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Alternative Names Return to topLeiomyoma; Fibromyoma; Myoma; Fibroids
Definition Return to top
Uterine fibroids are noncancerous tumors that develop within or attach to the wall of the uterus, a female reproductive organ.
Causes Return to top
Uterine fibroids are the most common pelvic tumor. Fibroids may be seen as many as 1 in every 5 women in their childbearing years (the time after starting menstruation for the first time and before menopause.)
Fibroids usually affect women over age 30. They are rare in women under 20 or in those who have gone through menopause. They are more common in African-Americans than Caucasians.
The cause of uterine fibroid tumors is unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly.
Fibroids can be so tiny that you need a microscope to see them. However, they can also grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there is more than one.
Sometimes, a fibroid hangs from a long stalk, which is attached to the outside of the uterus. This is called a pedunculated fibroid.
Symptoms Return to top
Note: There are often no symptoms.
Exams and Tests Return to top
A pelvic examination may reveal an irregularly shaped, lumpy, or enlarged uterus. Frequently, this diagnosis is reliable. In some cases, diagnosis of fibroids is difficult, especially in obese women. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the fallopian tubes, and pregnancy.
A transvaginal ultrasound or pelvic ultrasound may be done to confirm the diagnosis of fibroids.
An endometrial biopsy (biopsy of the uterine lining) or a pelvic laparoscopy may be needed to rule out cancer.
Treatment Return to top
Treatment depends on various factors, including:
Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid's growth.
Treatment for fibroids may include:
Some women may need hormonal therapy (Depo Leuprolide injections) to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The hormones create a situation in the body that is very similar to menopause. Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density. Hormone treatment may last several months. Fibroids will begin to grown as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.
Surgery and procedures used to treat fibroids include:
See also: Fibroid treatment
Support Groups Return to top
National Uterine Fibroid Foundation - www.nuff.org
Outlook (Prognosis) Return to top
A pedunculated fibroid can become twisted and cause a kink in the blood vessels feeding the tumor. This type of fibroid may require surgery.
A fibroid sometimes blocks the fallopian tubes and prevents sperm from reaching and fertilizing eggs, which may cause fertility problems. In some cases, fibroids may prevent a fertilized egg from implanting in the uterine lining. However, proper treatment may restore fertility.
After a pregnancy develops, existing fibroids may grow due to the increased blood flow and estrogen levels. The fibroids usually return to their original size after the baby is delivered.
Most women are able to carry their babies to term, but some of them end up delivering prematurely because there is not enough room in the uterus.
Some pregnant women with fibroids may need acesarean section because fibroids can occasionally block the birth canal or cause the baby to be positioned wrong.
Possible Complications Return to top
Fibroids may cause infertility. They may also cause premature delivery.
Severe pain or excessively heavy bleeding with fibroids may require emergency surgery.
In rare cases, cancerous changes may occur. These usually take place after menopause.
When to Contact a Medical Professional Return to top
Call your health care provider if gradual changes in your menstrual pattern occur, including a heavier flow, increased cramping,or bleeding between periods, or if fullness or heaviness develops in your lower abdomen.
References Return to top
Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: pp. 441-447.
Viswanathan M, Hartmann K, et al. Management of uterine fibroids: an update of the evidence. Evid Rep Technol Assess. 2007;154: 1-122.
Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007; 75(10): 1503-8.
Griffiths A, D'Angelo A, et al. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2006; 3: CD003857.
Hehenkamp WJ, Volkers NA, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol. 2005; 193(5): 1618-29.Update Date: 5/26/2008 Updated by: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.