- No “best” treatment
- Hysterectomy, hold the power morcellation
- Treatment options for heavy bleeding
- Treatment options for bulk symptoms
- Which treatment is right for you?
- What are Fibroids
- What are uterine fibroids?
- Singer FKA twigs said she had 6 huge fibroid tumors removed from her uterus — here’s everything you need to know about the painful growths
- Uterine Fibroids
- What are fibroids?
- What are the causes of fibroids?
- Symptoms associated with fibroids include:
- How do I know if I have fibroids?
- Diagnosing Uterine fibroids
- Treatment Options for Fibroids
- 1. Your Pelvis Feels Heavy
- 2. Your Periods Are Out Of Control
- 3. You Feel Fatigued
- 4. You’re Crazy Bloated
- 5. You Constantly Have To Pee
- 6. You Actually Can’t Pee—Or Poop
- 7. Your Pelvis, Legs, Or Back Are Killing You
- 8. You’re Feeling Pain During Sex
- Fibroid Pain: Beyond the Uterus
If you aren’t experiencing symptoms caused by your fibroids, you usually do not need any treatment. And, if your symptoms aren’t severe, you may decide you can put up with them. This may be especially true if you’re close to menopause—a time when fibroids shrink and symptoms resolve. It’s important to discuss all your options with your health care professional and consider his or her recommendations when weighing your treatment options.
You may want to try the “watch and wait approach,” where your health care professional periodically evaluates the size of your fibroids during routine pelvic exams and discusses how much discomfort you’re feeling or how the symptoms may be disrupting your lifestyle.
Fibroids that don’t cause symptoms rarely need therapy unless they get big enough to affect other structures in the pelvic area, such as the kidneys or the ureter (the tube that drains the kidney to the bladder).
The need for treatment and the type of treatment you choose depends on the size and position of the fibroids, as well as any symptoms they’re causing, your age and whether or not you want to have children in the future. Even with a variety of treatment options available, new fibroids may grow back to some degree in the years following most treatments. The need for repeat treatments ranges from 10 percent to 25 percent, depending on the number and sizes of the fibroids initially treated. No treatment—except hysterectomy—can guarantee that new fibroids won’t grow. The more fibroids you have, the more likely you are to have a recurrence after treatment.
If bleeding is your major symptom, some women opt for managing this symptom with medication before surgery or as a way to delay surgery if they’re close to menopause (because fibroids generally shrink and cause few or no problems after menopause).
Medical Treatment Options for Fibroids
Oral contraceptives (OCs). While OCs do not treat fibroids, they may be recommended to manage heavy bleeding caused by fibroids or for women who experience irregular ovulation in addition to fibroids. OCs are the first treatment option for many women, often combined with a nonsteroidal anti-inflammatory such as ibuprofen. OCs do not make fibroids grow.
Intrauterine device (IUD). The levonorgestrel intrauterine device (Mirena), which is usually prescribed for birth control, can help ease the heavy bleeding that accompanies some fibroids. The device won’t shrink the fibroids, however, and depending on whether or not the fibroids have distorted the inside of the uterus, it may or may not provide effective birth control. Although the levonorgestrel IUD is FDA-approved for heavy menstrual bleeding, it isn’t approved specifically for the treatment of fibroids, so if you are interested in this option, discuss it with your doctor.
GnRH agonists. Gonadotropin-releasing hormone (GnRH) agonists, including leuprolide (Lupron), nafarelin nasal (Synarel) and goserelin (Zoladex), temporarily shrink fibroids by blocking estrogen and progesterone production; estrogen is thought to stimulate their growth. They are mainly used in women close to menopause or to shrink fibroids before removing them surgically or to correct anemia caused by heavy bleeding associated with fibroids. GnRH agonists are considered a short-term treatment because they block hormone production by the ovaries, thus triggering menopausal symptoms caused by estrogen depletion, such as hot flashes, vaginal dryness and bone loss. The usual course of treatment is three to six months, and it may be combined with estrogen and/or progesterone hormones to minimize menopausal symptoms. Once this medication is stopped, fibroids usually grow back to near pretreatment size or larger within several months.
- Antifibrinolytic medicines. Antifibrinolytic medicines are drugs that help slow menstrual bleeding by helping blood to clot. The drug tranexamic acid (Lysteda) is FDA-approved for heavy menstrual bleeding. Rare side effects include headaches, muscle cramps, or pain. Antifibrinolytic medicines do not affect your chances of becoming pregnant. They should not be taken with hormonal birth control without prior approval from a health care professional as the combination can cause blood clots. Antifibrinolytic therapies are relatively new and expensive—and often not covered by insurance. Check with your insurer if that is a concern.
Minimally Invasive Treatment Options
Uterine artery embolization (UAE). UAE is a procedure that involves placing a small catheter (a thin tube) into an artery in the groin and guiding it via X-rays to the arteries in the uterus. Then, tiny particles similar in size to grains of sand are injected through the catheter and into the artery. As they move toward the uterus, they obstruct the blood supply to the fibroids. Without an adequate blood supply, the fibroids shrink. The uterus is spared, however, because an alternate blood supply develops to support it.
UAE takes about one hour to perform and is typically performed by an interventional radiologist. It usually requires a one-night hospital stay. Most women are back to their normal activities in seven to 10 days.
