Fibroids are muscular tumors that grow in the wall of the uterus (womb). Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.
Why should women know about fibroids?
About 20 to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.
Who gets fibroids?
There are factors that can increase a woman's risk of developing fibroids.
- Age - Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
- Family history - Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin - African-American women are more likely to develop fibroids than white women.
- Obesity - Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits - Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
- Heavy bleeding (which can be heavy enough to cause anemia) or painful periods
- Feeling of fullness in the pelvic area (lower stomach area)
- Enlargement of the lower abdomen
- Frequent urination
- Pain during sex
- Lower back pain
- Complications during pregnancy and labor, including a six-time greater risk of cesarean section
- Reproductive problems, such as infertility, which is very rare
What causes fibroids?
No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:
- Hormonal (affected by estrogen and progesterone levels)
- Genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. We do know that they are under hormonal control — both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.
Can fibroids turn into cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.
How do I know for sure that I have fibroids?
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.
How are fibroids treated?
Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:
- Whether or not you are having symptoms from the fibroids
- If you might want to become pregnant in the future
- The size of the fibroids
- The location of the fibroids
- Your age and how close to menopause you might be
If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
Myomectomy – Surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.
Hysterectomy – Surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy.