Uterine Fibroids

Uterine fibroids are usually noncancerous (benign) growths in or on the wall of your uterus made of muscle and fibrous tissue.

Women with fibroids may never have symptoms and may not know they have them. Sometimes, fibroids can cause various symptoms including but not limited to abnormal uterine bleeding (heavy flow during periods, prolonged or irregular bleeding), pelvic pain, pressure, urinary incontinence, constipation and fertility issues. 

Banner specialists are experts at diagnosing and treating uterine fibroids and will tailor a management plan to meet your individual goals of care. 

What are uterine fibroids?

Fibroids, also called leiomyomas or myomas, are growths that can develop in different parts of your uterus (surface, wall, cavity or cervix). Fibroids are dependent upon hormones for growth. As such, they are very common during your reproductive years. Fibroid symptoms, however, may persist beyond perimenopause and menopause. 

Their growth patterns vary and can range from a single large fibroid to many smaller fibroids. 

Types of uterine fibroids

There are four main types of uterine fibroids, based on where they grow in the uterus:

• Subserosal fibroids: These fibroids grow on the outer surface of the uterus and can press on nearby organs like the bladder or bowel, causing urinary or bowel symptoms like incontinence and/or constipation. 
• Intramural fibroids: The most common type; they grow within the muscular wall of the uterus.
• Submucosal fibroids: They grow just under the lining of the uterus and bulge into the uterine cavity. Even small submucosal fibroids can cause heavy bleeding or fertility problems.
• Pedunculated fibroids: They grow on a thin stalk (like a grape) attached to the inside or outside of the uterus. 

Symptoms of uterine fibroids

Many women have fibroids without any symptoms and never know they have them. Symptoms depend on the size and location of the fibroids.

Symptoms that you may notice include: 

• Heavy menstrual bleeding
• A longer menstrual cycle
• Irregular bleeding between or during periods
• Pelvic pain, pressure or a feeling of fullness
• Bloating
• Frequently needing to urinate or feeling like you can’t empty your bladder
• Constipation
• Pain during sex
• An enlarged abdomen
• Fatigue or weakness from anemia (low red blood cells) because of heavy bleeding

Can uterine fibroids affect fertility or pregnancy?

While many women with fibroids can get pregnant and have healthy pregnancies, fibroids may affect your fertility depending on their size and location. 

Submucosal fibroids are more likely to affect fertility. They can interfere with implantation, which is the ability for a fertilized egg to implant in the lining of the uterus.

Fibroids can also affect a baby’s growth during pregnancy. They may cause the baby to be in the wrong position, such as feet-first (breach) or sideways, instead head-first. In some cases, fibroids may prevent the baby from growing as much as it should.

Additionally, fibroids slightly increase the risk of miscarriage, preterm birth or the need for a cesarean birth, so your provider may monitor your pregnancy closely if you have fibroids.

What are the causes and risk factors for uterine fibroids?

Experts don’t know exactly what causes uterine fibroids, but these factors may put you at higher risk:

• Hormone levels: Estrogen and progesterone, the hormones that control your menstrual cycle, may help fibroids grow.
• Family history: You are more likely to have fibroids if a close family member, like your mother or sister, has them. 
• Age: You’re more likely to get fibroids during your reproductive years, especially your 30s and 40s. Fibroids may shrink after menopause.
• Race: Black women are more likely to develop fibroids, get them at a younger age, and have both larger fibroids and more fibroids.

How are uterine fibroids diagnosed?

If you see your health care provider for symptoms that could be caused by fibroids, they will ask about your medical history, menstrual cycle and symptoms. They will likely perform or recommend additional testing including:

Pelvic exam

During a pelvic exam, your health care provider may examine your uterus to see if it is enlarged or irregular in contour, which could be a sign of uterine fibroids.

Imaging tests

Imaging studies allow your provider to identify any fibroids that you may have and determine their size and location. They can use this information to guide a treatment plan focused on addressing your symptoms and is in line with your family planning goals.

They may order:

• Ultrasound: This is the first imaging test doctors recommend to look for fibroids. An ultrasound uses sound waves to take pictures of the uterus and other organs in the pelvic area.
• MRI: Provides detailed pictures to help map the number, size and location of fibroids.
• Sonohysterography: Fluid is placed into the uterus through a small catheter and then an ultrasound is done to better see fibroids. 
• Hysteroscopy: A thin, lighted camera is passed through the vagina and cervix and into the uterus to visually inspect the uterine cavity for any fibroids or masses.

Treatment options for uterine fibroids

Fibroids that don’t cause symptoms may not need to be treated. Treatment depends on:

• The size, number and location of fibroids
• How bothersome your symptoms are
• Your age and how close you are to menopause
• Whether you want to get pregnant in the future
• Whether or not you want to keep your uterus 

Treatment options are usually recommended to address your specific symptoms, like heavy bleeding and pain.