While this treatment option leaves your uterus intact, it’s not recommended for women who wish to become pregnant in the future.
Potential complications include fever, passage of small pieces of fibroid tissue through the vagina after the procedure, allergic reaction and hemorrhage. Complications can also occur if blood supply to the ovaries or other organs becomes compromised.
- Endometrial ablation. This technique is used to treat small fibroids within the uterus or heavy periods caused by fibroids. Endometrial ablation uses electrical energy, heat or cold to destroy the lining of the uterus. It is performed on an outpatient basis and is only offered as a treatment option to women who have finished childbearing. It is not recommended for women who wish to preserve fertility. However, using a reliable form of contraception after having ablation is important.
Surgical Options for Fibroids
Hysterectomy. A hysterectomy offers the only real cure because it completely removes the uterus.
However, hysterectomy is major surgery, requiring between two and eight weeks of recovery, depending on the type of surgery performed. Hospital stays and recovery times can vary based on the type of procedure used and the extent of the surgery performed. Because your uterus and, sometimes, your ovaries, are removed, it is not an option if you want to become pregnant. If your ovaries do not need to be removed, you may want to keep your ovaries to maintain estrogen production.
If you and your health care professional decide that a hysterectomy is the best choice for you, you may have several options about how the procedure is performed:
Abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. It is generally used for large pelvic tumors or suspected cancer because this procedure allows the surgeon to see and manipulate the pelvic organs more easily.
Vaginal hysterectomy, in which the uterus is removed through the vagina.
Laparoscopically hysterectomy, in which a surgeon uses a laparoscope (a small telescope) inserted through the abdomen to see inside your pelvis. Laparoscopic hysterectomy is less invasive than an abdominal hysterectomy, but more invasive than a vaginal hysterectomy.
Robotic-assisted laparoscopic hysterectomy, in which a robotic system assists in removal of the uterus in a laparoscopic hysterectomy. It may be helpful with some patients because of the flexibility it allows, but it also adds to the time and cost of the procedure.
Myomectomy. This procedure removes only the fibroids, leaving the uterus intact, which can preserve fertility. The procedure is performed through an incision in the abdomen (a laparotomy), which requires general anesthesia, or by laparoscopy, which uses a few small incisions to insert an operative camera and surgical instruments. Robotic myomectomy is a variation of laparoscopic myomectomy during which the surgical procedure is aided with a surgical robot. A full recovery from laparotomy can take up to six weeks and two weeks from laparoscopy. Your health care professional will recommend which procedure to use based on the size of the fibroids, as well as whether they are superficial or deep (which is too difficult for laparoscopy).
A hysteroscopic myomectomy is performed through the vagina and requires no incision. It is appropriate only for women whose fibroids are in the endometrial cavity. With this procedure, fibroids are removed using an instrument called a hysteroscopic resectoscope, which is passed through the vagina into the uterine cavity. A wire loop carrying electrical current is then used to shave off the fibroid.
Blood loss may be slightly greater with a myomectomy than with hysterectomy, but surgeons use tourniquets and medications to control blood loss, so that transfusion rates are no greater than with hysterectomy.
Magnetic resonance guided focused ultrasound. A more recent fibroid treatment option, magnetic resonance guided focused ultrasound surgery (MRgFUS or FUS) is a noninvasive treatment that takes place inside an MRI machine. The machine guides the treatment, which consists of multiple waves of ultrasound energy that go through the abdominal wall and destroy the fibroid. The procedure requires sedation but is usually performed on an outpatient basis. In the weeks and months that follow, fibroids shrink and heavy menstrual flow decreases. Pregnancy isn’t recommended after FUS, but it is possible to become pregnant following the procedure.
Radiofrequency ablation. Acessa is a new FDA-approved laparoscopic surgical procedure that uses radiofrequency energy to destroy fibroids. The energy heats the fibroid tissue and kills the cells, which are then reabsorbed by the lymphatic system, decreasing fibroid size and symptoms. The procedure is minimally invasive, performed under ultrasound guidance during an outpatient pelvic laparoscopy. The early results regarding the safety and effectiveness of Acessa are good. On average, women returned to normal activities in nine days. The long-term risk of fibroid recurrence has not yet been determined, though a 12-month follow-up in one study showed good results.
Fibroids can’t be prevented. If you are experiencing symptoms, such as heavy bleeding and pelvic pressure, contact your health care professional for an evaluation. If you have a family history of fibroids or have been treated for them in the past, you may want to be examined more frequently or investigate the various management strategies available to treat fibroids.
The other night, I sat in a restaurant with a group of girlfriends. We shared laughter, good conversation and some great wine. As I looked around, I realized that we were likely to share something else: uterine fibroids. Of the ten women sitting at the table, there was a good chance that seven of us would have uterine fibroids at some point in our lives.
Fibroids are noncancerous tumors that grow in the uterus. They may be smaller than a seed or bigger than a grapefruit. A woman may have only one fibroid or she may have many. Depending on their size, number, and location, fibroids can cause heavy bleeding and long menstrual periods (which can, in turn, cause anemia), pelvic pain, frequent urination, or constipation. Fibroids can also cause infertility and repeated miscarriages.
