Fibroids...what are they? How can they affect your life? Also known as uterine myomas or leiomyomas, fibroids are the most common solid pelvic tumor in women. They come in all shapes and sizes and can cause symptoms or not. This issue is one of the most common reasons I see women in my clinic and reason to perform a hysterectomy. They can present with all different types of symptoms such as abnormal uterine bleeding (heavy/irregular periods), bulk symptoms (such as pelvic pressure, urinary complaints, constipation, etc), pain (whether that be pelvic/abdominal/leg/back pain or pain with sex), or difficulty achieving a pregnancy. They are VERY common in women and can also be genetic. For example, by age 50 years old, ~70% of white women and ~80% of black women will have fibroids. Some don't even know that they have them, and that's ok. As long as they don't cause symptoms and are incidental findings, you do not have to seek surgery or management and can just go on living your life!
So what is a fibroid? A fibroid is a smooth muscle and fibrous connective tissue tumor that develops in the uterus, often from a muscle cell that grows faster than normal with stimulation of estrogen. You can have one or many and they can range in size from a pea to the size of a cantaloupe! They can be located on the outside, middle, or inside the cavity of the uterus. They usually regress or stop growing after menopause when they are no longer stimulated by hormones in your body (such as estrogen).
The way you can diagnose fibroids is usually by imaging such as an ultrasound. Sometimes if your uterus is large enough due to fibroids, it can be felt on exam in the office.
In some cases, women have difficulty achieving a pregnancy due to fibroids (however, an infertility work-up should be completed before attributing the sole cause of infertility to a fibroid). There are many different types ranging from type 0-8, with type 0 and 1 being shown to sometimes affect fertility. Type 0 is a fibroid that is completely located in the cavity of the uterus so it can affect the implantation and growth of an embryo . A type 1 is when the majority of the fibroid is in the endometrial cavity so it can also affect implantation of a pregnancy (sometimes restrict the appropriate blood flow needed to get to a baby to help it grow). However, other types of fibroids haven't been proven through research to officially affect fertility. You can use a camera (hysteroscope) to look inside the uterus and see/remove these fibroids (type 0 or 1) if discovered on imaging.
So, how do you manage fibroids? There are three ways: expectant management (watch and wait), medical management, or surgery. There are multiple different medications you can try: NSAIDs (ibuprofen/naproxen) to help with pain or hormonal medications to help with bleeding (such as a pill, IUD, injection, etc). Finally there is surgery, such as a myomectomy or hysterectomy. A myomectomy is when you specifically remove only the fibroids in the case you would want to preserve your ability to have a baby and keep your uterus. This can be done with just a few tiny small incisions in the belly or may require a larger single incision if you have multiple, large fibroids to remove. The alternative is to just take out the uterus. Depending on the size, this can alter the route of how to remove the uterus. You would need to discuss with your doctor about all these details, your symptoms, and which approach is best for you.
Hope you found this useful.
Thanks y'all!
Dr. Riley
References: ACOG Practice Bulletin #96: Alternatives to Hysterectomy in the Management of Leiomyomas
https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Alternatives-to-Hysterectomy-in-the-Management-of-Leiomyomas
