Uterine fibroids are benign (noncancerous) growths in the uterus. They are the most common type of growth found in a woman's pelvic region and occur most often in women ages 35 to 40.

Many women who have fibroids are not aware of them because the growths remain small and cause no symptoms or problems. However, in some women, fibroids can cause problems because of their size, number, and location. Like any growth, fibroids should be checked by your doctor.

• Types of Fibroids
• Causes
• Symptoms
• Diagnosis and Treatment
• Myomectomy
• Uterine Artery Embolization (UAE)
• Hysterectomy
• Uterine Fibroids and Pregnancy

Types of Fibroids

The size, shape, and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, or attached by a stem-like structure. Fibroids can range in size from small, pea-sized growths to large growths more than five or six inches wide. As they grow, fibroids can distort the inside as well as the outside of the uterus. Sometimes, they can fill the entire pelvis or abdomen. You may have only one fibroid or many of varying sizes.




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Causes

Fibroids are most common in women between the ages of 30 and 40 years, but they can occur at any age. Fibroids occur more often in black women than in white women and seem to occur at a younger age in black women and grow more quickly.

Although fibroids are quite common, little is known about what causes them. There seems to be a correlation between an increase in the female hormone estrogen and fibroid growth. Your levels of estrogen can increase or decrease based on natural events. For instance, pregnancy causes an increase in estrogen and menopause causes a decrease. Medications may also cause a change in estrogen levels and a corresponding change in the size of fibroids.

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Increases in your level of estrogen seem to encourage the growth of fibroids. Many women's fibroids grow during pregnancy and shrink during menopause -- times when your estrogen level naturally fluctuates.

Symptoms

Most fibroids, even those that are very large, cause no symptoms at all. When symptoms do occur, they often include:

• Changes in menstruation
• Pain in the abdomen or lower back
• Pain during sex
• Pressure that can cause difficult or frequent urination and constipation or difficult bowel movements
• Enlarged uterus or abdomen
• Infertility and miscarriage

Because many of the symptoms caused by uterine fibroids can also be caused by other medical problems, you should see your doctor if any of these symptoms occur.

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Diagnosis and Treatment

Often, uterine fibroids are first detected during your annual pelvic exam. Follow-up tests can provide more information, such as the type, size, and location of the fibroid and any affect on your uterus or surrounding organs.

If you have fibroids or have had them in the past, it is especially important to have regular pelvic exams. If you have symptoms of fibroids, see your doctor right away.

Fibroids that are small, do not cause symptoms, or occur in women nearing menopause often do not require treatment. However, there are certain signs that may signal the need for treatment:

• Heavy or painful menstrual periods
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of growth
• Rapid increase in the growth of the fibroid
• Infertility
• Pelvic pain

Treatment may include drugs to shrink the fibroids or surgery. Your doctor will work with you to determine the best approach considering your symptoms, health history, and desire to have children.

A myomectomy is the surgical removal of fibroids while leaving the uterus in place, allowing you to become pregnant if you wish. In most cases, an overnight stay in the hospital is not necessary with a myomectomy.

With this procedure, the blood vessels to the uterus are blocked, helping to stop the flow of blood to the fibroid and causing it to shrink. UAE works even if you have more than one fibroid. The effects of UAE on your fertility are not known so you should talk with your doctor about whether or not this treatment is right for you if you want to have children.

Hysterectomy is the surgical removal of the uterus; your ovaries may or may not be removed. Depending on the size of the fibroid, a hysterectomy may be done either vaginally or through an incision in the abdomen. Because you can no longer have children after a hysterectomy, this procedure is recommended only if pain or abnormal bleeding cannot be controlled, your fibroids are very large, other treatments are not possible, and you do want to have children.

A small number of pregnant women have uterine fibroids. Due to the blood that flows to the uterus during pregnancy, your fibroids may increase in size while you are pregnant. However, in most cases, fibroids cause no problems for you or your baby and decrease in size after pregnancy.

If you do experience discomfort or feelings of pressure or pain, your doctor will prescribe rest and, in rare cases, medication. In some cases, a cesarean delivery may be required depending on the size and location of your fibroid. In very rare cases, fibroids can also increase the risk of miscarriage, preterm birth, and breech birth.