Fibroids

What are fibroids?

Fibroids, also known as uterine leiomyomas, are non-cancerous tumors coming from the myometrium (the muscle layer) of the uterus. In rare cases (less than one in 1,000) will a cancerous fibroid occur, and having fibroids does not increase a woman’s chance of getting other types of cancer. Fibroids are extremely common. Up to four out of every five women have fibroids, although most of these women have no symptoms and do not need any treatment. Fibroids cause symptoms in approximately one out of every four women of reproductive age. They are usually detected in women in their thirties and forties and are more common in women of African-American descent than white women. Fibroids usually shrink after menopause.

Contact the Center for Minimally Invasive Gynecologic Surgery (MIGS) at 617-243-5205, or fill out our CareFinder Online Form.

• What are the different types of fibroids
• What symptoms do fibroids cause
• What are the treatment options for fibroids
• Animated Procedure Video

What are the different types of fibroids?

There are several types of fibroids, defined by their location within the uterus. Fibroids can be classified as submucosal, intramural or subserosal:

• Submucosal fibroids: These fibroids are located just underneath the endometrium, or lining of the uterus, and protrude into the uterine cavity. Submucosal fibroids can vary in how much of the fibroid protrudes into the uterine cavity and how much is in the muscle of the uterus. They often cause heavy bleeding and long periods, but they can also cause irregular bleeding.
• Intramural fibroids: These fibroids are found predominantly in the myometrium, or muscle of the uterus. Depending on their size and location, these fibroids can also extend toward and distort the uterine cavity or protrude outside the uterus. Intramural fibroids can be asymptomatic (causing no symptoms), cause bleeding abnormalities, or cause pressure and bulk symptoms.
• Subserosal fibroids: These fibroids are located near the outside of the uterus. They can be partially in the myometrium (muscle of the uterus) or hanging off the outside of the uterus. They can cause bulk symptoms such as bladder or rectal pressure.

What symptoms do fibroids cause?

Most fibroids cause no symptoms at all. Depending on their size, location and number, fibroids can become significantly problematic.

Some common symptoms associated with fibroids include:

• Abnormal uterine bleeding, heavy or long periods
• Bulk and pressure symptoms
• Bladder pressure, frequent urination
• Rectal pressure, constipation
• Pain
• Anemia

Pregnancy and Fibroids

The occurrence of fibroids can cause problems with pregnancy, including difficulty getting pregnant, recurrent miscarriages/ pregnancy loss, or complications during pregnancy. 10-30% of women with fibroids who are able to get pregnant experience complications such as abdominal pain, occasionally accompanied by light vaginal bleeding. There is also a risk that the influx of hormones may cause the fibroid to grow, crowding the fetus.

How are fibroids diagnosed?

Most often, fibroids are found through a routine pelvic exam, with your doctor feeling the irregularity with his or her fingers. Additional tests such as ultrasound or imaging (either MRI or CT scan) may be used to better show the size and location of fibroids. For even more in-depth examination, one of the following diagnostic procedures may be employed:

• Hysterosonography - transvaginal ultrasound with saline injected into the uterus to help outline masses
• Hysterosalpingography - uses dye to highlight the uterus and fallopian tubes on x-ray
• Hystersocopy - investigation of the inside of the uterus with a thin tube containing a video camera

What are the treatment options for fibroids?

There is a wide range of treatment options for fibroids. Many factors influence treatment choice. These include symptoms, fibroid location, size and number, age, reproductive plans and a woman's preferences.

Medical Management:

• Gonadotropin-releasing hormone agonists (GnRH agonists): This medication is given as an injection (shot), either every month or every three months, and puts you in a temporary state of menopause, causing the fibroids shrink. Once the medication is stopped, the fibroids usually re-grow and symptoms return. GnRH agonists are usually used to prepare women for surgery or to bridge women close to their natural menopause. GnRH agonists are not usually used for long-term treatment.
• Other hormone treatments: Progestins (oral, by injection or intra-uterine device [IUD]), oral contraceptive pills, androgenic agents (such as danazol) and anti-estrogens (such as raloxifene) have been used to try to control heavy bleeding in women with fibroids. However, these medications do not consistently decrease the size of the fibroids or uterus and are usually ineffective in reducing the amount of bleeding.

Surgical Management:

The surgical procedures provided at the MIGS Center combine current technology, medical and surgical expertise to treat fibroids on an outpatient basis.

• Myomectomy is a surgical procedure in which only the fibroids are removed, preserving the uterus. As an alternative to hysterectomy, one advantage of a myomectomy is that with the uterus in place, childbearing remains an option. A disadvantage of a myomectomy is that when the uterus remains in place, fibroids can recur, sometimes requiring additional surgery.

Fibroids can be removed by hysteroscopic myomectomy, laparoscopic myomectomy or an open abdominal myomectomy.

• Hysteroscopic myomectomy is a technique used to remove submucosal fibroids that are submucosal. A hysteroscope, a thin tube containing a video camera, is passed through the cervix and into the uterus. The fibroid is then removed by shaving it out. There are no incisions with a hysteroscopic myomectomy. It is a day surgery procedure (you typically leave the hospital 1 hour after the completion of the procedure) with a 1-day recovery period.
• Laparoscopic myomectomy is a technique used to remove fibroids that are intramural (deep in the muscle of the uterine wall), subserosal or pedunculated (on the outside of the uterus) fibroids. This minimally invasive technique uses a laparoscopic technique to remove the fibroids through very small incisions. It is a day surgery procedure (you typically leave the hospital 1-2 hours after the completion of the procedure) with a 1-2 week recovery period.
• Open myomectomy uses a traditional large abdominal incision to remove the fibroids. Most fibroids can be removed by minimally invasive techniques; the use of the open method is limited to women with specific situations where laparoscopic or hysteroscopic removal of fibroids is not appropriate.

• Uterine Artery Embolization/Uterine Fibroid Embolization (UAE/UFE) is performed by an interventional radiologist. The blood flow to the uterus and/or fibroid is blocked, leading to necrosis and a gradual shrinkage of the fibroid.
• MR-Guided Focused Ultrasound uses ultrasound energy to heat and destroy the fibroid causing gradual shrinkage of the fibroid.
• Fibroids can be treated with a hysterectomy, which involves removing the uterus with the fibroids. The hysterectomy can typically be done in a minimally invasive way.

More information about fibroids is available from the Society of Interventional Radiology.

Contact the Center for Minimally Invasive Gynecologic Surgery (MIGS) at 617-243-5205, or fill out our CareFinder Online Form.