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Home > Wellness > Health Library > Uterine Fibroids
Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside, on the outside, or in the wall of your uterus.
Your doctor may call them fibroid tumors, leiomyomas, or myomas. But fibroids are not cancer. You do not need to do anything about them unless they are causing problems.
Fibroids are very common in women in their 30s and 40s. But fibroids usually do not cause problems. Many women never even know they have them.
Doctors are not sure what causes fibroids. But the female hormones estrogen and progesterone seem to make them grow. Your body makes the highest levels of these hormones during the years when you have periods.
Your body makes less of these hormones after you stop having periods (menopause). Fibroids usually shrink after menopause and stop causing symptoms.
Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life. Fibroids make some women have:
Heavy bleeding during your periods can lead to anemia. Anemia can make you feel weak and tired.
Sometimes fibroids can make it harder to get pregnant.
To find out if you have fibroids, your doctor will ask you about your symptoms. He or she will do a pelvic exam to check the size of your uterus.
Your doctor may send you to have an ultrasound or another type of test that shows pictures of your uterus. These help your doctor see how large your fibroids are and where they are growing.
Your doctor may also do blood tests to look for anemia or other problems.
If your fibroids are not bothering you, you do not need to do anything about them. Your doctor will check them during your regular visits to see if they have gotten bigger.
If your main symptoms are pain and heavy bleeding, try an over-the-counter pain medicine like ibuprofen, and ask your doctor about birth control pills. These can help you feel better and make your periods lighter. If you have anemia, take iron pills and eat foods that are high in iron, like meats, beans, and leafy green vegetables.
If you are near menopause, you might try medicines to treat your symptoms. Heavy periods will stop after menopause.
There are a number of other ways to treat fibroids. One treatment is called uterine fibroid embolization. It can shrink fibroids. It may be a choice if you do not plan to have children but want to keep your uterus. It is not a surgery, so most women feel better soon. But fibroids may grow back.
If your symptoms bother you a lot, you may want to think about surgery. Most of the time fibroids grow slowly, so you can take time to consider your choices.
There are two main types of surgery for fibroids. Which is better for you depends on your age, how big your fibroids are, where they are, and whether you want to have children.
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The exact cause of uterine fibroids is not known. Fibroids begin when cells overgrow in the muscular wall of the uterus.
After a fibroid develops, the hormones estrogen and progesterone appear to influence its growth. A woman's body produces the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decline, fibroids usually shrink or disappear.
Uterine fibroid symptoms can develop slowly over several years or rapidly over several months. Most women with uterine fibroids have mild symptoms or none at all and never need treatment.
For some women, uterine fibroid symptoms become a problem. Pain and heavy menstrual bleeding are the most common symptoms. In some cases, difficulty becoming pregnant is the first sign of fibroids. The type of symptoms women have can depend on where the fibroid is located in the uterus.
Uterine fibroid symptoms and problems include:
Uterine fibroids can grow on the inside wall of the uterus, within the muscle wall of the uterus, or on the outer wall of the uterus. They can alter the shape of the uterus as they grow. Over time, the size, shape, location, and symptoms of fibroids can change.
As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s through menopause (around age 50). Uterine fibroids can stay the same for years with few or no symptoms, or you can have a sudden, rapid growth of fibroids.
Fibroids do not grow before the start of menstrual periods (puberty). They sometimes grow larger during the first trimester of pregnancy, and they usually shrink for the rest of a pregnancy. After menopause, when a woman's hormone levels drop, fibroids usually shrink and don't come back.
Complications of uterine fibroids aren't common. They include:
Fibroids can cause problems during pregnancy, such as:
Things that increase a woman's risk for uterine fibroids include:
Call to make an appointment if you have possible symptoms of a problem from a uterine fibroid, including:
Unless you have bothersome or severe symptoms, you will probably only need to have a fibroid checked during your yearly gynecological exam.
During a pregnancy, your doctor will check for changes in fibroid size and position.
Uterine fibroids can be diagnosed and treated by any of the following health professionals:
You may need to see a gynecologist for further testing or treatment.
