Prevalence

Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, 1/3 of these are due to fibroids.

Fibroid Tumors of the Uterus — An Overview

Question:
What are uterine fibroids?

Answer:
Uterine fibroids are the most common tumors of the female genital tract. You might hear them referred to as "fibroids" or by several other names, including leiomyoma, leiomyomata, myoma and fibromyoma. Fibroids are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.

The exact causes for fibroid development are unclear, but researchers have linked them to both a genetic predisposition and a subsequent development of susceptibility to hormone stimulation. Women may have a genetic predisposition to fibroid development and then subsequently develop factors that allow fibroids to grow under the influence of a number of hormones. This would explain why certain ethnic groups or racial groups are more likely to develop fibroids and also why there tends to be genetic predisposition in some families.

Fibroids range greatly in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow in the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus. In most cases, there is more than one fibroid in the uterus. There are three primary types of uterine fibroids.

Submucosal fibroids, which are just under the lining of the uterus. These are the least common fibroids, but they tend to cause the most problems. Even a very small submucosal fibroid can cause heavy bleeding — gushing, very heavy and prolonged periods.

Question:
What are typical symptoms?

Answer:
Most fibroids don't cause symptoms — only 10 percent to 20 percent of women who have fibroids ever require treatment. Depending on location, size and number of fibroids, a woman might experience the following:

* Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes clots. This often leads to anemia

* Pelvic pain

* Pelvic pressure or heaviness caused by the bulk or weight of the fibroids pressing on nearby structures

* Pain in the back or legs as the fibroids press on nerves that supply the pelvis and legs

* Pain during sexual intercourse

* Bladder pressure leading to a constant urge to urinate

* Pressure on the bowel, leading to constipation and bloating

* Abnormally enlarged abdomen

If you are experiencing these types of symptoms, consult with your personal physician.

Question:
Who is most likely to have uterine fibroids?

Answer:
Uterine fibroids are very common, although often they are very small and cause no problems. From 20 - 40 percent of women age 35 and older have uterine fibroids of a significant size.

African-American women are at a higher risk: as many as 50 percent have fibroids of a significant size.

Fibroid tumors may start in women when they are in their 20s, however, most women do not begin to have symptoms until they are in their late 30s or 40s. Physicians are not able to predict if a fibroid will grow or cause symptoms.

Question:
How are uterine fibroids diagnosed?

Answer:
Typically, fibroids are first diagnosed during a gynecologic internal examination. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged. The presence of fibroids is most often confirmed by an abdominal ultrasound. Fibroids also can be confirmed using magnetic resonance (MR) and computed tomography (CT) imaging techniques.

In some cases, a transvaginal ultrasound may be necessary. The radiologist inserts an ultrasound probe into the vagina so the inside of the uterus can be seen even more clearly than with the abdominal procedure. There is generally little if any discomfort associated with this procedure

Fibroids also can be confirmed using magnetic resonance (MR) imaging or computed tomography (CT). MR and CT also are painless diagnostic tests that can give accurate and clear information on the presence of fibroids.

Diagnostic hysteroscopy also is an option, particularly to evaluate the presence of submucosal fibroids. A long, thin probe-like instrument is passed through the vagina and cervix into the uterus, where the physician can check for growths and take samples of tissue. The lighted hysteroscope illuminates the uterus. This procedure, which can cause some discomfort, is generally performed by a gynecologist, and can be done without anesthesia or with a local anesthetic in an office.

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