Uterine Fibroids

Some women who have fibroids have no symptoms, or have only mild symptoms. Other women have more severe, disruptive symptoms. Symptoms of uterine fibroids may include:

• Heavy or prolonged periods
• Abnormal bleeding between periods
• Pelvic pain
• Frequent urination
• Low back pain
• Pain during intercourse
• A firm mass, often located near the middle of the pelvis, which can be felt by your healthcare provider

Fibroids are most often found during a routine pelvic exam. Your healthcare provider may feel a firm, irregular pelvic mass during an abdominal exam. Further tests to accurately diagnose uterine fibroids may include:

• X-Ray: Electromagnetic energy used to produce images of bones and internal organs onto film.
• Transvaginal Ultrasound: An ultrasound test using a small instrument, called a transducer, that is placed in the vagina.
• MRI: A noninvasive procedure that produces a two-dimensional view of an internal organ or structure.
• Hysterosalpingography: X-ray exam of the uterus and fallopian tubes that uses dye. It is often done to rule out tubal obstruction.
• Hysteroscopy: Visual exam of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
• Endometrial Biopsy: A procedure in which a sample of tissue is taken through a tube inserted into the uterus.
• Blood Test: This is to check for iron-deficiency anemia if heavy bleeding is caused by the tumor.

Since most fibroids stop growing or may even shrink as you approach menopause, your doctor may suggest "watchful waiting." With this approach, your doctor will monitor your symptoms carefully to make sure that there are no significant changes and that the fibroids are not growing. If your fibroids are large or cause significant symptoms, treatment may be necessary. Your specific treatment will be determined by your doctor based on your age, your desire for pregnancy, overall health, medical history and your tolerance for specific medications, procedures or therapies. Of course, your personal opinions and preferences will also be taken into consideration. Treatments include:

• Hysterectomy: This is the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the U.S.
• Conservative Surgical Therapy: Conservative surgical therapy uses a procedure called a myomectomy. With this approach, fibroids are removed, but the uterus stays intact. This may allow a future pregnancy.
• Gonadotropin-Releasing Hormone Agonists (GnRH Agonists): This approach lowers your estrogen level. This triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgery easier.
• Anti-Hormonal Medications: Certain medications oppose estrogen (such as progestin and Danazol), and seem to work to treat fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
• Uterine Artery Embolization: Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer technique. The arteries supplying blood to the fibroids are identified, then embolized, blocking blood supply to the fibroids, thus shrinking them.
• Anti-Inflammatory Painkillers: This type of medication is often effective for women who have occasional pelvic pain or discomfort.