What a Uterine Fibroid Diagnosis Means for Your Health

 Fibroids are benign 99 percent of the time, but that doesn't mean they can always be ignored, especially if they're preventing you from getting pregnant or causing you pain. 

Uterine fibroids are growths that commonly develop on a woman's uterus, many times without causing any symptoms that would make her aware that they are present. But for some, fibroids can cause discomfort and heavy bleeding.

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Fibroids affect women of all backgrounds, often during their reproductive years, but to varying degrees, explains John F. Steege, MD, director of the department of obstetrics and gynecology at the University of North Carolina in Chapel Hill, and director of the UNC Fibroid Care Clinic. For instance, African-American women are more likely to develop fibroids than white women and at an earlier age.

Fibroids: More Annoying Than Worrisome

Also known as leiomyomas or myomas, “each fibroid apparently arises from a single cell that has escaped the usual controls over growth,” explains Dr. Steege. Ranging in size from a grape to a small grapefruit, fibroids grow inside the uterus or uterine walls, or outside, but attached to, the uterus. Many women with fibroids have no symptoms and need no treatment.

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Fibroids can develop during a pregnancy without causing problems, although occasionally, some fibroids, particularly if they are large, can interfere with pregnancy or lead to miscarriages or infertility. Most fibroids shrink at menopause, but some grow so large that they press on other internal organs and have to be surgically removed.

Fibroids can be the reason behind heavy vaginal bleeding and iron-deficiency anemia. Some fibroids attached to the uterus by a stem can get twisted, causing pain and fever.

If you notice any of these symptoms, be sure to bring them to the attention of your ob/gyn:

• Heavy periods — bleeding that lasts longer and is more frequent than what you’re used to seeing
• Bleeding between periods
• Pain in your back or abdomen
• Difficulty eliminating, either during urination or bowel movements

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Regardless of size, “about 99.5 percent of fibroids are benign,” says Beth W. Rackow, MD, assistant professor in the department of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine. Only very rarely does a fibroid become cancerous, Dr. Rackow adds.

Fibroids: Interfering With Fertility

“Some fibroids get diagnosed during an evaluation for infertility or recurrent pregnancy loss,” according to Rackow. Usually, diagnosis requires imaging tests to assess the fibroids’ number, size, and location.

The type of fibroids that appear to cause the most problems, Rackow says, are those that form underneath a mucous membrane and jut [inwards] into the uterine cavity. This jutting sometimes “causes pregnancy failure and/or loss of fertility because it makes the uterine cavity abnormal and decreases the chance of pregnancy,” she explains.

Fibroids within the uterine wall can also alter the uterine cavity, block the fallopian tubes, or displace the cervix, the narrow opening at the end of the uterus, near the vagina, Rackow says.

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Fibroids: Treatment Options

How, or even if, fibroids are treated depends on your age, the severity of your symptoms, and whether you hope to get pregnant in the future. Because medications that shrink fibroids interfere with fertility, surgery that preserves fertility is the usual treatment for younger women, Rackow says.

Strategies for treating fibroids include:

• Medication. Anti-inflammatory drugs and contraceptives containing estrogen and progestin can be used to control abnormal bleeding, but studies show mixed results. An agent called a gonadotropin-releasing hormone agonist can shrink fibroids, but the effect is temporary and fibroids tend to grow back.
• Myomectomy. This involves surgically removing the fibroids and leaving the uterus intact. This procedure is an option for women who still want to have children, but in 20 to 40 percent of cases, the fibroids grow back. And in a few women, scarring from the surgery might cause infertility. Depending on the size of the fibroids and where exactly they are located, surgery may be done through the vagina, the navel, or an abdominal incision.
• Uterine artery embolization. In this procedure, blood flow to the fibroids is cut off, stopping their growth and causing them to shrink. Because it’s not certain how this treatment affects future pregnancies, it may not be the right choice for a woman still considering having children.
• Hysterectomy. This involves surgically removing the uterus along with the fibroids. Hysterectomy is an option if a woman has severe pain or abnormal bleeding or if fibroids are unusually large, but must be carefully weighed as an option because it ends a woman’s ability to bear children.

Because every case of fibroids is different and because your needs change at different times in your life, consulting with your ob/gyn will help you make the best choice for fibroid treatment.

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