Uterine Fibroids

Uterine fibroids, also known as leiomyomas or myomas, are benign (non-cancerous) growths of muscle tissue that develop in the wall of the uterus. They can vary greatly in size, from tiny seedlings invisible to the naked eye to bulky masses that can distort and enlarge the uterus. A woman can have a single fibroid or multiple ones. Fibroids are extremely common, affecting up to 80% of women by age 50, with higher prevalence in women of African descent. Many women with fibroids experience no symptoms at all, while others may have significant symptoms that affect their quality of life, including heavy menstrual bleeding, pelvic pain, and reproductive problems.

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What Causes It?

Genetic factors - Fibroids may develop when a muscle cell in the uterus multiplies excessively, creating a benign tumor. Genetic alterations have been found in fibroid cells that differ from those in normal uterine muscle cells.

Hormonal influences - Estrogen and progesterone appear to promote fibroid growth. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells and tend to shrink after menopause when hormone levels decrease.

Growth factors - Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Extracellular matrix (ECM) - This material, which makes cells stick together like mortar between bricks, is increased in fibroids and makes them fibrous.

Family history - Having a mother or sister with fibroids increases your risk.

Race - Women of African ancestry are more likely to develop fibroids and at an earlier age.

Early onset of menstruation - Beginning menstruation at an early age increases lifetime exposure to estrogen.

Obesity - Women with obesity have higher estrogen levels, which may contribute to fibroid development.

Vitamin D deficiency - Some research suggests a link between vitamin D deficiency and fibroid development.

Diet - Red meat consumption has been associated with increased risk, while green vegetables may be protective.

Signs & Symptoms

Heavy menstrual bleeding (menorrhagia) - Periods lasting more than a week or requiring frequent changing of pads/tampons.

Pelvic pressure or pain - A feeling of fullness or pressure in the lower abdomen.

Frequent urination - Due to fibroids pressing on the bladder.

Difficulty emptying the bladder - Complete emptying may be hindered by large fibroids.

Constipation - Fibroids pressing on the rectum can cause constipation or difficult bowel movements.

Backache or leg pain - Fibroids pressing on nerves or muscles in the back or legs.

Pain during intercourse - Depending on the location of fibroids.

Prolonged menstrual periods - Often with excessive bleeding, sometimes with clots.

Reproductive problems - Including infertility, multiple miscarriages, or early onset of labor during pregnancy.

Abdominal swelling - The abdomen may appear enlarged, similar to early pregnancy, with large fibroids.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Pelvic Examination

During a routine pelvic exam, your doctor may feel irregularities in the shape of your uterus that suggest fibroids. If your uterus is enlarged or has an irregular shape, fibroids may be suspected.

Ultrasound

This is usually the first imaging test used to investigate potential fibroids. Using sound waves, ultrasound creates a picture of your uterus, allowing the doctor to see the size, location, and number of fibroids. Transvaginal ultrasound (where the ultrasound wand is inserted into the vagina) often provides the clearest images.

Magnetic Resonance Imaging (MRI)

MRI provides detailed images of fibroids, showing their exact location and size with high precision. This test is particularly useful in determining the appropriate treatment approach, especially when considering procedures like uterine fibroid embolization or focused ultrasound surgery.

Hysteroscopy

This procedure allows your doctor to examine the inside of your uterus by inserting a thin, lighted scope through your vagina and cervix. Hysteroscopy can identify submucous fibroids (those that protrude into the uterine cavity) and can sometimes be used to remove smaller fibroids during the same procedure.

Hysterosonography (Saline Infusion Sonogram)

This specialized ultrasound uses a small amount of saline (salt water) injected into the uterus to expand the uterine cavity, making it easier to visualize the inner lining of the uterus and any fibroids that may be affecting it.

Hysterosalpingography

This X-ray technique uses a contrast material injected into the uterus and fallopian tubes. It's primarily used to look for blockages in the fallopian tubes but can also help identify fibroids that might be affecting the uterine cavity and potentially fertility.

Endometrial Biopsy

While not used to diagnose fibroids directly, this procedure may be performed to rule out abnormal tissue or cancer in women with abnormal bleeding, which can sometimes be confused with symptoms of fibroids.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Watchful Waiting

Many fibroids don't require treatment if they're not causing symptoms. Your doctor may recommend periodic monitoring with pelvic exams or ultrasounds to track any growth. This approach is particularly appropriate for women approaching menopause, as fibroids often shrink naturally when estrogen levels decrease.