No “best” treatment
Given how common uterine fibroids are, you’d think there would be a lot of research comparing treatment options. In fact, there are only a few randomized trials to guide treatment. In a clinical practice article in today’s New England Journal of Medicine, Dr. Elizabeth A. Stewart, professor of obstetrics and gynecology at the Mayo Clinic, lays out the options and discusses the factors that women and their doctors should consider when making treatment decisions.
First, are the fibroids causing symptoms? If not — which is often the case — no treatment is needed.
Next, what are the symptoms? These can be broadly divided into two categories: heavy menstrual bleeding and “bulk” symptoms. Bulk symptoms, like pelvic pain and frequent urination, are caused by the presence of large fibroids in the abdomen.
“I consider the severity of symptoms and the impact of those symptoms on a woman’s quality of life to be the foundation of treatment decision making,” says Dr. Aaron Styer, an obstetrician-gynecologist at Harvard-affiliated Massachusetts General Hospital. “For example, is the woman missing work, requiring frequent hospitalizations, or missing out on normal, daily life? If so, that information will guide the treatment I recommend.”
Whether a woman would like to have children, her age, and how close she is to menopause can also ninfluence the treatment decision. Once a woman enters menopause, fibroids often shrink or even disappear. But until menopause, they may continue to form or reappear after they are removed.
Hysterectomy, hold the power morcellation
Removal of the uterus (hysterectomy) is a popular option for women who are done having children. With the uterus gone, new fibroids can’t form. But traditional hysterectomy, in which a surgeon makes a large incision in the abdomen, is major surgery.
In laparascopic hysterectomy, the surgeon removes the uterus through three or four small incisions in the wall of the abdomen. Recovery is quicker and there are usually fewer complications than with a traditional hysterectomy.
Laparascopic hysterectomy has historically been accompanied by a procedure called power morcellation. It uses a device to cut the uterus into fragments so it can be removed through the small incisions. But the FDA recently recommended limiting the use of power morcellation because of the small chance that a woman having surgery to remove fibroids may have undiagnosed uterine cancer. If power morcellation is performed in these women, there is a risk that the procedure will spread the cancer throughout the abdomen and pelvis. This is precisely what happened in the much-publicized case of Dr. Amy Reed, an anesthesiologist at Boston’s Brigham and Women’s Hospital.
Treatment options for heavy bleeding
Women with heavy bleeding who do not want to have a hysterectomy can turn to both medical and surgical options. Some medications reduce heavy bleeding by helping blood clot. Hormonal birth control works by thinning the endometrium. This is the nutrient-rich lining of the uterus that is shed during a woman’s period. Medications can relieve symptoms, but they don’t treat the underlying problem.
A surgical option to treat heavy bleeding is hysteroscopic myomectomy. In this procedure, a thin tube called an endoscope is passed through the cervix and into the uterus. The fibroid is shaved and removed, but the uterus is left intact. If a woman does not want to have children, she can opt for endometrial ablation. In this procedure, the endometrium is destroyed, often with heat or cold.
Treatment options for bulk symptoms
When fibroids cause pelvic pain or frequent urination, the goal of treatment is to reduce the size of the fibroids. Medications called GnRH agonists effectively shrink fibroids. However, fibroids grow back once the treatment is stopped, and these drugs are not intended for long-term use.
Myomectomy — this time done through a larger incision in the abdomen — can reduce the size of the fibroids while preserving a woman’s ability to have children. However, fibroids can recur after myomectomy. Another option is uterine artery embolization. This procedure blocks the blood supply to fibroids, causing them to shrink and die. Women are significantly more likely to have a successful pregnancy and delivery after myomectomy than after embolization.
A treatment option that is increasingly being used to treat uterine fibroids is MRI-guided ultrasound surgery. It uses ultrasound waves to shrink fibroids and reduce heavy menstrual bleeding.
Which treatment is right for you?
While there are many treatment options for uterine fibroids, there is no clear winner. That means you and your doctor can choose a treatment based on your preferences and reproductive plans along with other medical considerations.
As you decide, ask your doctor:
- Which treatment gives me the best chances of having a healthy pregnancy?
- Which treatment is most likely to offer permanent removal of fibroids?
- What are my personal risks and benefits of medical versus surgical treatment options?
Let your doctor know:
- whether you plan to have more children
- if you’d prefer to keep your uterus, even if your childbearing days are over
- which symptoms you find most bothersome and how they affect your quality of life.
There may be no “best” treatment for uterine fibroids. But there is a best treatment for you.
What are Fibroids
What are uterine fibroids?
Fibroids are benign tumors made of smooth muscle cells and fibrous connective tissue. They develop in the uterus. It is estimated that 70-80% of women will develop fibroids in their lifetime—however, not everyone will develop symptoms or require treatment. The most important characteristic of fibroids is that they are not cancer, and they do not have the potential to become cancer. Because of that, it is reasonable for women without symptoms to opt for observation rather than treatment. Studies show us that fibroids grow at different rates, even in the same woman, and can range from the size of a pea to the size of a watermelon.
What causes uterine fibroid tumors?
The cause of uterine fibroids is not known, although studies demonstrate there may be a genetic component. There is no food or external exposure that a woman can have that can cause her to develop fibroids.
Who is at risk for uterine fibroids?
