What are uterine fibroids?

Uterine Fibroids are non-cancerous growths located within the pelvis. They are the most common gynecological tumor and contribute to the widespread discomfort of millions of women. Depending upon the size, position, and number of growths a woman's risks and symptoms are generally increased. Fibroids can grow as a single or multiple tumors. They can be as small as an apple seed or as large as a grapefruit. In unusual cases they can become even larger.

What are the symptoms?

Many women with uterine fibroids have no symptoms. Approximately one third of women with fibroids will present with symptoms that include:

• Heavy bleeding which can be heavy enough to cause anemia or painful periods
• Pelvic and lower back pain
• Pain during sexual intercourse
• Pressure, fullness feeling in the pelvic area
• Frequent urination
• Pregnancy complications- including a six-time greater risk of cesarean section
• Miscarriages
• Infertility

These symptoms can be caused by other medical problems and not just by fibroids. Thus, you should regularly see a doctor for routine gynecological care and for any of these types of symptoms. It should be emphasized that although the majority of women have fibroids, only 20% of women with fibroids have fibroid related symptoms. Fibroids are often found on routine pelvic exams or during tests for other problems.

Why should women know about fibroids?

It is critical that women understand Uterine Fibroid because as many as 60-80 percent of women may develop fibroids by the time they reach age 50. Most women with fibroids have no or minimal symptoms. However, in a substantial group of women, symptoms can be significant or severe, generally resulting in bleeding and/or pain. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure, back pain or pain during sexual intercourse. Large multiple, fibroids can cause the abdomen to enlarge, making a woman look pregnant.

Who is at risk for uterine fibroids?

There are various 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.

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 and for an annual cervical PAP smear. The doctor may be able to feel the fibroid with his or her hands during an ordinary pelvic exam, as a (usually painless) firm lump on the uterus. For medium and larger fibroids, your doctor will describe the size of your fibroids by comparing them to different stages of pregnancy. For example, you may be told that the size of your fibroids is similar in size to a uterus carrying a 20-week pregnancy (at the level of the belly button). Or the fibroid might be compared to fruit such as lemons, oranges or grapefruit to demonstrate a comparative size.

One of several imaging test generally confirms the size, position, and dynamic of Fibroids. The two most common modalities include Ultrasound and Magnetic Resonance Imaging (MRI):

• Ultrasound
  Using sound waves with frequencies (pitch) much higher than audible sound, ultrasound is the most commonly used type of scan for pelvic evaluation. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to help scan the uterus and ovaries. It is quick and simple and generally accurate. However it relies on the experience and skill of the person performing the scan to produce good results and may not always demonstrate larger fibroids or other conditions such as adenomyosis.
• Magnetic Resonance Imaging (MRI)
  MRI uses magnets and radio waves to produce the picture. It is considered the single best test for the uterus and can exactly demonstrate the number and location of fibroids as well as distinguish adenomyosis from fibroids. We rely primarily on MRI to triage patients to therapy.
• Hysterosalpingogram (HSG)
  An HSG is usually used in women with trouble conceiving a baby to demonstrate the anatomy of the inside of the uterus (uterine cavity) and fallopian tubes. It does not evaluate the size of the uterus or uterine wall reliably. After a small catheter tube is placed in the uterus, x-ray dye is slowly injected via the catheter into the uterus and x-ray pictures are taken.
• Hysterosonogram
  A hysterosonogram is used to see the inside of the uterus (uterine cavity) with ultrasound and injected fluid. After a small catheter tube is placed inside the uterus, water is injected while a series of ultrasound images are taken. This test can confirm the presence of uterine polyps or intracavitary fibroids that can cause heavy bleeding.

If these tests don't adequately determine the source of your pelvic pain, you might also need surgery. The least invasive surgeries for diagnosis is know as laparoscopy

• Laparoscopy
  During laparoscopy, through tiny incision made in or near the navel, a long, thin scope is inserted into the abdomen and pelvis. The scope has a bright light and a camera and allows your doctor to see the uterus and surrounding structures to determine if you have conditions such as endometriosis, which can cause pelvic pain.
• Hysteroscopy
  For suspected abnormalities inside the uterine cavity, a long, thin scope with camera and light is passed through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for cavitary fibroids or endometrial polyps.