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The Facts on Fibroids

Common questions about fibroids answered by Dr. Hye-Chun Hur, Minimally Invasive GYN Surgeon at Beth Israel Deaconess Medical Center.

Question: How common are fibroids?

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

Q: What causes fibroids?

Dr. Hur: We don't exactly know what causes fibroids. We do know there can be a genetic or hereditary component, and fibroids are more common among African-American women. However, many women have fibroids with no predisposition or family history.

Q: What symptoms are related to fibroids?

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 they can be so severe they interfere with daily activities.

Q: How severe do symptoms need to be to consider fibroid treatment?

Dr. Hur: Fibroid treatments should be tailored to the patient's symptoms and life status or life goals. Sometimes treatment is necessary because the fibroid symptoms have become severe. Alternatively, some fibroids (such as those that grow in the uterine cavity) may be asymptomatic, but among reproductive-aged women may pose an increased 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 fibroid treatment?

Dr. Hur: A variety of treatments exist. They range from doing nothing in the asymptomatic patient to the most extreme, which is hysterectomy - physically removing the uterus and fibroids. There are a variety of treatments that fall in between, many of which are conservative and minimally invasive. Birth control pills are one of the most common medical treatments for fibroids. They serve as a method of hormonal regulation to manage fibroid symptoms. Hormones come in many forms - pills, injections, implants, patches, and rings - which may all potentially be used for fibroid treatment.

If you have fibroids growing within the uterine cavity, you may be a candidate for a minimally invasive procedure called a hysteroscopic myomectomy. This is an incisionless procedure where a little camera is inserted into your womb to resect the fibroid. Other minimally invasive treatment options include procedures like a uterine artery embolization, where the blood supply to the fibroids 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 a Mirena IUD insertion or an endometrial ablation. The Mirena IUD is inserted in the office and is a simple office procedure. The Mirena IUD is a little contraceptive device that sits in the uterine cavity and thins the uterine lining by releasing small amounts of hormone called progestin. The uterine lining, called the endometrium, becomes very thin and results in less uterine bleeding.

Endometrial ablation is a minor, same day procedure that is performed in the hospital. It destroys the lining of the uterus to decrease the amount of uterine bleeding. Not all patients are candidates for this treatment. Patients with fibroids growing into the uterine cavity may not qualify - they may be better suited for a hysteroscopic myomectomy (see above). Alternatively, surgical options such as a total laparoscopic hysterectomy or laparoscopic myomectomy are minimally invasive treatments that may provide a timely and definitive cure for your fibroid symptoms. It is important to discuss your life goals, symptoms, and treatment options with your provider to select the best treatment 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 (e.g. birth control pills or progestin IUDs) and/or mechanical destruction (e.g. endometrial ablation) might be equally effective, depending on the patient. However, if you have compression symptoms, pelvic pressure, urinary frequency, back pain or constipation from sizeable fibroids compressing on adjacent structures, then physically removing the fibroids with surgery may be superior to hormone regulation alone. The best treatment plan for the patient 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 very important for women to seek help when they are experiencing fibroid symptoms. Women typically are not complainers. Generally, they are the caretakers of the family and are not used to putting themselves first. I often encounter women who are in the late stage of symptoms - either with severe pain or with low blood counts from anemia due to excessive bleeding. If women seek help when their condition is symptomatic but not so excessive, they may have more treatment options available to them, including the more conservative therapies. If a woman presents with severe pain that has been ongoing for months, or excessive bleeding causing very low blood counts, we may not have the opportunity to try conservative options before moving on to something more invasive. Women should be aware there is help out there - and the sooner they learn about 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 September 2011

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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