As women age their likelihood for developing fibroids increases. Studies have demonstrated that women with a family history are more likely to develop fibroids. Fibroids are also more common in African American women. Obesity has also been linked to an increase risk of fibroids. There are no foods or diets that are known to increase a woman’s risk of developing fibroids.
What are the symptoms of uterine fibroids?
Most women with fibroids will experience no symptoms at all. However, for many women large or numerous fibroids can cause the following symptoms:
- Heavy or prolonged periods
- Bleeding between periods
- Pelvic pain and pressure
- Frequent urination
- Low back pain
- Pain during intercourse
- Difficulty getting pregnant
How are uterine fibroids diagnosed?
Fibroids are most often found during the physical exam. Your healthcare provider may feel a firm, irregular pelvic mass during an abdominal or pelvic exam. Other tests may include:
- Transvaginal ultrasound. This is an ultrasound performed inside the vagina to better assess if you have fibroids. It can help establish the diagnosis as the first imaging test.
- MRI. This imaging test does not use radiation, and allows your provider to gain a road map as to the size, number, and location of each of your fibroids. It is often recommended before proceeding with some surgical options.
- Saline Sonohysteragram. This is a vaginal ultrasound performed in the office while putting fluid (saline) into the uterus. By expanding the uterine cavity with this fluid your provider may be able to see if you have fibroids growing within the uterine cavity.
- Hysteroscopy. This is a surgical procedure performed to gain direct visualization of the uterine cavity. It does not visualize or treat fibroids outside the cavity.
How are uterine fibroids treated?
Since most fibroids stop growing or may even shrink as you approach menopause, your healthcare provider may simply suggest “watchful waiting.” With this approach, your healthcare provider monitors your symptoms carefully to be sure that there are no significant changes.
If your fibroids are large or cause significant symptoms, treatment may be an option. Treatment will be discussed with you by your healthcare provider based on your age, fertility goals, the number and size of your fibroids, any previous fibroids treatments, other health conditions.
In general, treatment for fibroids may include:
- Watchful waiting
- Medical Management
- Fibroid removal
- Uterine Artery Embolization
- MR Guided Focused Ultrasound
- Other medical options
What are the complications of uterine fibroids?
It is uncommon for fibroids to cause severe health consequences. However, women can have heavy bleeding which can lead to dangerous anemia. Rarely, large fibroids can press on the bladder and ureter, leading to kidney damage. Other complications include infertility and recurrent pregnancy loss.
Key points about uterine fibroids
- Uterine fibroids are the most common tumor of the reproductive tract.
- Fibroids are not cancer. They do not increase a woman’s risk for uterine cancer, and they do not become cancer.
- Women who are nearing menopause are at the greatest risk for fibroids. Fibroids are most often found during a routine pelvic exam.
- Symptoms may include heavy and prolonger periods, bleeding between periods and pelvic pain.
- Fibroids are most often found during a routine pelvic exam.
- There are a variety of treatment options available, which may include watchful waiting, medicines or surgery.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
UCLA Health Library: Uterine Fibroids
Singer FKA twigs said she had 6 huge fibroid tumors removed from her uterus — here’s everything you need to know about the painful growths
- FKA twigs opened up about her experience with fibroid tumors in a recent Instagram post.
- The singer wrote that she had surgery to remove six large tumors.
- “I felt really alone and my confidence as a woman was knocked,” Twigs wrote in her caption.
- Fibroid tumors affect many women of childbearing age, but they often go undiagnosed because not all women experience symptoms.
In a recent Instagram post, FKA twigs called attention to a painful medical condition that affects many women.
The singer shared she has been recovering from a laparoscopic surgery to remove six fibroid tumors from her uterus. “The tumors were pretty huge, the size of two cooking apples, three kiwis, and a couple of strawberries,” she wrote in her Instagram caption. “A fruit bowl of pain every day.”
Twigs also wrote that her nurse compared the weight and size of her tumors with being “six months pregnant,” and shared that she struggled with her confidence since she underwent surgery in December.
“I was so scared, despite lots of love from friends and family, I felt really alone and my confidence as a woman was knocked,” she wrote in her caption. “I tried to be brave but it was excruciating at times and to be honest I started to doubt if my body would ever feel the same again.”
But the singer said that pole dancing has helped her move through the pain and find her sense of self again.
Twigs initially debated whether or not to open up about her experience, but she wrote that she hopes doing so will help other women know that they are not alone and that many women are affected by uterine fibroids.
Fibroid tumors are noncancerous growths in the uterus that often affect women during childbearing years.
Uterine fibroids can be as small as apple seeds or as big as a grapefruit, according to the Office on Women’s Health. In some cases, they can be so large that they distort the shape of the uterus and push it up toward the rib cage, according to the Mayo Clinic.
Fibroids become more common as women reach their 30s and 40s, according to the Office on Women’s Health. Uterine fibroids aren’t associated with an increased risk of cancer and they almost never develop into cancer, but they can cause a variety of health problems for women, according to Mayo Clinic.
Many women have fibroids sometime during their lives but many don’t know they have them because there are often no symptoms.
Because many women don’t have symptoms, fibroids are often discovered during a pelvic exam or ultrasound, according to the Mayo Clinic.
