Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Fibroids

Fibroids are also known as leiomyomas or myomas. They are growths from the muscle layer of the uterus. What causes fibroids to grow initially is unclear, but growth is stimulated by hormones. Fibroids are very common and occur in approximately 25% of Caucasian women and 50% of African American women. If microscopic fibroids are included, the prevalence is 70-80% of all women and the average affected uterus contains 6-7 fibroids. Thankfully, most fibroids do not cause symptoms. Symptomatic fibroids can cause heavy or irregular vaginal bleeding, pelvic pressure or pain. In pregnancy, fibroids are stimulated to grow by the high levels of hormones. This may result in pain and alarm. Thankfully, fibroids rarely cause serious complications in pregnancy. Fibroids require treatment only when they cause symptoms.

Fibroids remain the leading indication for hysterectomy. Hysterectomy remains the most common treatment for fibroids because it is the only treatment that provides a definitive cure and eliminates the possibility of recurrence. Patients with symptomatic uterine fibroids may desire treatment alternatives other than hysterectomy in order to preserve childbearing or to avoid the surgical risks of hysterectomy. Surgical alternatives to hysterectomy include myomectomy and embolization. Both of these procedures work best when a single problematic fibroid can be isolated and treated. The problem is that often many fibroids are present. Furthermore, fibroids can be present within the cavity of the uterus, deep in the muscle layer, or on the surface. The location of the fibroids will determine the method in which they can be removed. Myomectomy is the removal of the visible and accessible fibroids while leaving the uterus intact. This can be performed by laparoscopy (camera in the abdomen), laporatomy (incision on the abdomen), or hysteroscopy (camera in the uterus). Hysteroscopy can be performed only for small fibroids that are in the innermost layer of the uterus. Laparoscopy and laporotomy are reserved for myomectomies of the outermost layer of the uterus. A myomectomy cannot be performed for fibroids deep within the muscle layer as they are not accessible. Uterine artery embolization can be performed for inaccessible fibroids. It works best if there are one or two large fibroids rather than many small ones. Embolization is performed by an interventional radiologist at a hospital. During embolization, tiny particles are injected in the blood vessels that feed the fibroids. The particles block the blood supply to the fibroids causing them to shrink.

Because fibroids respond to hormone levels, symptomatic fibroids may respond to oral contraceptives. Oral contraceptives can be used to help reduce the heavy and irregular periods that may be associated with fibroids. Unfortunately, women who receive hormone replacement therapy may have continued stimulation and growth of fibroids that would otherwise shrink with the lack of hormones in the post-menopausal state. This possibility is not a contraindication for hormone replacement therapy but should be considered by women who have symptomatic fibroids.

In very rare cases, patients thought to have fibroids are found to have leiomyosarcoma, cancer of the muscle of the uterus. This is different from cancer of the uterine lining. The risk of leiomyosarcoma of the uterus is less than the risks associated with hysterectomy so fear of this cancer should not be an indication for hysterectomy.

In summary, fibroids are very common non-cancerous growths in women. Fibroids that are not symptomatic should be left alone. Women with symptoms such as abnormal vaginal bleeding, pain, or pelvic pressure should be evaluated by their physician. Evaluation will include a physical exam, ultrasound, and in some cases laboratories. The decision to proceed with treatment of fibroids should be dependant on the severity of symptoms as well as the risks and benefits. The type of treatment should be an individual decision dependant on type of symptoms, desire for future childbearing, and desire for definitive therapy.