- Fibroids are also known as "myomas" or "myomata".
- Fibroids are very common, non-cancerous (benign) smooth muscle
tumors of the uterus (womb).
- Fibroids can occur as a single growth or multiple growths
and can vary in size from as small as a pea, to the size of a grapefruit,
or even to the size of a full-term pregnancy.
- Fibroids can grow on the surface of the uterus, within the
walls of the uterus, or inside the uterine cavity.
- Fibroid typically grow larger over time, until menopause when
they stop growing or regress in size.
- Fibroids are generally estrogen dependent tumors.
- Fibroids occur in 20-50% of women, depending upon age and
race. African-American women are three times more likely than Caucasian women
to have fibroids. Black women also have larger and more numerous fibroids
at the time of diagnosis.
- Fibroids are the most common cause of non-emergency uterine
- Fibroids are the reason given for most hysterectomies.
It is estimated that fibroids are responsible for 66% of the 600,000 hysterectomies
per year in the US (400,000 hysterectomies per year). AHRQ estimates
that fibroids account for 30% of hysterectomies in white women and 50% of
hysterectomies in black women.
- AHRQ estimates that the cost of treating fibroids in the US
in 1997 was more than $2 billion.
- The actual incidence of fibroids is not known, because most
fibroids don't cause symptoms. The Agency for Healthcare Research and
Quality (AHRQ) estimates that the cumulative incidence of fibroids in women
aged 25 to 45 is 30%.
- Depending on size, number and location, fibroids can cause no symptoms or
they can be responsible for changes in the menstrual cycle, pain in the abdomen
or lower back, pelvic pain, pain during sex, difficult or frequent urination,
constipation, miscarriage, infertility, or anemia (due to excessive menstrual
bleeding). Fertility problems are attributable to fibroids that block the
fallopian tubes or prevent implantation of a fertilized egg in the uterus.
- There are three different types of fibroids:
- Submucosal fibroid - grows from the uterine wall into the uterine
cavity, sometimes distorting it. This may lead to pain, abnormal bleeding,
- Subserosal fibroid - grows from the uterine wall to the outside
of the uterus and can cause pressure on the bladder, bowel and intestine.
These fibroids can cause bloating, abdominal pressure, cramping and pelvic
- Intramural fibroid - remains confined within the uterine wall
and causes symptoms similar to the submucosal and subserosal fibroids.
- Diagnosis of fibroids:
- Many fibroids are diagnosed during routine pelvic exams, but in order
to rule out other uterine conditions that can be mistaken for fibroids (e.g.,
ovarian tumors, bowel masses or pregnancy), several diagnostic tests can
- Ultrasound - high frequency sound waves are used to create a picture
of the pelvic region. In a specialized ultrasound called sonohysterogram
or salin infused sonography, a small amount of saltwater solution may
be infused into the uterus, through the vagina and cervix, to improve
visibility. Ultrasound can be performed without anesthesia, and is an
- Hysterosalpingography (HSG) - using a special dye, an X-ray is taken
of the inside of the uterus and tubes to outline abnormalities. No anesthesia
is used. HSG is performed in a radiology suite.
- Diagnostic hysteroscopy - the uterine cavity is viewed using a telescope-like
instrument called a hysteroscope that is inserted in the uterus through
the vagina and cervix. Hysteroscopy can be performed as an office procedure
under a local anesthetic, or as an outpatient surgical procedure using
local or general anesthesia. Once diagnosed, fibroids can sometimes be
removed using a hysteroscope (see myomectomy description below).
- Treatment options for fibroids and polyps
- Drug therapy: Treatment involves long-term use of hormone therapy
that can shrink the fibroid and minimize symptoms. The fibroids may regrow,
however, and the symptoms often return after treatment is discontinued.
In addition to being costly, hormone therapies can have adverse side effects,
such as those associated with induced menopause (i.e., hot flashes, insomnia,
- Surgical Options:
- Myomectomy is a surgical procedure that removes only the fibroid,
leaving the uterus intact. Drug therapies are often recommended as a
pre-surgical treatment to shrink fibroids before removal. Myomectomy
can be performed either through an open incision in the abdomen or through
- Laparoscopic Myomectomy - fibroid is removed using a laparoscope
inserted through the abdomen. A surgical instrument called a tissue
morcellator may be used to cut up and remove the fibroids through a
- Hysteroscopic Myomectomy - fibroid is removed using a telescope-like
instrument called a hysteroscope that is inserted through the vagina
and cervix into the uterus. With this approach, the fibroid can be
removed intact or a targeted electric current shaves away or vaporizes
- Uterine Artery Embolization is an investigational, nonsurgical
method of treating uterine fibroids. During an embolization, the blood
supply to the fibroid is blocked so that over time the fibroid shrinks.
This procedure is performed by a physician who specializes in radiology.
- Hysterectomy, the surgical removal of the uterus, is the
only way to guarantee that fibroids will not recur. A hysterectomy is major
surgery; woman should consider other less invasive options first. If a
woman and her physician decide hysterectomy is the best option, there are
less invasive approaches to performing the procedure that may lessen post-operative
pain, recovery time and scarring, compared to the traditional "open" approach.
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Created: 11/2/2001  - Donnica Moore, M.D.