But women who do experience symptoms have painful periods or heavy bleeding (which can be heavy enough to cause anemia), a feeling of fullness in the pelvic area, enlargement of the lower abdomen, frequent urination, pain during sex, and lower back pain, according to the Office on Women’s Health. Fibroids can also lead to complications during pregnancy and labor.
Treatment options for fibroids may include medication, hormonal therapy, and noninvasive or invasive surgery. The type of treatment depends on the severity of the fibroids. People who don’t experience symptoms may not need treatment at all because fibroids usually shrink after menopause, according to UCLA Health.
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Uterine fibroids are the most common benign muscular tumor affecting the female reproductive system. They affect about 30 percent of women ages 30-45.
What are fibroids?
Fibroids are growths, which may appear alone or in groups. They range from the size of a pea to the size of a melon and can be confined to the wall of the uterus or grow into the cavity of the womb. They can also grow outward from the uterus on stalks. Less than 0.5 percent of the time they can become cancerous. Fibroids tend to shrink after menopause.
What are the causes of fibroids?
The causes of fibroids are unknown; there is a genetic link, and estrogen promotes their growth.
Fibroids are commonly asymptomatic.
Symptoms associated with fibroids include:
- Emergency symptoms: sharp, sudden pain in the abdomen (when a fibroid on a stalk becomes twisted or if it has outgrown its blood supply)
- Heavy periods, resulting in anemia
- Abdominal discomfort, abdominal fullness
- Lower back pain
- Bladder or rectal pressure
Fibroids can also be associated with infertility or problems in pregnancy, including preterm labor, abnormal attachment of the placenta, increased need for C-section, or post-partum hemorrhage.
How do I know if I have fibroids?
Women should have annual pelvic exams once they reach the age of 21 or when they plan to become sexually active; to aid in early detection and treatment of abnormalities. A pelvic examination, during which the doctor presses on the uterus, may reveal the presence of uterine fibroids.
Diagnosing Uterine fibroids
To diagnose uterine fibroids, your doctor may order one of the following tests:
- Abdominal and/or transvaginal ultrasound (also known as a sonogram). An ultrasound probe projects sound waves onto the internal organs, which reflect the sound back in the form of a picture. The doctor can see the size, shape and texture of the uterus and evaluate any growths. It is a painless test and usually lasts 30 minutes.
- Magnetic resonance imaging (MRI). This is a form of advanced imaging technology that provides highly refined, optimal images of internal body parts, useful in determining the exact location and characteristics of fibroids, and in planning minimally invasive treatments.
Treatment Options for Fibroids
For asymptomatic fibroids, your doctor may recommend watchful waiting, with regular follow-up visits and ultrasounds.
If treatment is needed, options may include:
- Non-hormonal treatment: non-steroidal anti-inflammatory agents (like ibuprofen or naproxen) may reduce menstrual bleeding associated with fibroids
- Hormonal treatment:
- Oral contraceptive pills may help control bleeding, but do not affect the size of fibroids
- Progesterone-containing agents (pills or injection) may also control bleeding but do not affect the size of fibroids. The progesterone-releasing IUS (Mirena™) also works in this way
- Gonadotropin-releasing hormone (GnRH) agonists (leoprolide acetate) work to shrink fibroids by inducing a temporary menopausal state and reducing the amount of estrogen in the body. The side- effects with this are similar to natural menopause, which limits its long-term use.
- Procedural options:
- Traditional Abdominal Myomectomy: Using an abdominal incision, fibroids are removed from the uterus leaving the uterus intact. This is the best option for women interested in preserving fertility. The main risks are bleeding, scar tissue formation, and a 1 percent chance of uterine rupture in a future pregnancy. There is also a 50 percent chance that new fibroids will be seen on ultrasound in five years, but only 10 percent of women will require another treatment.
- Laparoscopic or robotic myomectomy. This procedure uses “keyhole” incisions to perform the same myomectomy as described above. This is associated with less blood loss, scarring, and pain than traditional myomectomy, and leads to a faster recovery. Hospital stay is usually one day. Not all patients are appropriate candidates for minimally invasive myomectomy. Your doctor will determine this by your examination and imaging studies, as well as your past medical and surgical history.
- Hysteroscopic myomectomy. This is an outpatient procedure for fibroids bulging into the uterine cavity. A camera in inserted through the cervix into the uterus, and instruments are used to shave off the visible portions of the tumors.
- Hysterectomy or removal of the uterus. This can be accomplished abdominally via an incision, laparoscopically or robotically, depending on the size of the uterus and location of the fibroids, prior medical and surgical history. Again, the minimally invasive approach is associated with less blood loss, pain, scarring, and shorter hospital stay and recovery period. Also, discuss with your doctor options for preserving or removing the ovaries and cervix.
- Uterine artery embolization or fibroid embolization (UAE). This procedure involves cutting off the blood flow to the fibroids, which causes them to shrink. An interventional radiologist performs this procedure, using x-rays for guidance. S/he sedates the patient, makes a small nick in the groin, and passes a small tube or catheter into the artery. The catheter is guided to the uterus, and plastic or gelatin sponge particles the size of grains of sand are injected into the vessels to the fibroids, blocking the blood supply to them. Patients typically stay in the hospital one night and recover in a week. It is successful in 80 percent of patients; however, as with myomectomy, since the uterus is left in place, additional treatments may be needed in the future for new fibroids.
