Fibroids are smooth muscle tumors of the uterus. As many as 75% of women have fibroids. They are rarely cancerous, and they cause symptoms in only about 20% of the women who have them. However, those symptoms (typically heavy menstrual bleeding, bad cramps, pelvic pressure, constipation, or frequent urination) can disrupt women's lives. Even if fibroids don't cause symptoms, they may grow into the uterine cavity, potentially complicating a pregnancy and raising the risk of miscarriage.
"Managing uterine fibroids depends on several factors, such as a woman's symptoms, whether or not she wants to have children, her age, and her personal preferences," says Dr. Hye-Chun Hur, director of the Division of Minimally Invasive Gynecologic Surgery at Harvard-affiliated Beth Israel Deaconess Medical Center and associate medical editor of the Harvard Women's Health Watch. "I often see women who are in the late stage of symptoms—either with severe pain or with low blood counts from anemia due to excessive bleeding," Dr. Hur says. "If women seek help when their condition is symptomatic but not so excessive, they may have more treatment options available to them, including the more conservative therapies. The sooner they can get relief, they can get on with their lives."
There are several effective therapies that can be tailored to suit individual women, including the following:
- Medical treatment. Both traditional combined oral contraceptives (which contain both estrogen and a progestin) and progestin-only therapies can stabilize the uterine lining to reduce bleeding. Although these treatments can be very effective, fibroid symptoms typically return when women stop taking the medication.
- Uterine artery embolization. In this minor procedure, a radiologist deposits small particles into the uterine artery that block off the blood supply to the fibroids, thereby shrinking them and reducing bleeding. This procedure is not advised for women who want to have children in the future.
- Endometrial ablation. This minor, same-day procedure destroys the lining of the uterus and decreases the amount of uterine bleeding. Although pregnancy is less likely after an endometrial ablation, this procedure does not provide contraception, and those who conceive after an ablation are at increased risk of pregnancy complications.
- Myomectomy. This term refers to a surgical procedure that removes fibroids while leaving the uterus in place. It is often used in women who still want to have children. Fibroids may be surgically removed through a variety of techniques; the best approach depends on the fibroid location.
- Hysterectomy. This refers to the removal of the entire uterus, along with the attached fibroids. It provides a permanent solution for women who aren't interested in having children.
Read the full-length article: "What you should know about fibroids"