefore more likely to cause symptoms requiring treatment.
Besides age and race–diet, obesity, family history, high blood pressure and reproductive history have been linked to a higher risk of developing uterine fibroids.
How do I know if I have fibroids?
The reality is you may never know! If fibroids are small or few in number, many people will not experience symptoms or require treatment.
Fibroids are often an incidental finding during other care–such as an annual pelvic exam, pelvic ultrasound or kidney scan. Small fibroids are unlikely to cause pain; even if they are discovered, your provider will likely not recommend further action in the absence of symptoms. It’s typically when fibroids get large and push up against other organs that symptoms occur.
In some cases, fibroids may be the cause of severe symptoms, including heavy bleeding and/or feelings of bulk, severe pressure or pain in the lower abdomen. If you experience these symptoms, especially to the point that they affect your quality of life, schedule an appointment with your provider so they can help diagnose the cause and offer treatment options.
When should I be worried about fibroids?
Fibroids are not rare or uniquely concerning. In 99% of cases, they are noncancerous. If they cause bothersome symptoms, treatment is often non-invasive and can be done in a way that accommodates your goals and lifestyle.
Can fibroids affect pregnancy?
Depending on the location and the size, fibroids can affect someone’s ability to become and maintain a pregnancy–and increase the risk of some other pregnancy complications. Your provider will discuss this with you in more detail depending on your unique situation.
What is the best treatment for fibroids?
Pelvic pain from large fibroids and/or heavy bleeding are the most common reasons for treatment. It’s worth pointing out that both severe pelvic pain and heavy bleeding can be caused by other factors. No matter what, treatment for fibroids is a shared decision that you make together with your provider, and the path forward depends on your goals. There is rarely only one option, and care is tailored to your unique history.
Here are three common types treatment for fibroids and/or related symptoms:
- Medication – Most frequently some form of hormonal birth control or hormonal suppression, medication is well-tolerated and can be used to help with symptoms like heavy bleeding and pelvic pressure.
- Radiologic – called fibroid embolization, this is a minimally-invasive procedure that cuts off blood flow to the fibroid to make it shrink.
- Surgical – Two types of surgical procedures can be considered: myomectomy to remove fibroids while preserving the uterus (generally reserved for those seeking future fertility), or hysterectomy to remove the uterus if pregnancy is not desired.
Federal Fibroid Legislation
As evidence of the disruptive and disparate effects of fibroids on millions of people, several pieces of national legislation have been introduced in an attempt to better understand and treat them. In the summer of 2020, then-Senator Kamala Harris introduced the Uterine Fibroid Research and Education Act to initiate crucial research and education to help people suffering from fibroids receive the medical care they need. The bill did not pass. In 2021, the Stephanie Tubbs Jones Uterine Fibroid Research and Education Act was introduced in a similar effort to facilitate research and improve public awareness about fibroids. This bill is still pending review.
I encounter fibroids frequently in my practice–both with and without symptoms. Regardless of the cause, regular symptoms that disrupt your life should be evaluated by a gynecologist. Together, you can decide the path forward that best meets your current and future goals.