Research at Johns Hopkins Medicine
At Johns Hopkins, we are constantly seeking new and better ways to diagnose, treat, and prevent conditions affecting our patients’ quality of life. In addition to being recognized globally for these efforts, we often partner with other researchers from around the country and the world. Ask you doctor about ongoing trials in which you can participate.
- Read more about our research in Finding a Way to Attack Fibroids Through Their Extracellular Matrix.
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It was, said the singer FKA twigs, “a fruit bowl of pain every day”. She likened the size of the fibroids – benign tumours that had been removed from her uterus in December – to fruit: two cooking apples, three kiwis and a couple of strawberries. The nurse, she added, “said that the weight and size was like being six months pregnant”. Her experience, the singer said, was “excruciating at times and, to be honest, I started to doubt if my body would ever feel the same again … I know that a lot of women suffer from fibroid tumours and I just wanted to say after my experience that you are amazing warriors and that you are not alone.”
She shared the post on Instagram last week, which was picked up by news organisations around the world – indicating how rare it was for anyone to talk openly about fibroids, even though it is a condition that affects about a third of women at some point in their life.
Fibroids are non-cancerous growths of the uterine muscle that develop in or around the uterus. “It’s unusual for them to be painful,” says Dr Virginia Beckett, a consultant gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists. “Usually, they’re very small and harmless. They can occur either on the outside of the womb, within the muscle wall of the womb or pushing on to the inside of the womb.” Many women will never even know that they have them but, for some, they can cause debilitating pain, bleeding, heavy periods, discomfort during sex and, in some cases, fertility problems.
Their cause is unknown, but thought to be linked to oestrogen levels – women of childbearing age are more likely to develop them and they can shrink in women who have been through the menopause. African-Caribbean women are more likely to suffer from larger fibroids that cause symptoms. There is no known way of cutting your risk, says Beckett. “There are no dietary methods or medications and having your baby early or late makes no difference.”
A recent all-party parliamentary group on women’s health – which also covered the condition endometriosis – found “unacceptable treatment” for women with fibroids. It reported that 42% of women said they were not treated with “dignity and respect” and nearly half were not told about the short- or long-term side effects of treatment. It found that 12% of women took up to two years even to be treated for their fibroids. One woman told the survey she had been told by her gynaecologist that there was only one treatment option. “I was only offered a hysterectomy and only through my own online research did I discover the other options out there. I had to ask for these other treatments,” she said. Another respondent said her symptoms were ignored.
“Far too often, women put up with symptoms and incredible pain because they are not aware of what is ‘normal’ and they feel stigmatised by talking about ‘women’s problems’,” said the report.
Bridgette York, a solicitor who founded the Fibroid Network patient and campaign group, was diagnosed with fibroids when she was in her mid-20s. She says that, at the time, some 20 years ago, women – even young women who hadn’t had children – were being pushed towards unnecessary hysterectomies. “It was very distressing emotionally and people weren’t talking about it,” says York. After doing lots of research, she was treated nine years after the diagnosis with a myomectomy, which removed the fibroids but kept her womb intact. She had four fibroids removed, with one measuring 33cm (13in) across and the largest weighing 5kg (11lb). York recovered well and went on to have twins.
One of her concerns now is the number of women who are offered medication to treat symptoms rather than a cure. Some drugs also act as contraceptives and are often prescribed to women in their 20s and 30s who may not be aware that it may delay their ability to conceive once they come off it. Medication can be useful for some women, but York says there are safety and efficacy concerns. She points to the drug Esmya (ulipristal acetate) – in February, the Medicines & Healthcare Products Regulatory Agency informed medical professionals that it was the subject of a new EU safety review after several women suffered serious liver damage while taking it. The agency ruled that it should not be prescribed to new patients and that liver function should be tested once a month for women already on it.
“We’re concerned that women are not being given all of the options, and not being given informed choice, and that drugs have as much effect as they think it might do, especially if they have large fibroids,” says York.
The all-party parliamentary report found that 70% of women were told about hysterectomy, with 38% undergoing one. However, in many cases, fibroids can be treated with less extreme surgery, but also non-surgical interventions such as uterine fibroid embolisation, which is carried out by a radiologist who essentially blocks the blood vessels “feeding” the fibroid. Woodruff Walker, a pioneer of uterine fibroid embolisation, says not enough women are being told about the treatment by gynaecologists, either because they are not familiar with it or because it is not something they offer. “For about 25% of patients who come to me, who have fought their way through the system, embolisation is not mentioned by their gynaecologist as an option.” There are also newer treatments involving laser or ultrasound to destroy the fibroid, but the NHS points out that “the long-term benefits and risks are unknown”. “We do have some medical therapies, but they’re not useful for very large fibroids,” says Beckett.
For large fibroids, she explains, “you would probably offer a hysterectomy. You can do open surgery to remove the fibroids and leave the womb, but that can be quite complicated. You can remove smaller ones laparascopically . You can do minimally invasive techniques to interfere with the blood supply of the fibroid and, if they are impinging on the lining of the womb, you can remove them through a camera that goes into the womb through the cervix.” Embolisation “is not extremely widely available and there are some disadvantages to it. You can get quite significant pain afterwards and the data on fertility is not very well established. The data is much more established with traditional surgical methods,” she says.
