Uterine Fibroids

Uterine fibroids (also called leiomyomas) are growths made up of the muscle and connective tissue from the wall of the uterus. These growths are usually not cancerous (benign).

Causes of Uterine Fibroids #

The causes of fibroids are not known. Most fibroids happen in people of reproductive age. They typically aren’t seen in young people who haven’t had their first period yet.

Symptoms of Uterine Fibroids #

Most fibroids do not cause any symptoms and don’t require treatment other than regular observation by your healthcare provider. These are typically small fibroids. When you don’t experience symptoms, it’s called an asymptomatic fibroid.

Larger fibroids can cause you to experience a variety of symptoms, including:

• Excessive or painful bleeding during your period (menstruation).

• Bleeding between your periods.

• A feeling of fullness in your lower abdomen/bloating.

• Frequent urination (this can happen when a fibroid puts pressure on your bladder).

• Pain during sex.

• Low back pain.

• Constipation.

• Chronic vaginal discharge.

• Inability to urinate or completely empty your bladder.

• Increased abdominal distention (enlargement), causing your abdomen to look pregnant.

Diagnosis of Uterine Fibroids #

Ultrasonography #

This non-invasive imaging test creates a picture of your internal organs with sound waves. Depending on the size of the uterus, the ultrasound may be performed by the transvaginal or transabdominal route.

Magnetic resonance imaging (MRI) #

This test creates detailed images of your internal organs by using magnets and radio waves.

Computed tomography (CT) #

A CT scan uses X-ray images to make a detailed image of your internal organs from several angles.

Hysteroscopy #

During a hysteroscopy, your provider will use a device called a scope (a thin, flexible tube with a camera on the end) to look at fibroids inside your uterus. The scope is passed through your vagina and cervix and then moved into your uterus.

Hysterosalpingography (HSG) #

This a detailed X-ray where a contrast material is injected first and then X-rays of the uterus are taken. This is more often used in people who are also undergoing infertility evaluation.

Sonohysterography #

In this imaging test, a small catheter is placed transvaginally and saline is injected via the catheter into the uterine cavity. This extra fluid helps to create a clearer image of your uterus than you would see during a standard ultrasound.

Laparoscopy #

During this test, your provider will make a small cut (incision) in your lower abdomen. A thin and flexible tube with a camera on the end will be inserted to look closely at your internal organs.

Treatment of Uterine Fibroids #

Medication #

Iron supplements #

If you have anemia from the excess bleeding, your provider may also suggest you take an iron supplement.

Birth control #

• Birth control can also be used to help with symptoms of fibroids specifically heavy bleeding during and between periods and menstrual cramps.

• Birth control can be used to help control heavy menstrual bleeding.

• There are a variety of birth control options you can use, including oral contraceptive pills, intravaginal contraception, injections and intrauterine devices (IUDs).

Gonadotropin-releasing hormone (GnRH) agonists #

• These medications can be taken via a nasal spray or injection and they work by shrinking your fibroids.

• They’re sometimes used to shrink a fibroid before surgery, making it easier to remove the fibroid.

• However, these medications are temporary and if you stop taking them, the fibroids can grow back.

Oral therapies #

• Elagolix is a new oral therapy indicated for the management of heavy uterine bleeding in people who haven’t experienced menopause with symptomatic uterine fibroids.

• It can be used up to 24 months.

• Talk to your doctor for pros and cons of this therapy.

• Another oral therapy, Tranexamic acid, is an antifibrinolytic oral drug that’s indicated for the treatment of cyclic heavy menstrual bleeding in people with uterine fibroids.

• Your doctor will monitor you during this therapy.

Fibroid surgery #

• There are several factors to consider when talking about the different types of surgery for fibroid removal.

• Not only can the size, location and number of fibroids influence the type of surgery, but your wishes for future pregnancies can also be an important factor when developing a treatment plan.

• Some surgical options preserve the uterus and allow you to become pregnant in the future, while other options can either damage or remove the uterus.

Myomectomy #

• Myomectomy is a procedure that allows your provider to remove the fibroids without damaging the uterus.

• There are several types of myomectomy.

• The type of procedure that may work best for you will depend on where your fibroids are located, how big they are and the number of fibroids.

• The types of myomectomy procedure to remove fibroids can include:

Hysteroscopy #

• This procedure is done by inserting a scope through the vagina and cervix and into the uterus.

• No incisions are made during this procedure.

• During the procedure, you provider will use the scope to cut away the fibroids.

• Your provider will then remove the fibroids.

Laparoscopy #

• In this procedure, your provider will use a scope to remove the fibroids.

• Unlike the hysteroscopy, this procedure involves placing a few small incisions in your abdomen.

• This is how the scope will enter and exist your body.

• This procedure can also be accomplished with the assistance of a robot.

Laparotomy #

During this procedure, an incision is made in your abdomen and the fibroids are removed through this one larger cut.