Uterine fibroids, also known as leiomyomas, are common, benign, smooth muscle tumors of the uterus. They are found in nearly half of women over age 40 and infrequently cause problems. Synonyms include Fibroids, Myomas, and Leiomyomata.

Fibroids tend to grow under the influence of estrogen, and regress when the estrogen levels are reduced. Thus, growth frequently occurs during pregnancy, followed by regression following delivery. After the onset of menopause, fibroids generally regress.

High-dose birth control pills, by virtue of their high estrogen content, can cause fibroids to grow larger. Low-dose birth control pills, in contrast, leave circulating estrogen levels the same (or reduced) and do not stimulate fibroid growth. Low doses of estrogen used to treat menopausal symptoms usually do not stimulate fibroid growth.

Symptoms Most women with uterine fibroids have no symptoms, but some do. Symptoms that might be experienced include:

• • Heavy menstrual flows: This happens more often with submucous fibroids (just below the surface of the endometrium) that expand the cavity size leaving a much larger surface area for bleeding. Pedunculated fibroids that protrude into the uterine cavity and also cause menorrhagia or heavy bleeding by interfering with the normal contractile mechanisms of the uterus.
  • Another symptom can be Bleeding between periods: Pedunculated fibroids and submucosal fibroids can mechanically traumatize the uterine lining, leading to dysfunctional bleeding.
  • Another symptom is Pain: This may take the form of menstrual cramps, painful intercourse on deep penetration, pain of acute fibroid degeneration, and chronically inflamed fibroids with a dull, aching or heaviness that is mostly constant.
  • Infertility is sometimes related to fibroids: Fibroids, depending on their location, can interfere with fertility.
  • There’s also Pelvic Pressure: This heaviness in the pelvis is distracting and annoying but not dangerous.
  • Stress Urinary Incontinence may be a symptom: The fibroid bulk and irregular contour of fibroids can distort the pelvic anatomy sufficiently to interfere with normal urinary retention and release.
  • Finally, If large enough and filling the pelvis, fibroids can put pressure on and partially obstruct the ureters, increasing the risk of infection, stones and renal disease.

Clinical Findings are usually straightforward.

The uterus is irregularly enlarged and usually somewhat asymmetrical. It may be tender and may assume very large sizes. Unlike the soft uterus containing a pregnancy or adenomeiosis, the fibroid uterus is very firm.

Confirmation of Diagnosis

The diagnosis is usually based on the clinical findings of an enlarged, irregularly shaped, firm uterus that may or may not be tender. Sometimes, the diagnosis is unclear and diagnostic tests are used to delineate the fibroids and rule out other problems.

Ultrasound is a reliable means to show the fibroids and distinguish between ovarian and uterine growth.

MRI and CT Scanning can be useful, showing, for example, whether the ureter is obstructed and ruling out bowel involvement.

Laparoscopy is Rarely used for diagnostic purposes when considering fibroids, but it might occasionally be used for confirming the diagnosis of fibroids as opposed to an adnexal mass.

As the risk of malignancy in a mass thought clinically to be a fibroid is <1%, histology is only infrequently chosen to make the diagnosis of fbroids, you are concerned because of rapid growth or other quickly evolving symptoms

Let’s consider Mangement Options. No single treatment plan is best for all women with fibroids. In most cases, no treatment is required. The fibroids are measured and observed over time, with the expectation that at menopause, they will regress. However, for those with significant symptoms, very large fibroids, or rapidly growing fibroids, a number of treatments can be considered. Important factors in deciding therapy are the severity of the symptoms, associated symptoms, age, and preservation of fertility:

Hysterectomy is the only permanent cure for fibroids. It provides definitive treatment, but requires major surgery, abdominal, vaginal or laparoscopic.

For women who wish to preserve their childbearing capacity, Myomectomy, or removal of just the fibroids, while leaving the uterus alone, could be the best option. Unfortunately, myomectomy is often a more complicated procedure than hysterectomy, involving longer recovery, greater risk of blood transfusion and greater risk of infection. There is no certainty following surgery that other fibroids will not grow.

Birth Control Pill and other Progestins are sometimes used to treat fibroids. While these will not shrink fibroids, they may be effective enough in controlling the symptoms (particularly bleeding) that the patient can make it through to menopause.

GnRH Analogs such as Lupron can also be used. Through suppression of the release of gonadotropins, these GnRH Analogs effectively reduce estrogen concentration to menopause or near menopause levels. This has the desired effect of shrinking the fibroids. Unfortunately, after 6 months, when the GnRH must be stopped, the fibroids will rapidly re-grow, making this only a temporary treatment. But temporary treatment may be very satisfactory if the goal is to shrink the fibroids to a more manageable size prior to surgery. The menopausal symptoms can usually be controlled with add back estrogen, if desired.

