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Managing Fibroids


Managing Fibroids

Managing Fibroids examines the different types of fibroids, symptoms, and complications. You'll discover who’s most at risk for fibroids. THis Guide takes you through the various treatment options, so you can understand the risks and benefits. And gives you tips to work with your doctor to determine the best way to manage your condition, taking into account your preferences and goals.

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A majority of women will develop a fibroid in the uterus at some point—although they may never know it. By age 50, an estimated 70% of women have these smooth muscle tumors of the uterus, also called leiomyomas or myomas.

While the term tumor may sound scary, fibroids are noncancerous (benign) growths. More often than not, these growths are harmless, and many women with fibroids don’t have any symptoms. Unless a doctor identifies the fibroid during a medical exam, it may go unnoticed.

But for other women, fibroid symptoms may be painful, even debilitating. Symptoms, which often get worse during a woman’s period, include:
• menstrual periods that contain clots and are heavy, long-lasting, or both
• a bloated, heavy, or full feeling in the pelvis
• constipation
• trouble emptying the bladder or the need to urinate more often
• back or leg pain
• pain during sexual intercourse.

In some cases, fibroids make it more difficult for a woman to become pregnant. They also may cause pregnancy complications, including miscarriage, early birth, or delivery problems.

Fibroids are the most common type of noncancerous tumor in women’s reproductive organs. They grow within the uterus. Some take up space inside the uterine cavity. Others grow inside the muscular wall of the uterus or outward from the surface of the uterus.

The resulting symptoms are related to how many fibroids a woman has, where they are located, and how large they are. Fibroids can be tiny, or so large that it appears the woman is pregnant.

Treatment to address problems linked with fibroids costs an estimated $2.1 billion each year in the United States alone. But the toll fibroids take isn’t calculated only in dollars. Fibroids are the No. 1 reason women opt for a surgical procedure to remove the uterus, known as a hysterectomy.

Because fibroids affect women differently, there’s no one-size-fits-all treatment. Options include everything from active monitoring to medications and surgery. How your doctor manages your condition will depend on several factors, including the fibroid size and location, your symptoms, your preferences, and, perhaps most importantly, your age and whether you want to have children.

Regardless of which strategy you choose, the good news is that symptomproducing fibroid tumors are typically easy to diagnose and can, in most instances, be managed effectively. Nevertheless, many women delay getting treatment, believing that their symptoms are related to menstruation and are normal.

Managing Fibroids examines the different types of fibroids, symptoms, and complications. You'll discover who’s most at risk for fibroids. THis Guide takes you through the various treatment options, so you can understand the risks and benefits. And gives you tips to work with your doctor to determine the best way to manage your condition, taking into account your preferences and goals.

Prepared by the editors of Harvard Health Publishing in consultation with Sarah L. Cohen, MD, MPH, Assistant Professor of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School Director of Research and Fellowship Program Director, Division of Minimally Invasive Gynecology, Brigham and Women’s Hospital. (2019).

About Harvard Medical School Guides

Harvard Medical School Guides delivers compact, practical information on important health concerns. These publications are smaller in scope than our Special Health Reports, but they are written in the same clear, easy-to-understand language, and they provide the authoritative health advice you expect from Harvard Health Publishing.

  • Benign, but sometimes problematic
  • Your uterus and types of fibroids
  • Causes and risk factors
  • Complications of fibroids
  • Diagnosis
  • Treatment
    • Watchful waiting
    • Medications
    • Procedures
    • Complementary and alternative therapies
  • Lifestyle changes and support
  • Resources

Causes and risk factors

No one knows for sure what causes fibroids. But experts suspect that in some cases, these growths originate from a single mutated stem cell, which begins dividing rapidly, creating a ball-shaped mass. A stem cell is one of the body’s universal cells, capable of morphing into any other type of cell.

Researchers are still struggling to understand what triggers this process, and they aren’t sure why some women get fibroids and others don’t. A combination of genetic and environmental factors may be at work.

Hormones, specifically estrogen and progesterone, appear to fuel the growth of fibroids. This explains why they are most likely to cause symptoms during the childbearing years. Most women with fibroids start to have symptoms in their 30s. Not surprisingly, fibroids are most commonly diagnosed when women are in their 30s and 40s. But fibroids can start to develop much earlier, with some cases detected as early as the teens or 20s.

This hormonal effect on the growth of fibroids is not entirely straightforward, however. During pregnancy, a time when the body produces high levels of estrogen and progesterone, some fibroids will grow more rapidly, some will stay the same size, and some will become smaller. In many women, fibroids will shrink or become less problematic after menopause, when estrogen levels drop.

Although the exact cause of fibroids is still unknown, the following factors have been associated with increasing a woman’s risk of developing these benign tumors.

While fibroids are estimated to affect about 70% of women by age 50, they are even more common, and often more problematic, in African American women. By age 50, as many as 80% of African American women are estimated to have fibroids. These often develop at an earlier age and grow faster and larger than in women from other racial and ethnic backgrounds. African American women also tend to have more severe symptoms.

Family history
If you have a family member with fibroids, the chances go up that you will have them too. Women who have family members with fibroids may have up to three times the average risk of developing fibroids themselves.

Women who are obese may be more likely than other women to develop uterine fibroids.

It is difficult to conclusively prove the effect of diet on certain diseases, as there are many other factors that can interact with diet and confuse the picture. However, eating a lot of red meat, such as beef and pork, has been linked with a higher risk of fibroids, as has vitamin D deficiency. There is some evidence based on studies of patients in China that women who eat a lot of processed snacks or drinks containing food additives or pickled foods may be more likely to develop fibroids. Risk was also higher among women who drank a lot of soybean milk. Conversely, eating plenty of green vegetables seems to be somewhat protective against fibroids. Some studies have found that fibroids are more common among women who frequently drink alcohol. One study that focused on African American women found that those who drank a beer a day had a 50% higher-than-average risk of fibroids. However, other studies have not found the same link.

No pregnancies
Women who have never been pregnant appear to be at higher risk for fibroids.

High blood pressure
Some studies suggest that the risk of fibroids may increase with elevated blood pressure.


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