Uterine fibroids

Alternative Names

Treatment

Treatment depends on the severity of symptoms, the patient's age, whether or not she is pregnant, the desire for future pregnancies, her general health, and characteristics of the fibroids. Some women may just require monitoring of the fibroid. This requires pelvic exams or ultrasounds every once in a while.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn may be recommended for women who have cramps or pain with menstruation. Birth control pills (oral contraceptives) may be used to help control heavy periods and to stop the fibroid from growing. Iron supplements may be given to prevent anemia in women with heavy periods.

In some cases, hormonal therapy involving drugs such as injectable Depo Leuprolide is prescribed to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The hormones create a situation in the body that is very similar to menopause. Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density.

Hormone treatment may last several months. Fibroids will begin to grown as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.

Hysteroscopic resection of fibroids (an outpatient surgical procedure) may be needed for women with fibroids growing inside the uterine cavity. In this procedure, a small camera and instruments are inserted through the cervix into the uterus to remove the fibroid tumors.

Uterine artery embolization is a new procedure aimed at preventing the need for major surgery. The method stops the blood supply that makes fibroids grow.  The long-term effects of this procedure are still unknown, and the safety of pregnancy after this procedure is questionable.

A myomectomy is a surgical procedure to remove just the fibroids. It is frequently the chosen treatment for premenopausal women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have.

Support Groups

National Uterine Fibroid Foundation - www.nuff.org

Outlook (Prognosis)

Prior to menopause, fibroids are likely to grow slowly.

As a general rule, fibroids don't interfere with fertility. However, a tumor sometimes blocks the fallopian tubes and prevents sperm from reaching and fertilizing eggs. In some cases, fibroids may prevent a fertilized egg from implanting in the uterine lining. However, proper treatment may restore fertility.

After a pregnancy is established, existing fibroids may grow due to the increased blood flow and estrogen levels. These usually return to their original size after the baby has been delivered.

Most women are able to carry their babies to term, but some of them end up delivering prematurely because there is not enough room in the uterus.

Cesarean section may be needed for delivery since fibroid tumors can occasionally block the birth canal or cause the baby to be positioned wrong. After menopause, new fibroids rarely develop and those already present usually shrink.

Possible Complications

Fibroids may cause infertility. They may also cause premature delivery.

Severe pain or excessively heavy bleeding with fibroids may require emergency surgery.

In rare cases, cancerous changes may occur. These usually take place after menopause. The most common warning sign is rapid growing of a fibroid. A definite diagnosis is usually not made until the time of surgery.

When to Contact a Medical Professional

Call your health care provider if gradual changes in your menstrual pattern occur (heavier flow, increased cramping, bleeding between periods), or if fullness or heaviness develops in your lower abdomen. Frequently there is associated pressure or discomfort and occasionally interference with normal urination frequency.

References

L Speroff, M Fitz. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Lippincott Williams & Wilkins; 2004.

Casini ML, Rossi F, Agostini R, Unfer V. Effects of the position of fibroids on fertility. Gynecol Endocrinol. 2006 Feb;22(2):106-9.