Fibroids are abnormal (non-cancerous) growths that develop in or on a woman’s uterus. They are also known as leiomyomas or myomas. But most females don’t know that they have fibroids because often they cause no symptoms. They are diagnosed incidentally only during routine examinations or when undergoing examination for any other problem. They can vary in number and size and can occur anywhere in the uterus may be on the outer surface of the uterus or within the wall. Most of them are asymptomatic.
Symptoms Associated with Uterine Fibroids:
- Depending on their size and location they can cause a variety of symptoms causing a major impact on women’s health, fertility, and quality of life.
- The most common being heavy and painful menstrual periods which can cause anemia. The pain can be more troublesome during the time of periods. The pain and bleeding can be so severe that females are unable to carry out their routine outdoor activities leading to social withdrawal.
- Apart from these they can cause vaginal bleeding between periods, pains in the legs, backaches(mostly dull, aching pain), miscarriage, infertility, and pain during intercourse.
- Fibroids which are attached to the uterus can undergo torsion(twist) and then cause pain, nausea, or fever.
- Similarly, big fibroids or the ones growing very rapidly or degenerating (dying) can cause heaviness or lump in the lower abdomen, nausea and abdominal bloating.
- They can also cause increased frequency of urination, constipation, pain in the rectum or uneasy bowel movements.
- Rarely fibroids can be cancerous.
How are Fibroids diagnosed?
Fibroids can be detected during a routine pelvic examination or ultrasound. Your doctor can recommend an MRI if there is uncertainty in diagnosis. If fibroids are not causing symptoms, they may not need treatment at all. However, depending on the size and location the treatment may non-surgical or surgical.
Thus, although fibroids do not cause any symptoms if you notice any changes in your health or any of the above symptoms you should immediately consult your gynecologist.
You’re bloated like never before and your period has been acting CRAZY for the past few months. Probably just PMS gone wild, right? Not so much. Those are both symptoms of uterine fibroids, which you definitely shouldn’t just ignore.
Fibroids are abnormal uterine muscle tissue growths. They can occur inside the uterine cavity, within the uterine wall, on the outside edge of the uterine wall, or even outside of the uterus, and they strike roughly 70 percent of women at some point in their lives, according to Taraneh Shirazian, M.D., a gynecologist at NYU Langone Health specializing in minimally invasive gynecologic surgery.
So why isn’t anyone talking about them? Probably because the majority of women who have them never even know they’re there, says Shirazian. “Uterine fibroids symptoms vary depending on how many you have, where they’re located, and how large they are,” she says. So if they’re small and few enough, chances are, you’ll never feel anything. But in some women, they can be very serious—and if they’re large or painful enough, they may have to be removed via medical or surgical methods.
“Typically, when women come in with fibroids, it’s because they’re experiencing pelvic pressure or abnormal bleeding,” she says. But there are other symptoms of fibroids you can look out for—and if you’re experiencing one or two of the issues below, you should get to your ob-gyn for a full workup ASAP.
1. Your Pelvis Feels Heavy
This is probably the most common symptom of fibroids. “We call this a mass-effect symptom—an effect of having some sort of growth in your body,” says Uchenna Acholonu Jr., M.D., obstetrician-gynecologist at Weill Cornell Medicine and New York-Presbyterian in New York. Women with larger fibroids tend to feel a sensation of something pushing down on the pelvis—because there is something pushing down on the pelvis.
The exact feeling is hard to describe because, unless you’ve had a bun in the oven, you have probably never felt this sort of pressure before. But, when you feel it, you know it, he says.
2. Your Periods Are Out Of Control
There are a lot of things that can cause changes to your menstrual cycle, and fibroids are a super-common culprit. “If you have what we call a submucosal fibroid, a fibroid within the uterine cavity, you’ll bleed much more than typical,” says Shirazian. “That means your period would be longer, heavier, or you might bleed in between periods.”
We’re not talking an extra day or a little spotting here—the bleeding would be significantly greater than or different from your norm.
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3. You Feel Fatigued
Some fibroids can actually lead to anemia, a lack of red blood cells, or iron deficiency. The reason comes down to those heavy periods. “Usually with submucosal fibroids, women bleed quite extensively, even to the point of requiring blood or iron transfusions,” says Shirazian.
Symptoms of anemia include fatigue, shortness of breath, lightheadedness, dizziness, or an overactive heartbeat. Your doctor can also perform a simple blood test to diagnose anemia.
4. You’re Crazy Bloated
“Women will come to me and say, ‘people are saying that I look pregnant, but I’m clearly not.’ That’s usually the result of a fibroid,” says Shirazian. For the most part, fibroids just make you look or feel bloated, but they can even grow to a size where they can cause difficulty breathing or kidney failure, says Shirazian.
“If your abdomen is expanding in size, don’t just write it off as weight gain if you’re not gaining weight elsewhere,” she says.
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5. You Constantly Have To Pee
If you’ve noticed that you’re peeing more frequently, or just feel the urge to pee more frequently, it might be the result of a fibroid. “Because the uterus is located right next to the bladder, a mass growing on the left side of your uterus could very well cause urinary pressure or frequency,” says Shirazian.
