Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids are also known as uterine myomas, leiomyomas, or fibromas. They are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus.
Approximately 99 percent of fibroids are benign (non-cancerous). The reported incidence of a fibroid being cancerous ranges from 0.05 to 0.28 percent. Benign uterine leiomyomas (fibroids) are very common: estimated lifetime risk of 70 percent in white women and 80 percent in black women. They range in size, from the size of a pea to the size of a softball or small grapefruit.
Risk Factors
Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.
Symptoms
The following are the most common symptoms for uterine fibroids, however, each individual may experience symptoms differently.
- Heavy or prolonged menstrual periods
- Abnormal bleeding between menstrual periods
- Pelvic pain (caused as the tumor presses on
pelvic organs) - Frequent urination
- Low back pain
- Pain during intercourse
- A firm mass, often located near the middle of
the pelvis
Treatment
Hysterectomy. Hysterectomies involve the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the United States.
Conservative Surgery. Conservative surgical therapy uses a procedure called a myomectomy. With this approach, the fibroid is removed leaving the uterus intact.
Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers levels of estrogen and triggers a “medical menopause.” But over the last few years newer, oral GnRH agonists have come about that add back estrogen/progesterone within the tablet eliminating menopausal symptoms ex: MyFembree or Orgovyx.” Lastly, sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier. “
Anti-hormonal agents. Certain drugs that oppose estrogen appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used, but neither are used long-term. Both are usually used to shrink the fibroid or stop the heavy bleeding in order to increase a patient’s blood count prior to surgery.
Uterine artery embolization. Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally invasive technique. The arteries supplying blood to the fibroids are identified, and then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them.
Laparoscopic Radiofrequency Ablation (Acessa Procedure), is also an option. This allows for shrinkage of the fibroid or fibroids via a laparoscopy.
Magnetic resonance imaging (MRI)-guided localization and treatment of uterine leiomyomas with focused ultrasound therapy. This noninvasive approach uses high-intensity ultrasound waves directed into a focal volume of a leiomyoma, thus shrinking the size of the fibroid.
Anti-inflammatory painkillers. This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers levels of estrogen and triggers a “medical menopause.” Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.