Frequently Asked Questions
Our Jefferson Fibroid Center team is here to answer all of your questions, starting with the frequently asked questions below.
What are uterine fibroids?
Uterine leiomyomas, or fibroids, are non-cancerous, smooth muscle tumors. Fibroids grow within the uterus and may occur as solitary or multiple tumors. Fibroids may range in size from microscopic to over twelve inches in diameter.
Fibroids are classified based on their appearance and location within the uterus.
- Submucosal fibroids grow just underneath the interior lining of the uterine cavity.
- Intramural fibroids grow within the intermediate, muscular layer of the uterus.
- Subserosal fibroids grow just underneath the outer lining of the uterus.
- Pedunculated fibroids, a subset of fibroids that grow on stalks, are seen both within the uterine cavity and on the outside of the uterus.
How common are uterine fibroids?
Up to 75 percent of reproductive-aged people in the United States have uterine fibroids during their lifetime, though only 25 percent may experience symptoms. Fibroids are detected in most people during their 30s or 40s. Many people have multiple fibroids in their uterus.
Fibroids affect different groups of people at different rates. African Americans are two to five times more likely to develop fibroids compared to people of other racial backgrounds. Overweight people also have a higher incidence of fibroids.
How are fibroids diagnosed?
Clinicians can diagnose fibroids by observing an enlarged or irregularly shaped uterus based on a pelvic examination or imaging studies such as ultrasound, MRI or CT. Tests like hysterosalpingography (HSG) and sonohysterography (SHG), which use both fluid and imaging to better visualize the uterine cavity, may provide additional information.
Direct visualization of the uterine cavity may be necessary via a hysteroscopy, a technique that involves insertion of a small camera into the uterus through the vagina. In addition, a laparoscopy can enable the visualization of the outside of the uterus by introducing a small camera into the abdominal cavity through an incision.
Do fibroids become cancerous?
No, most fibroids are not cancerous. Fibroids are usually considered benign (non-cancerous) tumors and are not associated with an increased risk of future uterine cancer.
What causes fibroids to grow?
Current research links fibroid growth to a number of hormones. Estrogen and progesterone have long been accepted as major factors influencing fibroid growth. Newer research now suggests that growth factors and other hormones may also play a role in promoting cell growth in already established fibroid tumors.
High levels of estrogen and progesterone have been shown to independently enhance fibroid growth. Interestingly, fibroids express higher levels of estrogen and progesterone receptors than normal uterine tissue, suggesting enhanced sensitivity and responsiveness to these hormones. Absence of estrogen and/or progesterone correlates with decreased fibroid size.
From a clinical and therapeutic perspective, these findings support observations that fibroids expand in states of elevated estrogen and progesterone, such as pregnancy and generally throughout the reproductive years. Conversely, fibroids decrease in size when levels of these hormones drop, such as during menopause and with certain drug therapies.
Will my fibroids continue to grow?
If you are premenopausal, fibroids typically will continue to increase in size because fibroid growth is linked to female hormone levels in the body.
Will my fibroids shrink when I enter menopause?
Most, but not all, people experience an improvement in fibroid-related symptoms after menopause, which is thought to be secondary to the decreased estrogen and progesterone levels that accompany menopause. While fibroids often stop growing and decrease in size at this time, people who take hormone replacement therapy (HRT) may not experience the same level of reduction in fibroid size.
If I have fibroids, will I be able to have a baby?
Fibroids can contribute to a number of reproductive problems, ranging from infertility, recurrent pregnancy loss, preterm (early) delivery, fetal malpresentation (breech), to complications in labor. By treating symptomatic fibroids, the chances of being able to have a baby may improve. Many people with fibroids, however, have no difficulty conceiving and go on to have normal pregnancies, even without treatment.
The therapies available for treating symptomatic fibroids do have risks and side effects. Some medical treatments disrupt normal hormonal balance, therefore temporarily interfering with fertility. Surgical and minimally invasive treatments have led to many normal pregnancies, but success rates vary with the type of therapy used. The type of fibroids present in the uterus, as well as the number of procedures completed also influence the chances of being able to have a baby.