Your doctor may suspect that you have a uterine fibroid problem based on:
You will probably also have a pelvic ultrasound or hysterosonogram to confirm that you have one or more uterine fibroids. A hysterosonogram is done by filling the uterus with sterile saline during a transvaginal pelvic ultrasound.
If you have had heavy menstrual bleeding, you may have a complete blood count (CBC) to check for anemia.
Laparoscopy may be used to look for and locate fibroids on the outer surface of the uterus before removal (myomectomy).
Hysteroscopy is a procedure that allows a doctor to look at the inside of the uterus.
If you have severe pain, bleeding, or pelvic pressure or have had repeat miscarriages or trouble becoming pregnant, you will probably have other tests to look for other possible causes of your symptoms. Two examples of possible causes are endometriosis and pelvic inflammatory disease (PID).
And tests for specific symptoms, such as urinary or bowel problems, may be needed to diagnose the problem or to help build a treatment plan.
Most uterine fibroids are harmless, do not cause symptoms, and shrink with menopause. But some fibroids are painful, press on other internal organs, bleed and cause anemia, or cause pregnancy problems. If you have a fibroid problem, there are several treatments to consider. Fibroids can be surgically removed, the blood supply to fibroids can be cut off, the entire uterus can be removed, or medicine can temporarily shrink fibroids or manage symptoms. Your choice will depend on whether you have severe symptoms and whether you want to preserve your fertility.
If you have uterine fibroids but you have few or no symptoms, you don't need treatment. Instead, your doctor will recommend watchful waiting. This means that you will have pelvic exams to check on fibroid growth and symptoms. Talk with your doctor about how often you will need a checkup.
If you are nearing menopause, watchful waiting may be an option for you, depending on how tolerable your symptoms are. After menopause, your estrogen and progesterone levels will drop, which causes most fibroids to shrink and symptoms to subside.
If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a simple menstrual cycle problem or other problems. For more information, see the topic Abnormal Uterine Bleeding. The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods, but they do not shrink fibroids:
If you have fibroids, there is no way of knowing for certain whether they are affecting your fertility. Fibroids are the cause of infertility in only a small number of women. Most women with fibroids have no trouble getting pregnant.
If a fibroid distorts the wall of the uterus, it can prevent a fertilized egg from implanting in the uterus. This may make an in vitro fertilization less likely to be successful, if the fertilized egg doesn't implant after it is transferred to the uterus.footnote 3
Surgical fibroid removal, called myomectomy, may improve your chances of having a baby.footnote 3 Because fibroids can grow again, it is best to try to become pregnant as soon as possible after a myomectomy.
If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, you can consider shrinking the fibroid, removing the fibroid (myomectomy), or removing the entire uterus (hysterectomy). After all treatments except hysterectomy, fibroids may grow back. Myomectomy or treatment with medicine is recommended for women who have childbearing plans.
To shrink a fibroid for a short time, hormone therapy with a gonadotropin-releasing hormone analogue (GnRH-a) puts the body in a state like menopause. This shrinks both the uterus and the fibroids. Fibroids grow back after GnRH-a therapy has ended. GnRH-a therapy can help to:
GnRH-a therapy is used for only a few months, because it can weaken the bones. It also may cause unpleasant menopausal symptoms.
To shrink or destroy fibroids without surgery, uterine fibroid embolization (UFE) (also called uterine artery embolization) stops the blood supply to the fibroid. The fibroid then shrinks and may break down. UFE preserves the uterus, but pregnancy is not common after treatment. UFE is not usually recommended for women who plan to become pregnant.footnote 2
Another treatment used to destroy fibroids without surgery is MRI-guided focused ultrasound. This treatment uses high-intensity ultrasound waves to break down the fibroids. Studies show that this treatment is safe and works well at relieving symptoms. But more studies are needed to find out if it works over time.footnote 2 This treatment may not be available everywhere.
Endometrial ablation is a treatment that destroys the lining of the uterus. It may use a laser beam, heat, electricity, freezing, or microwaves. As the lining of the uterus heals, it will scar. This scarring reduces or prevents bleeding.