Embolization is another option in some areas. Under interventional radiology guidance, a catheter is threaded through the uterine arteries and a bolus of tiny plastic pellets injected. These pellets lodge in the small arterioles leading to the fibroids, reducing their blood flow and causing necrosis. Good results have been reported in a limited number of cases by skilled hands in a few centers. Serious complications have also been noted, leading to emergency surgery and life-threatening problems. Whether this approach will prove to be widely accepted remains to be seen.

– To hear that there’s a chance that you might
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lose your uterus, is unnerving to say the least.
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The first indication that I had fibroids was fatigue.
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I got to a point where I was always tired.
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And I found myself always sleeping
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and not feeling rested.
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And so while I had other symptoms before then,
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that was the main indicator to me that
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something was wrong, you need to figure out what it is.
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– What led me to the doctor was the ER,
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but I will go back.
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About eight months before I ended up in the ER
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and then with my new doctor,
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I was having super heavy cycles,
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I couldn’t even function when my cycle was on.
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I’ve always had very heave and sometimes painful periods
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but I could normally take an ibuprofen and be cool.
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– I’ve always been anemic and I just attributed that
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to genetics and my environment
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and it wasn’t until late twenties
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when I felt like my anemia was impacting my quality of life.
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– I found out later that I was very anemic,
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to a point where, as it started to get worse
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and started to progress, I was always cold
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and could never ever get warm.
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– I go to the doctor and I’m like, “Hey it’s time
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“for my pap smear but I have these questions
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“because my body is doing things that are even abnormal
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“for me and I’m a person with a heavier cycle.”
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So I told them what was going on and he was like,
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“Oh okay, no problem, I’m just going to give you
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“some birth control and you should be good.”
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Well I’ve heard people that take birth control
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that feel better in a couple of months.
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I was like, “Okay, so that’s gonna be my story.”
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– My period started to get very heavy.
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Definitely a big indicator I think
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for a woman anytime your menstrual cycle changes.
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– First I tried to manage the symptoms in terms
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of my anemia, then I realized that I was losing weight.
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I’m a small person to begin with and when I got down
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to 105 pounds, I wondered if it was stress
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but then I said, “Wait a second, what’s happening?”
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So I went to my ob/gyn again and I realized that I’d
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lost so much blood because of my heavy periods.
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And then he ordered immediately a blood transfusion.
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So I was a bit nervous about a blood transfusion
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so I said what are my options?
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And then he recommended iron infusions
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and that was a way to build my iron up.
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– When I can think back to maybe there was the first change
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in my cycle, was about two years before I actually
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had my surgery to have them removed.
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But again at that time I didn’t recognize anything.
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That was probably, when I think back, the very first,
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could’ve been the earliest symptom.
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The one thing about fibroids is that
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they don’t know how fast they grow.
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They progress differently in every single person.
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– Every cycle I’m still having the same exact period.
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Not only is it the same for a few months,
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it starts to get worse.
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The bleeding’s heavier, the periods are lasting longer,
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the pain is worse.
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And I’m like, “Okay, well maybe it’s just
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“the wrong birth control.”
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But honestly I didn’t even feel like
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going back to the doctor, so I just kind of ran with it
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until I landed in the ER.
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– Over the course of a year, I did every other week
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iron infusions and we checked it after a while,
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and it was still low.
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He said, “You may want to consider options
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“to getting your fibroids removed.”
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And I was really nervous because I didn’t want
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to go do any kind of invasive surgery.
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So there’s a procedure I opted for initially
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which was MyoSure.
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It was an outpatient experience so no down time,
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was able to go back to work in two days.
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– My doctor, as soon as she went to examine me,
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she was able to feel the fibroids.
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And she was able to feel that they were pretty sizable.
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We initially didn’t want to have surgery,
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doctors try to avoid that if they don’t need to
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but my symptoms progressed so much that
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not only did I end up having to have surgery
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we moved it up.
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– The day before I went to the ER I was taking a shower,
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and then next thing I know I’m blacking out.
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The next day I got up and went into work
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and I was still in all this pain but
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I’m like, I’ve been doing this since I’ve had a period,
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I’m not gonna not go to work because of my period.
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So I’m sitting at my desk and next thing I know,
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I get this pain that was so severe.
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I go to the bathroom and as a person with a heavy cycle
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to say that I was completely freaked out
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when I went to the restroom,
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I was like, “OMG, am I hemorrhaging?”
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I call the advise nurse and I’m telling her
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what my symptoms are and she’s like
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“You need to go to the ER, you can’t even wait for
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“a next day appointment, you need to go.”
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– I was like, “Okay cool.
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“Let’s see what my next cycle will tell me.”
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And after that it just got worse
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to the point where, I was filling a maxi-pad,