Medications

Various medications can help manage fibroid symptoms. Hormonal options include birth control pills, progesterone-releasing IUDs, or GnRH agonists that create a temporary menopause-like state. Non-hormonal options include tranexamic acid or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce heavy bleeding and pain during periods.

Minimally Invasive Procedures

Several procedures can treat fibroids without major surgery. Uterine fibroid embolization (UFE) cuts off blood supply to fibroids, causing them to shrink. MRI-guided focused ultrasound surgery uses sound waves to destroy fibroid tissue. Radiofrequency ablation uses heat to destroy fibroids. Endometrial ablation destroys the uterine lining to reduce bleeding.

Traditional Surgery

Surgical options include myomectomy, which removes fibroids while preserving the uterus, and hysterectomy, which removes the entire uterus. Myomectomy can be performed abdominally, laparoscopically, or hysteroscopically, depending on the size and location of fibroids. Hysterectomy is a definitive solution for women who no longer wish to maintain fertility.

Home Remedies

Heat Therapy

Applying a heating pad or warm compress to the lower abdomen can help relieve pelvic pain and cramping associated with fibroids. The heat improves blood flow and relaxes muscles, reducing discomfort.

Dietary Adjustments

Some women find that reducing red meat and increasing fruits, vegetables, and whole grains helps manage symptoms. Foods rich in iron can help combat anemia from heavy bleeding. Limiting caffeine and alcohol may also reduce symptoms in some women.

Regular Exercise

Moderate physical activity may help reduce fibroid-related pain and discomfort by releasing endorphins (natural pain relievers) and improving blood circulation. Regular exercise may also help maintain a healthy weight, which can affect hormone levels that influence fibroid growth.

Stress Management

Techniques such as yoga, meditation, deep breathing exercises, or progressive muscle relaxation can help manage stress, which may exacerbate fibroid symptoms. Stress reduction may also help improve overall quality of life when dealing with chronic symptoms.

Over-the-Counter Pain Relievers

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce heavy bleeding. These medications work by reducing the production of prostaglandins, which are chemicals that cause pain and inflammation.

Prevention Tips

Maintain a healthy weight through balanced nutrition and regular physical activity, as obesity is a risk factor for fibroid development.

Eat a diet rich in fruits, vegetables, and whole grains, which may help reduce fibroid risk according to some studies.

Consider including green leafy vegetables, which contain compounds that may help the body process estrogen more efficiently.

Include sources of vitamin D in your diet, or talk to your doctor about supplements if you're deficient, as low vitamin D levels have been linked to fibroid growth.

Limit red meat consumption, which has been associated with increased fibroid risk in some studies.

Reduce alcohol intake, which may affect estrogen metabolism and potentially influence fibroid development.

Avoid environmental toxins when possible, including certain plastics containing BPA, which may disrupt hormonal balance.

Manage stress through techniques like meditation, yoga, or other relaxation methods, as stress may affect hormone levels.

Attend regular gynecological check-ups to monitor for early signs of fibroids, especially if you have risk factors like family history.

Discuss your contraceptive options with your doctor, as some hormonal methods may help control symptoms in women with fibroids.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Myomectomy

A surgical procedure that removes fibroids while preserving the uterus, making it appropriate for women who wish to maintain fertility. The approach depends on the size, number, and location of fibroids: abdominal myomectomy involves a larger incision; laparoscopic or robotic myomectomy uses small incisions and specialized instruments; hysteroscopic myomectomy accesses fibroids through the vagina and cervix without incisions.

Hysterectomy

The surgical removal of the uterus, which provides a definitive cure for fibroids by eliminating the organ where they grow. This may be recommended for women with severe symptoms who don't want future pregnancies. Approaches include abdominal, vaginal, laparoscopic, or robotic-assisted, each with different recovery profiles. The ovaries may be preserved to maintain hormone production.

Uterine Fibroid Embolization (UFE)

A minimally invasive procedure performed by interventional radiologists that cuts off blood supply to fibroids, causing them to shrink. Small particles are injected through a catheter into the arteries supplying the fibroids. This option preserves the uterus and requires minimal recovery time, though pregnancy is not recommended afterward due to potential complications.

Radiofrequency Ablation

A minimally invasive procedure that uses heat generated by radiofrequency energy to destroy fibroid tissue. This can be performed laparoscopically or through the vagina using specialized equipment. The procedure preserves the uterus and normal uterine tissue while targeting just the fibroids.

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