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Common Questions On Fibroids

Answered by Dr. Hye-Chun Hur, Minimally Invasive GYN Surgeon, Beth Israel Deaconess Medical Center, Boston

Question: How common are fibroids?

Dr. Hur: Fibroids are smooth muscle tumors of the uterus (womb). They are incredibly common among women. In fact, some studies suggest that 25%-75% of all women may have fibroids, although only about 20 percent ever have symptoms. Roughly 50% of all hysterectomies performed are due to fibroids.

Uterine fibroids diagram

Q: What causes fibroids?

Dr. Hur: We don't really know what causes fibroids, although we do know there can be a genetic or hereditary component. It's more common among African American women, but plenty of women can just have fibroids with no predisposition.

Q: And what are those symptoms?

Dr. Hur: Symptoms might include abnormal bleeding, pain, bad cramping or pelvic pressure. Fibroid compression on the surrounding pelvic structures can cause bladder pressure, frequent urination, constipation, or general discomfort.and fullness The symptoms can be mild, or can be so severe it interferes with daily activities.

Q: How severe does it need to be to consider doing something about it?

Dr. Hur: Fibroid treatments should typically be tailored around the patient's needs or life goals. Sometimes, treatment is needed because the symptoms have become severe. Sometimes, fibroids grow in the uterine cavity and can potentially impact a women's pregnancy outcome, including heightening the risk of miscarriage. These are the times we encourage women to seek expert advice in the best way to tackle fibroids.

Q: What are the options for treatment?

Dr. Hur: A variety of treatments exist out there and they range from doing nothing in the asymptomatic patient to the most extreme which is hysterectomy -- physically removing the uterus and fibroids. Then there are a variety of treatments that are in between. Many of them can be conservative treatments and minimally invasive. There are medical treatment options like birth control pills, and other forms of hormonal suppression to try to manage the symptoms related to fibroids. Hormones come in many forms-pills, injections, implants, patches, and rings. If you have fibroids growing within the uterine cavity, you may be a candidate for a hysteroscopic myomectomy. This is an incisionless procedure where a little camera is inserted into your womb to resect the fibroid. Some of minimally invasive treatment options include procedures like uterine artery embolization which is performed by a radiologist. The blood supply to the uterus is cut off. This treatment typically results in diminished amounts of uterine bleeding and a decrease in fibroid size. There are other minor procedures like an endometrial ablation or Mirena IUD insertion. The Mirena IUD insertion is a simple office procedure that thins the uterine lining called the endometrium to diminish the amount of uterine bleeding. Again, it doesn't resect the fibroid. The Mirena IUD is a little contraceptive device that sits in the uterine cavity and thins the lining (and lessens bleeding) through a release of small amounts of hormone called progestin. The endometrial ablation is a simple same day procedure that is performed in the hospital. It doesn't actually resect the fibroids, but it does destroy the lining of the uterus to decrease the amount of bleeding from the uterus. Not all patients are candidates for this treatment. Patients with fibroids growing into the uterine cavity may not qualify. It is important to discuss your life goals, symptoms, and treatment options with your provider to select the best treatment course for you.

Q: How effective is hormone treatment?

Dr. Hur: How we target treatment very much depends on the symptoms. If you have abnormal bleeding, hormones (eg birth control pills or progestin IUDs) and/or mechanical destruction (e.g. endometrial ablation) might be equally effective, it just depends on the patient, but if you have compression, urinary frequency or constipation from the size of the fibroids compressing on adjacent structures, then typically, unless you debulk the fibroids and physically remove them, patients may not have enough symptom relief from just hormone regulation alone. So a lot of the best planning for the patient very much will depend on the patient's profile as well as their symptoms.

Q: Is it important for women to seek help early on with fibroid and/or bleeding problems?

Dr. Hur: It is. Women typically are not complainers. They are generally the caretakers of the family and so they are not use to putting themselves first. I do find many women come to me in the late stage of symptoms, when they may already have low blood counts from anemia due to excessive bleeding, for example. If women seek help when their condition is symptomtic but not so excessive, they will have more treatment opportunities available to them, including the more conservative options. If a woman comes in suffering from incredible pain that has gone on for months or excessive bleeding causing very low blood counts , we may not have the time to try a couple of conservative options before moving into something more invasive. Women should know there is help out there-and the sooner they can find out the possible treatments, the sooner they can get relief and get on with their lives.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2010

Contact Information

Minimally Invasive Gynecologic Surgery
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus, Shapiro 8
330 Brookline Avenue
Boston, MA 02215
617-667-4030
617-667-2999

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