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an overnight pad, in an hour.
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I was extremely insecure about being anywhere public
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during that time.
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I just did this procedure, why is it even
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worse than it was before?
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So that was the point where I decided,
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with consultation from the doctor and my family
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that I needed to get a myomectomy.
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– When she confirmed that I had them,
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that was a relief in a way
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to know that that’s what was wrong.
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What did kind of hit me and what got me the most nervous
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and scared about them was when
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we talked about having surgery.
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And anytime they tell you you have to have surgery,
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there are risks associated with it.
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They’re going to do surgery to remove some things
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inside and outside your uterus.
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There’s always a risk that you could lose it.
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I cried about it, I thought about it,
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I overthought it.
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I realized I still had to do it,
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in order to at least attempt to keep a healthy uterus
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to hopefully be able to have children later.
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– I go to the ER, and I’m signing in and
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they’re asking me what my symptoms are
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and again I’m still feeling like a complete idiot
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because here I am telling these nurses that
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I’m coming to the ER for my period.
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I almost felt like I was being judged,
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I probably wasn’t, it was probably all in my head
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but I felt like it.
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And the doctor comes in and they take my blood count,
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and he was like, “You’ve lost almost enough blood
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“to warrant a blood transfusion.”
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– They had to build up my iron to get the myomectomy,
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so a series of months again, doing the iron infusions.
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December 15 of 2011 was when I had my myomectomy surgery.
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– Come to find out the doctor that I went to see
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about the symptoms eight months earlier,
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that gave me the birth control,
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he didn’t tell me I was anemic.
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So I’m severely anemic at that point
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and then this happens and of course
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that takes my blood levels all the way down.
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– Fast forward, had my myomectomy, great,
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got married and of course we want to start a family.
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And the first thing I did when I went to my doctor
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was check to see if I had fibroids, and lo and behold
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they came back.
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– I think having all of the symptoms before
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I was able to recognize certain things that were happening
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to my body that made me feel like they were back.
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I only found out this past June for sure that they were.
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It’s pretty common.
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I believe it’s at least there’s a 50% chance
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that they can recur.
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– We have not discussed any non-surgical options.
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It really comes down to which type of surgery I’ll need.
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And to be honest, even if she were able to put me
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on a different birth control or do something like that,
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honestly I want this fibroid out.
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To say that the last year and a half has been awful,
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that’s an understatement.
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– A few years ago I’d gone through the procedure,
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and in less than three years they came back.
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I was really nervous when we were thinking about conceiving,
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what would happen.
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And fortunately for us, we were able to conceive,
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and the fibroids and the fetus coexisted.
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– Fibroids themselves are fairly common.
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Most people just don’t know that they have them.
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A lot of people go through life with them
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and just don’t really have symptoms at all.
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And that’s why they don’t know a lot about it,
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Not until people have symptoms, ’til they come in
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and we found out that something is wrong with them.
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– In all my research that I’ve done on fibroids
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I found out that it affects African-American women
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more prominently than any other race.
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And as I think about my friends, I can count probably
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over a dozen of my friends who’ve either had a myomectomy,
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fibroids or something of that nature.
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And it’s a bit disheartening because you just think about
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something’s that prevalent, it’s just like
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you have the myomectomy, you have these other procedures,
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but they grow back,
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so it’s like why are they growing back?
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– We do so much.
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We have to come in to work and succeed,
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we have to be fly outside of work,
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we have babies, we take care of homes.
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But the thing that we don’t always do
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is take care of ourselves.
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Put your health first, if there is something wrong,
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and you haven’t been to the doctor
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or you’re afraid to go because you don’t have insurance,
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look into other options.
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And for women who do have the insurance,
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but don’t make the time, go make the time.
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Because at the end of the day, you only get one body.
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And if you’re not taking care of that one body, then what?
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– I have two lessons.
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One is about really doing your own research.
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Once you are able to do that and understand
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what’s happening, you are a better patient
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because you know what questions to ask your doctor
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and can advocate on behalf of yourself.
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The second thing I learned, I think perhaps
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the most important was that sharing is caring.
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So the idea of me sharing this with my friends
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and family members and not keeping it to myself
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offered me the opportunity to gain
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much more knowledge than I initially had.