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Women’s Reproductive Health: Fibroids

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D.

Fibroids are a benign (non-cancerous) tumor of the uterine muscle wall that occurs with over-growth of the smooth muscle cells. This type of tumor occurs in 5 to 80% of women. The large range in prevalence rates depends on how the fibroids are diagnosed and the group of women studied. Older women (ages 40 to 60 years) seem to develop fibroids more frequently than younger women (ages 20 to 30). There may also be a higher rate of fibroids in black women than white women.

Symptoms/Risk:

Even though fibroids are common, not all women with this condition experience symptoms. A woman who experiences symptoms may have pelvic pain (30% of women with fibroids) or painful, heavy menstrual cycles (34% of women). Infertility can also be a concern with larger fibroids or if the fibroid affects the shape of the uterine cavity.

Obese women are at increased risk of fibroids. Black women, women over forty years, and women who have never been pregnant are also at increased risk. A women's risk of fibroids decreases with the use of oral contraceptive pills, multiple pregnancies, entering menopause, and smoking. Again however, the widespread negative effects of smoking on a woman's health outweigh the decrease in risk of developing fibroids. As a result, a women should not start smoking as a preventative strategy.

Diagnosis:

If a woman has an enlarged uterus (found during a routine pelvic exam), her doctor may suspect that she has fibroids. Usually, the presence of fibroids are confirmed by a radiological procedure (e.g, ultrasound or magnetic resonance imaging), which allows images of the uterus to be created and examined on a computer screen outside of the body. Sometimes, a hysteroscopy is performed. During a hysteroscopy, a camera is placed into the vagina and through the cervix so that the inside of the uterus can be viewed.

Treatment:

The selection of the most appropriate treatment for fibroids depends on the severity of the symptoms. If a woman's fibroids do not cause symptoms, they can be "left alone" and monitored to see if they grow in size and start to cause pain or increases in bleeding. If a woman experiences pain or a heavy menstrual flow because of her fibroids, then she is most commonly treated either with NSAIDs (e.g., ibuprofen) or oral contraceptive pills.

If a woman has severe symptoms that can not be controlled by medications, then other treatment options include myomectomy, hysterectomy or uterine artery embolization. A myomectomy is a surgical procedure where only the fibroid is removed, but the rest of the uterus is left in place. This surgery is beneficial for women who still want the option of becoming pregnant. A hysterectomy, on the other hand, is a surgical procedure where the fibroid is removed along with the entire uterus. Following this surgery a women will not be able to get pregnant.

Uterine artery embolization is a radiological procedure that blocks the blood supply to the uterus and, therefore, the fibroids. Without a supply of blood, the fibroids shrink. This procedure avoids surgery, but does not preserve fertility. In other words, women who have uterine artery embolization will also be unable to conceive children. Studies suggest a low complication rate associated with embolization, but recurrence of fibroid symptoms is higher with uterine artery embolization than with hysterectomy.

Prognosis:

The prognosis of patients with fibroids has not been well studied. However, fibroids tend to shrink after menopause. Also, studies of uterine artery embolization found that women with symptomatic fibroids had up to a 75% success rate 5 years out from the procedure.