Many factors weigh into predicting the chances of a successful pregnancy and delivery. Every woman with fibroids desiring future fertility should consult an obstetrician to discuss their unique situation and the therapies that will lead to the best outcome.
What is expectant management?
Expectant management, or the wait and see approach, is an option for women who do not have symptoms related to their fibroids. With expectant management, we will monitor, but not treat, the uterine fibroids.
We may schedule periodic exams, such as an ultrasound, to check for enlargement of the fibroids as a basis for comparison and to confirm that the pelvic mass is a fibroid uterus and not an ovarian mass.
If the patient remains asymptomatic, however, there is little benefit in checking for growth. Fibroids do tend to increase in size until menopause. Unless this enlargement is accompanied by symptoms, expectant management may be continued.
What are the treatment options & which one is best for me?
While up to 75 percent of reproductive-aged people in certain populations may have uterine fibroids during their lifetime, only about 25 percent of people experience symptoms. For people who experience fibroid-related symptoms, there are several treatment options. Treatments for symptomatic fibroids range from medications to minimally invasive procedures to surgeries. The recommended treatment plan depends on fibroid size, number and location as well as patient age and desire for future pregnancy.
What are the medical treatment options?
Medical treatment may alleviate fibroid-related symptoms and pain. Medications may be used alone, or as an adjunct to surgery. The medications most commonly used to treat fibroids are pain and hormonal medications.
- Pain medications: women with painful symptoms may be prescribed pain medications. These range from over-the-counter medicines, such as NSAIDs and ibuprofen, to potent drugs, such as narcotics. In most cases, these medications are only necessary during menses.
- Hormonal agents: heavy, painful or prolonged menstrual bleeding, may also be managed with hormonal agents. Oral contraceptive pills, progestins such as Provera® or Depo-Provera®, may improve symptoms and control bleeding by decreasing proliferation of the uterine lining.
- Progesterone IUD: an IUD embedded with progesterone works by inducing atrophy of the endometrium. 80 percent reduction in menstrual blood loss has been reported at three months. An in-office procedure, the progesterone IUD is placed into the uterine cavity. The IUD may be left in place for up to 5 years at a time and has a very low rate of complications or side effects, while also providing effective contraception.
- Gonadotropin releasing hormone agonists (GnRH): Gonadotropin releasing hormone (GnRH) agonists, such as Lupron®, induce low estrogen states, or temporary menopause-like states, causing fibroids to temporarily decrease in size. In addition to reducing fibroid bulk and alleviating mass-related symptoms, including pelvic pressure, GnRH agonists can also alleviate bleeding symptoms, which may allow anemic patients to temporarily improve their blood counts. Side effects of GnRH agonists include menopausal symptoms, such as hot flashes, vaginal dryness, decreased sex drive, bone loss and depression. Therapeutic courses are usually limited to three to six months, often prior to surgery. These medications are also very expensive. After discontinuation of GnRH agonist therapy, fibroids begin growing again, enlarging to their original size within three months.
What are the surgical treatment options?
There are several surgical treatment options for fibroids.
Myomectomy is a surgical option that removes fibroids while keeping the uterus intact, preserving future fertility. The procedure may be hysteroscopic, inserting a camera and instruments through the vagina into the uterus, or laparoscopic, inserting a camera and instruments through small incisions directly in the abdomen. Most commonly, an open procedure, or laparotomy, is used to remove the fibroids through an incision in the abdomen.
Endometrial ablation is a technique for treating fibroids associated with irregular bleeding. In this minimally-invasive outpatient treatment, the endometrial lining is destroyed with microwaves. The procedure requires less than five minutes and data shows a reduction in bleeding in over 90 percent of patients.
Another surgical option is hysterectomy, in which the uterus is removed along with the fibroids. While hysterectomy is the only definitive treatment for fibroids, it also eliminates future fertility. Hysterectomy may be performed by either a vaginal or abdominal approach, and may be assisted by a camera in a laparoscopically assisted vaginal hysterectomy (LAVH).
Please speak with your provider or call us at 215-955-5000. You can also view additional Frequently Asked Questions about managing your Jefferson Health OBGYN visit.