To surgically remove fibroids, myomectomy can often be done through one or more small incisions using laparoscopy or through the vagina (hysteroscopy). Some surgeries can be done using robotic tools. Sometimes, a larger abdominal incision is needed depending on where the fibroid is located in the uterus. Myomectomy preserves the uterus, and it makes pregnancy possible for some women.
To surgically remove the entire uterus, hysterectomy is available to women with long-lasting or severe symptoms who have no future pregnancy plans. Hysterectomy has both positive and negative long-term effects. For more information, see the topic Hysterectomy.
There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.footnote 1
It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to think about. For more information, see the topic Hysterectomy.
Home treatment can ease menstrual period pain and anemia that may be linked to uterine fibroids.
Painful menstrual periods (dysmenorrhea) are one of the most common symptoms of fibroids.
Why fibroids cause pain is not known. Try one or more of the following tips to help relieve your menstrual pain:
Anemia occurs when your body cannot produce blood as fast as it is being lost. As a result, you have fewer red blood cells in the blood. A test called a complete blood count (CBC) can tell you whether you have anemia. Increasing the amount of iron in your diet may help prevent anemia.
Medicine can be used to help relieve uterine fibroid problems. The goals of medicine treatment are to:
When treatment is stopped, symptoms usually return.
The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods—they do not shrink fibroids:
The following medicine is used to shrink fibroids before surgery and to temporarily relieve symptoms:
Ulipristal (Fibristal) is used to treat moderate to severe symptoms of fibroids in women who are planning to have surgery. This medicine should not be used for more than 3 months.
If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a menstrual cycle problem that can be improved with birth control hormones and/or NSAID therapy. For more information, see the topic Abnormal Uterine Bleeding.
GnRH-a therapy is sometimes used to stop bleeding and improve anemia. But taking iron supplements can also improve anemia and does not cause the troublesome side effects and bone weakening that can happen with GnRH-a therapy.
To treat uterine fibroids, surgery can be used to remove fibroids only (myomectomy) or to remove the entire uterus (hysterectomy).
Surgery is a reasonable treatment option when:
Surgical treatment options include:
Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina, or through a larger abdominal cut (incision). The method depends on your condition, including where, how big, and what type of fibroid is growing in the uterus and whether you hope to become pregnant.
If you are hoping for a future pregnancy, myomectomy is your one surgical option.
Heavy, prolonged, and painful periods caused by uterine fibroids will stop naturally after you reach menopause. If you are nearing menopause and your symptoms are tolerable, consider controlling symptoms with home treatment and medicine until menopause. Uterine fibroid embolization (UFE) may also be a reasonable option for you, although it has some risks.
Uterine fibroid embolization (UFE) (also called uterine artery embolization) is another option for treating uterine fibroids. It shrinks or destroys uterine fibroids by blocking the artery that supplies blood to them. During a UFE procedure, a radiologist places a thin, flexible tube called a catheter into the upper thigh and guides it into the uterine artery that supplies blood to the fibroids. A solution is then injected into the uterine artery through the catheter.
UFE is a nonsurgical alternative to hysterectomy or myomectomy. It relieves fibroid symptoms for most women. But in rare cases it can lead to complications such as serious infection or early menopause.
UFE may be a reasonable treatment option when:
Pregnancy is possible after UFE. Whenever you need to prevent pregnancy after UFE, be sure to use a dependable form of birth control.
Heavy, prolonged, and painful periods caused by uterine fibroids will stop naturally when you reach menopause. If you are nearing menopause and your symptoms are tolerable with home treatment or medicines, then the benefits of UFE may not outweigh the risks.
Parker WH (2012). Uterine fibroids. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 438–469. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.
Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and reproductive function. Fertility and Sterility, 90(3): S125–S130.
Fritz MA, Speroff L (2011). The uterus. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 121–155. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
Haney AF (2008). Leiomyomata. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 916–931. Philadelphia: Lippincott Williams and Wilkins.
Current as ofMay 14, 2018
Author: Healthwise StaffMedical Review: Sarah A. Marshall, MD - Family MedicineKathleen Romito, MD - Family MedicineMartin J. Gabica, MD - Family MedicineElizabeth T. Russo, MD - Internal MedicineDivya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology
Current as of:
May 14, 2018
Medical Review:Sarah A. Marshall, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology
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