Watchful waiting

If fibroids cause no symptoms or are not affecting your quality of life, your provider may recommend expectant management (watchful waiting). This may include watching for new or worsening symptoms or periodic check-ups with exams and/or imaging. Fibroids may grow slowly and some shrink after menopause as hormone levels naturally drop.

Medications

Medicines may be recommended to regulate abnormal bleeding and manage pain. Some may potentially shrink fibroids. These treatments may temporarily inhibit your ability to get pregnant but do not permanently affect your fertility.   

Common medication options include:

• Oral hormone therapies: Birth control pills (oral contraceptives), like combination or progestin-only pills can help regulate your menstrual cycle and reduce heavy bleeding and cramps.
• Other hormone therapies: Injections and other long-acting hormonal management options such as intrauterine devices (IUDs) that contain progestin to help improve bleeding and reduce pain associated with fibroids.
• Gonadotropin releasing hormone (GnRH) agonists and antagonists: These medications lower hormone levels to reduce bleeding and potentially shrink fibroids. Some may cause symptoms like those experienced during menopause, such as hot flashes and vaginal dryness.

Your provider may also recommend nonhormonal medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) for pain or tranexamic acid for heavy bleeding when you have your period.

Minimally invasive procedures 

These treatments aim to shrink fibroids or cut off their blood supply. They may help relieve heavy bleeding and pelvic pain with a faster recovery compared to traditional surgery. 

Uterine artery/fibroid embolization (UAE/UFE) 

An interventional radiologist threads a small catheter into the arteries and injects small particles to block the blood flow to the uterus or fibroids.

This can cause a reduction in fibroid volume of up to 60% to 70% within 12 months after the procedure, in some cases. It can also significantly reduce heavy bleeding. This may not be an ideal recommendation for those desiring future fertility. 

Learn more about uterine fibroid embolization. 

Radiofrequency ablation (Acessa, Sonata procedure)

A doctor uses a laparoscopic or transcervical device with ultrasound guidance to deliver radiofrequency energy into fibroids. This heat destroys the fibroid tissue and can make the fibroids much smaller and reduce vaginal bleeding. 

Surgery

If uterine fibroids are causing significant symptoms or fertility issues, you may need surgery to remove the fibroids or the entire uterus. 

Some fibroid surgeries can be performed using minimally invasive gynecologic surgery techniques, including laparoscopy or robotic-assisted surgery. These approaches use smaller incisions and may mean less pain, fewer complications and a faster recovery compared to traditional open surgery. However, not all patients are candidates for minimally invasive surgery.

Myomectomy 

This surgery removes fibroids that may be causing symptoms while preserving your uterus. It can be a good option if you want to get pregnant. 

Myomectomy can be done three ways:

• Hysteroscopy (small camera through the vagina/cervix)
• Small incisions in your abdomen via laparoscopy/robotic-assisted surgery (camera in the abdomen)
• A small abdominal incision called a mini laparotomy

For larger and more complex fibroid uteri, a large abdominal incision may need to be made. 

Hysterectomy

This surgery permanently removes the uterus (with or without the cervix) and is an option if you do not want future pregnancies. 

A total hysterectomy refers to removal of the cervix along with the uterus and any fibroids. A supracervical (non-total) hysterectomy refers to the removal of the uterus with retention of the cervix. 

Hysterectomies can often be done with minimally invasive techniques, which may mean less pain, fewer complications and a faster recovery compared to traditional open surgery.

Not everyone is a candidate for every management or treatment option. Your provider will work with you to create a plan that meets your goals of care.   

When should you see a doctor for fibroids?

You should see a health care provider if you have:

• Heavy, irregular or long-lasting menstrual bleeding
• Pelvic pain or pressure
• A rapid increase in the size of your abdomen
• Trouble getting pregnant
• Anemia symptoms, such as feeling tired, weak, short of breath or light-headed

Get care for uterine fibroids at Banner Health

At Banner Health, our experienced gynecology specialists use advanced diagnostic imaging and minimally invasive techniques to diagnose and treat uterine fibroids. We work with you to understand your symptoms, your lifestyle and your future fertility goals, then design a personalized care plan that fits your needs.

If you need evaluation or treatment for uterine fibroids or another gynecological issue, make an appointment with a Banner women’s health specialist.

Frequently asked questions about uterine fibroids

Are fibroids cancer?

Uterine fibroids are almost always benign (non-cancerous). There is no test to know for sure whether a fibroid is benign, however, there are several tests that can be performed to calculate the risk of abnormal fibroid tissue. 

Can fibroids go away on their own?

Fibroids may shrink after menopause, although some patients may have symptoms years after their last period. 

Can birth control help fibroids?

Yes. Hormonal birth control may help manage bleeding and pain due to uterine fibroids. 

Do fibroids always need treatment?

Not always. Treatment is targeted at a patient’s symptoms, health and goals of care. 

Can fibroids come back after treatment?

It’s possible for fibroids to return after treatment, even after removal via myomectomy.