Fibroids in the uterus are noncancerous growths which may appear in women of childbearing age. They range from tiny specks to bulky masses, which can distort the appearance of the uterus. They never develop into cancer.

What issues can they cause?

Often fibroids do not cause any symptoms at all. If symptoms occur, they are influenced by the size, location and number of fibroids. Even small fibroids can cause heavy menstrual bleeding, long menstruation and cramping. Large fibroids cause symptoms by exerting pressure on other structures. These symptoms include constipation, frequent urination, pelvic pressure and pain, backache and even leg pains. Occasionally, fibroids can cause infertility.

How do I know if I have fibroids?

If you are experiencing any of these symptoms, a primary care physician or a gynecologist may recommend a pelvic ultrasound to assess for any abnormalities including fibroids. If the ultrasound is inconclusive, your doctor may order an MRI or other studies. A doctor also may check a complete blood count to assess for anemia and laboratory tests to exclude bleeding disorders and hormone imbalances.

Should I worry if I have fibroids?

If your symptoms are mild and not troublesome and something you can tolerate, then waiting may be the best option. Fibroids often shrink after menopause when hormone levels change. Fibroids are not cancerous so there is no role for any additional screening.

What are my treatment options?

There are many options available for the treatment of uterine fibroids, depending on the location, number and size of the fibroids. Treatment options also will change depending on whether you wish to preserve your fertility.

A doctor may recommend medications in an attempt to shrink the fibroids, to relieve heavy bleeding or to decrease pain related to fibroids. These range from tablets to a progestin-releasing intrauterine device.

• Gonadotropin-releasing hormone agonists block estrogen and progesterone and cause a temporary post-menopausal state. These medications are used to shrink the fibroids, usually in preparation for another procedure.

• A progestin-releasing intrauterine device can decrease heavy bleeding caused by fibroids, but does not shrink them.

• Tranexamic acid is a nonhormonal medication that can be taken on heavy bleeding days to decrease heavy menstrual bleeding.

Traditional surgical procedures

• Abdominal myomectomy: For women who have multiple or large fibroids, a surgeon may use an open abdominal procedure to remove the fibroids instead of a hysterectomy. Scarring may affect future fertility.

• Hysterectomy: The uterus may be removed with or without the ovaries.

Minimally invasive procedures can destroy uterine fibroids without surgically removing them.

• Endometrial Ablation: A surgeon may insert an instrument into the uterus to use heat to destroy the lining of the uterus, ending menstruation or reducing your flow.

• Myomectomy: A surgeon may opt to surgically remove some or all of the fibroids.

• Myolysis/cryolysis: A surgeon may laparoscopically insert an instrument through your abdomen to heat or freeze the fibroids.

• Uterine fibroid/artery embolization: A doctor may refer you to a minimally invasive specialist called an interventional radiologist to perform this procedure. Small particles are injected into the arteries supplying the uterus, cutting off blood flow to the fibroids and causing them to shrink and die. This procedure will relieve both heavy menstrual bleeding as well as bulk symptoms caused by large fibroids without removing the uterus. Patients usually enjoy a shorter hospital stay and return to work faster compared to a hysterectomy. An interventional radiologist can discuss the risks and benefits of this procedure with you.

Agnieszka Solberg is an interventional radiologist at CHI St. Alexius Health.  Solberg performs minimally invasive, image-guided procedures to diagnose and treat medical conditions.

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