Uterine Fibroids the Diagnosis and Treatment


Uterine fibroids are benign tumors found in the womb or uterus. They are composed of dense fibrous tissue and can cause a variety of symptoms including excessive menstrual bleeding, pain, abdominal swelling and infertility. Fortunately, there is a wide range of effective treatments for fibroids.

The medical term for uterine fibroids is leiomyoma. A rare cancer of the uterus is called a leiomyosarcoma, but having fibroids does not lead to this tumor or increase the risk of it. However, fibroids can have serious impact on a woman’s health.

No one knows for sure what causes fibroids but there are risk factors that make them more common, obesity being one of them. They are also more common in women in their 30’s and 40’s although they often shrink after menopause. African American women are more likely to have fibroids and so are women with a family history of the condition. While the causes of fibroids are not known, the risk can be decreased by avoiding obesity and the consumption of a healthy diet rich in vegetables.

From 20% to 80% of women will develop fibroids in a lifetime. It is known that diet can have an influence on the development of fibroids with the consumption of lots of vegetables and fruits being protective while large quantities of red meat seem to encourage fibroid growth.

Some fibroids cause no symptoms at all, even when sizeable. Common symptoms of fibroids are heavy menstrual periods, heaviness in the lower abdomen and pelvis, urinary symptoms and painful sexual intercourse. Fibroids can complicate pregnancy and greatly increase the chances of requiring a cesarean delivery.

Fibroids are classified by where in the uterine wall they occur. Submucosal fibroids grow into the uterine cavity while intramural fibroids are contained inside the muscle wall and subserosal fibroids grow on the outside of the womb. Pedunculated fibroids grow on a thin stalk and look something like a mushroom.

There are many different means of treating fibroids when they require treatment at all. Asymptomatic fibroids only require watching for problems and are common. When symptoms cause a great deal of pain or anemia from heavy bleeding, there are surgical and nonsurgical options. Size and location of the fibroids may dictate the types of therapy available.

For women who do not wish to preserve childbearing, hysterectomy or removal of the uterus is a direct solution. It is also often possible to remove just the troublesome fibroids by a procedure called myomectomy. Conception may be possible after that option. Another option is uterine lining ablation which is done with a variety of techniques. After ablation, conception is not possible.

Medical control of fibroids may be as simple as the use of NSAIDs or acetaminophen for discomfort or may use hormones and anti-hormonal drugs to control symptoms. Low dose birth control pills may work for some women while others require hormone suppressing drugs such as Lupron or mifespristone. The problem with these drugs is that the fibroids may grow again when the medication stops.

Women with fibroids may not even know they are present or may have significant symptoms, but modern treatments make this diagnosis one that should not be terrifying. Diagnosis can usually be made by imaging with X-ray, ultrasound or MRI but occasionally is done by inserting a special scope into the uterus through the vagina (hysteroscopy) or through the abdominal wall (laparoscopy.) Biopsies can be taken to confirm the diagnosis in this way.