6. You Actually Can’t Pee—Or Poop
On the flip side, a fibroid can actually make it harder to use the bathroom, too. “If you’re accommodating urinary frequency and your body gets used to that, after a while, your anatomy changes so much that the urethra, the tube that leads from the bladder out, becomes so kinked or bent you have difficulty urinating,” says Acholonu. “Some people will actually have to lift up on the fibroid or lift up on their uterus to straighten out the urethra enough to allow themselves to void.”
It’s the same effect with constipation—if the fibroid is in the back of the uterus, it going to push on your rectum, which can limit bowel movements, says Shirazian.
Constipation happens to everyone from time to time, but if it doesn’t clear up in a couple of days or you are experiencing difficulty urinating, you need to talk to your doctor about your symptoms.
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7. Your Pelvis, Legs, Or Back Are Killing You
Pain is less common with fibroids than it is with, say, endometriosis or other gynecological issues, but you may experience it—although it’s difficult to define. “Pain for some people is just a light ache, for other people it’s a stabbing, hard pain they can’t walk or talk through. And you can have the full range with fibroids,” says Acholonu. “It really depends on location. If you have a fibroid within the uterus, that may cause more central pelvic pain; if you have fibroids that are really pushing against your back bones, you can have lower back pain or pain all the way down your leg.”
8. You’re Feeling Pain During Sex
This isn’t a fibroid symptom that ob-gyns are going to hang their hats on, but it can occur along with other fibroid symptoms. “You could have a fibroid that protrudes or bulges down into the vagina,” says Acholonu, which could cause pain during penetration, “or, because a fibroid is generally attached to the uterus, it could be jostled during intercourse and hit another part of the anatomy, which can result in pain.”
Painful sex can result from several other down-there issues, ranging from cervical cancer to vaginal dryness. Pain is nothing to shrug off, but talk to your gyno before sounding any alarms.
Ashley Mateo Ashley Mateo is a writer, editor, and UESCA-certified running coach who has contributed to Runner’s World, Bicycling, Women’s Health, Health, Shape, Self, and more.
Fibroid Pain: Beyond the Uterus
Uterine fibroids, the most common pelvic growth among women, have different effects for each woman who has them.
“Fibroids are like fingerprints — no two are ever alike,” says Steven Goldstein, MD, board-certified ob-gyn at New York University Langone Medical Center in New York. What determines how much pain and discomfort they cause is not necessarily size, but where they’re growing. “It’s like real estate — location, location, location,” says Dr. Goldstein.
Fibroids are made of the muscle tissue found in the uterus, but their location isn’t limited to inside the uterine cavity. They can also grow on the outside of the uterus, and within the uterine walls, and can even attach themselves to the uterus by a stem of sorts.
And especially for woman whose fibroids are growing outside of the uterus, other organs can be affected, too.
Apart from pelvic symptoms like pain, heavy bleeding, and possibly infertility, fibroids can also cause problems with bladder and bowel elimination. This happens when fibroids affect the urinary and G.I. systems, leading to a variety of side effects.
The Effects of Fibroids on Other Organs
Fibroids can have a chain reaction effect that includes:
- The rectum. A large enough fibroid can push down on the rectum, making bowel movements difficult. “If the fibroid is on the underside of the uterus, you could have constipation or pain when defecating,” explains John C. Petrozza, MD, board-certified ob-gyn and chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility Center in Boston. Hemorrhoids can be another unpleasant result of rectal pressure and difficulty moving your bowels.
- The bladder. “If the fibroid is on the other side of the uterus, growing toward your bladder, you might find you get up three or four times a night to go to the bathroom — you don’t have the capacity to hold urine because of it,” says Dr. Petrozza. In addition to having to urinate more often, you might have difficulty or pain while urinating.
- The stomach. Pelvic symptoms of fibroids include feeling like you have a full stomach. A fibroid can push up to your stomach creating “early satiety,” explains Petrozza. You feel full faster and may not be able to eat as much as previously, oftentimes leading to weight loss. If the fibroid grows big enough, your lower abdomen can look enlarged, as though you were pregnant.
- The kidneys. In very rare instances, says Goldstein, a fibroid can grow large enough to affect the ureter, the tube that connects the kidney and the bladder. If the flow of urine is backed up because of a fibroid pressing on a ureter, the back-pressure can cause the kidney to swell, a condition called hydronephrosis. Symptoms may include painful urination, a greater urge to go or going more often, and pain on one side. Kidney damage may result. In this case, in Goldstein’s opinion, the only option is surgery to remove the fibroid.
Treating Fibroids When Other Organs Are Affected
Still, despite the potential effects of fibroids, some women do nothing to treat them. “The fibroids typically will grow at a certain rate per year, and a lot of women just grow into their symptoms and minimize them,” says Petrozza. “However, if you’re 40, for example, you may have another 11 to 12 years before menopause, when they typically stop growing.” That’s a long time to put up with the discomfort you’re experiencing.
Talk to your doctor about how best to manage your fibroids. There are a variety of fibroids treatments that may help, from medication to surgical techniques, some designed to preserve fertility if you want to have children. But keep in mind, as Petrozza cautions, that the longer you wait and the bigger they get, the fewer fibroid treatment options you’ll have.
Learn more in the Everyday Health Women’s Health Center.