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About 50% of women diagnosed with uterine fibroids do not suffer from any symptoms. Only fibroids that are causing issues need to be treated. Source
Uterine fibroids are benign (non-cancerous) tumors that arise from the lining of the uterus. Other examples of benign tumors include skin moles, certain colon polyps, and skin tags.
Although fibroids are benign, they can still cause many problems in some women due to their size and location.
Among patients with symptomatic uterine fibroids, 56.4% reported heavy periods, 32.3% reported passage of clots, 26.4% reported spotting between periods, 25.8% reported constipation/bloating/diarrhea, and 20.4% reported pelvic pressure. Source
Uterine fibroids are usually diagnosed during a routine gynecological examination. Doctors can generally feel the enlarged fibroids during a pelvic exam. If a mass is felt during an exam, your doctor will order an ultrasound to confirm that what they are feeling is a uterine fibroid, as opposed to other types of gynecological masses.
Once you've been diagnosed with fibroids, your doctor will ask you a series of questions to see if the fibroid(s) are causing problems.
There are three types of uterine fibroids which differ based on their location within the uterus. We will discuss the types of fibroids and the layers of the uterus together.
The first layer of the uterus is the endometrium, the innermost layer closest to the uterine canal. The endometrium is the layer that grows every four weeks in preparation for pregnancy.
Fibroids located close to the endometrium are termed submucosal fibroids. Submucosal fibroids are the rarest type of uterine fibroid and can sometimes distort the size of the uterine cavity. It is also possible for large submucosal fibroids to block the fallopian tubes, which can impair pregnancy.
The second layer of the uterus is the myometrium, which is the middle layer. The myometrium is the muscular layer of the uterus and is the primary layer responsible for uterine contractions.
Fibroids that develop within the myometrium are called intramural fibroids and are the most common fibroid type. When an intramural fibroid expands, it distorts the shape of the uterus, causing it to feel larger than usual. Intramural fibroids often cause "bulk symptoms" or symptoms related to the enlarged uterus pushing on adjacent structures; they can also cause excessive bleeding.
The third layer of the uterus is the serosa, which is the outermost layer. This is a thin layer that secretes a lubricating substance to reduce friction between the uterus and nearby structures like the bladder and colon.
Fibroids that grow in or around the serosa, near the outer lining of the uterus, are termed subserosal fibroids. These fibroids are also referred to as pedunculated fibroids because they often grow on a stalk. Subserosal fibroids cause symptoms related to pressure on adjacent structures. Sometimes the stalk of a subserosal fibroid can twist and cause severe pain.
Uterine fibroids are almost always benign, meaning non-cancerous. It is vital to note that doctors do not think benign fibroids become cancerous. In other words, if a fibroid is benign, it will probably always be benign. In less than 1 in 1000 patients, uterine cancer may look similar to a benign fibroid. Source
Therefore, having benign fibroids does not increase the risk of developing uterine cancer, also called leiomyosarcoma. Doctors can usually determine if a fibroid is benign or cancerous based on your medical history and medical imaging, like an MRI. Because uterine cancer is so uncommon, doctors rarely perform fibroid biopsies before treatment.
Another way doctors ensure uterine cancer is not present is by closely monitoring your symptoms and imaging over time. For example, if your fibroid was treated due to frequent heavy menstrual bleeding and pelvic pain, but your symptoms did not resolve after treatment, and an MRI afterward showed that the fibroid had grown in size rather than shrunk, then your doctor would consider alternate diagnoses such as uterine cancer. The good news, uterine cancer is very rare and with precise imaging and close monitoring, it is usually easy to detect.
Birth control pills and other hormone therapies like GnRH analogs can effectively treat uterine fibroid symptoms. Unfortunately, these treatments may not be enough to completely manage symptomatic uterine fibroids and some women have adverse side effects related to hormone therapy. Specific hormone therapies, like birth control pills, do not reduce fibroid growth or shrink fibroids. However, intrauterine devices (IUDs) that slowly release hormones can effectively decrease heavy menstrual bleeding related to fibroids. Source
Myomectomy is a surgical procedure where fibroids get cut out of the uterus. There are multiple ways to perform myomectomy, including abdominal myomectomy, where a 3-4 inch incision is made along the abdominal wall; hysteroscopic myomectomy, where a scope is inserted through the vagina into the uterine canal; as well as laparoscopic myomectomy, where four small incisions are made in the abdominal wall.
Although the data is limited, myomectomy does have the most data supporting fertility preservation for women that desire future pregnancy. Myomectomy is highly effective at treating symptomatic uterine fibroids with a success rate of over 90%. Unfortunately, when fibroids are numerous or large, myomectomy can be challenging. This is due to an increased risk of blood loss and incomplete treatment. About 50% of the time, an abdominal myomectomy is required, which is also associated with longer hospital recovery times. Still, myomectomy is a highly effective treatment for symptomatic uterine fibroids.
Hysterectomy or complete surgical removal of the uterus is a highly effective method for treating symptomatic uterine fibroids because the entire uterus and all of the fibroids are removed. Having a hysterectomy ensures that no fibroids will grow back due to the uterus being permanently removed. However, a hysterectomy is a major surgery that usually requires 3-5 days in the hospital and 6-8 weeks of recovery. Hysterectomy has also been associated with an increased risk of heart disease and mental health conditions later in life. It is also not an option for women looking to preserve their uterus or for women who want to bear children in the future.
Uterine fibroid embolization (UFE) , also referred to as uterine artery embolization (UAE) , is a same-day, minimally-invasive, non-surgical procedure for treating uterine fibroids. During the procedure, doctors inject tiny particles into the uterine arteries that are 'feeding' the fibroids to block their blood supply. Without a blood supply, the fibroid will slowly shrink over a few weeks to months as the body heals naturally. Uterine fibroid embolization is an option for patients who want to avoid surgery and keep their uterus. Additionally, UFE is a good option for women who want the quickest recovery times possible.
The best treatment strategy for fibroids is personalized for each patient based on various patient-specific factors and fibroid-specific factors.
If the answer to either of these questions is "Yes," then hysterectomy is usually not a good first treatment. However, there are excellent uterine-sparing and fertility-sparing treatment options available.
The next question to answer is:
If the answer is "Yes," then uterine fibroid embolization can be an excellent first-line treatment.
Many patients choose to start with a minimally-invasive treatment (fast recovery) before escalating to more invasive treatment strategies that require longer recovery times. In practice, medications are often attempted first because no procedure or surgery is needed. However, medication management is frequently ineffective. Other patient-specific factors that will be discussed between you and your doctor are co-existing medical conditions, history of prior surgeries, and menopausal status.
The size, number, and location of fibroids must also be considered. Uterine fibroid embolization can be an excellent first-line treatment when fibroids are large or numerous. Hysteroscopic myomectomy can be an ideal first-line treatment for women with small to medium-sized submucosal fibroids that protrude into the endometrial canal. Alternatively, hysterectomy can be an excellent treatment if your symptoms did not fully resolve after UFE or myomectomy.
Regardless of your situation, your doctor will help you understand fibroid-specific factors that impact treatment decisions.