Uterine fibroids are the abnormal growth of cells in the muscular wall of the uterus. The growths are benign (not cancerous). Uterine fibroids are fairly common and occur in up to 25% of all women. They occur most often in women 30 to 45 but can occur at any age. Although fibroids are not cancerous, they can cause problems due to their size, location and number. Fibroids should be checked by a physician.

There are three major types of fibroids which are determined by location in the uterus. Suberous appear on the outside, submucous occur inside, intramural are confined to the wall of the uterus and rarely fibroids can involve the cervix. Fibroids may be as small as pea-sized to large, round ones more than 5 inches wide. A woman may have several of varying size or only one. They may be small and then grow rapidly or grow slowly. Their unpredictability make them difficult to treat.

The cause of uterine fibroids is unknown. Estrogen is required for their stimulation and growth. They are rare in prepubertal girls and postmenopausal women.

Most fibroids, even large ones, produce no symptoms. When symptoms occur, they often include the following:

• changes in menstruation which include bleeding between periods or menstruation becoming more frequent with possibly heavier bleeding occasionally with large clots and cramps
• may be anemia indicated by weakness, fatigue or paleness
• may be feelings of pressure on the bladder causing difficulty urinating or frequent urination
• may be pain in the lower abdomen or lower back which is usually dull, achy or may be sharp
• rarely there is painful sexual intercourse

Risk increases with use of oral contraceptives and estrogen replacement therapy. Genetics may also play a role as fibroids are 3 to 5 times more common in black women than Caucasian women.

Since most fibroids do not produce symptoms, they may be detected first during a pelvic exam. Some tests which will show more information about fibroids include:

• Ultrasound which uses sound waves to create a picture of the uterus or pelvic organs
• Hysteroscopy uses a hysteroscope to help the doctor see the inside of the uterus. It is inserted through the vagina and cervix allowing the doctor to see fibroids located inside the uterus.
• Hysterosalpingography (HSG) is a special x-ray which can be used to detect abnormality in the size and shape of the uterus and fallopian tubes
• Laparoscopy uses a laparoscope to look inside the abdomen. It is inserted through a small cut just below or through the navel. Fibroids on the outside of the uterus and some inside the uterine wall ca be seen.
• MRI and CT are rarely needed to make this diagnosis but fibroids may be found when these procedures are used to check other medical problems.

Complications include heavy bleeding and anemia. They can become infected but usually only if there is an infection already in the area. Very rarely (less than 0.5%) changes happen in the fibroid tissue causing it to become malignant. Very rapid growth may be a signal of this complication. Fibroids can cause infertility, and a woman may be able to become pregnant after treatment. Fibroids may also cause complications in pregnancy such as spontaneous abortion, premature labor and placental separation. With a large fibroid, fetal growth may be at risk because blood flow is diverted from the fetus to the fibroid.

Fibroids may return following surgical removal.

Fibroids that do not cause symptoms often do not require treatment. Some signs which would indicate the need for treatment include:

• heavy or painful menses
• bleeding between periods
• uncertainty about whether the tumor is fibroid
• rapid increase in size of the fibroid
• pelvic pain
• infertility

Fibroids may be treated by removing them surgically. Drugs such as gonadotropin-releasing hormone (GnRH) agonists including Lupron-Depot and Synarel may be used to shrink fibroids temporarily to prepare for surgery. Usually this treatment is not used for longer than 6 months and will cause a temporary artificial menopause stopping bleeding. Fibroids may be removed with myomectomy which removes fibroids leaving the uterus or hysterectomy which is removal of the uterus. The treatment depends on factors such as your desire and medical advice about the location and size of the fibroids.

Surgery may be recommended, and different procedures are possible. If surgery is recommended be sure to understand all aspects of the procedures before making a decision.

Myomectomy is the removal of fibroids leaving the uterus in place. A woman who does become pregnant after myomectomy may need to have a caesarian delivery. Sometimes a myomectomy causes internal scarring that causes infertility. Fibroids may reoccur and if so another surgical removal is needed 20 to 40% of the time. This procedure may be done through a laparotomy through a laparoscope or through a hysteroscope. The method of removal depends on size and location of the fibroids. An incision is made the abdomen for a laparatomy. Fibroids are then removed through the incision. They may also be removed through a laparoscope (a telescope instrument with fiber optic light to examine inside the abdominal cavity).

Hysteroscopy can be used if the fibroids are accessible from the cavity of the uterus. A hysteroscope is inserted through the cervix into the uterus. The fibroids may be removed with a resectoscope which is a tiny wire loop that uses electric power or with a laser. Usually a general anesthetic is used and a hospital stay may be required.

Hysterectomy is the removal of the entire uterus. Ovaries may or may not be removed. Hysterectomy may be considered when pain or abnormal bleeding persists, other treatment is not possible, fibroids are large or a woman no longer desires children.

In summary, about one in 4 or 5 women will have benign growths called uterine fibroids. Fibroids may cause no symptoms and need no treatment. But if you have uterine fibroids or have had them in the past, you should have regular checkups with your doctor.