Most American women will develop fibroids at some point in their lives. In fact, National Institutes of Health reports by age 50, 70 percent of whites and 80 percent of African Americans had fibroids. Fibroids are growths of uterine muscle, usually spherical. Uterine fibroids are the most common noncancerous tumors in women of childbearing age, and they can be as small as a pinhead to as large as a basketball.
There are three main places women may develop fibroids, including:
• Inside the uterus (in the uterine cavity) — these are called submucosal fibroids
• Within the muscle of the uterine wall — these are called intramural fibroids
• Outside surface of the uterus — these are called subserosal fibroids
With the exception of submucosal fibroids, most small fibroids have no effect on your ability to get pregnant. Submucosal fibroids, those that grow inside the uterine cavity, are fibroids most likely to produce problems, specifically heavy and crampy menses.
Although fibroids may be worrisome for some women, I see patients with uterine fibroids every day, and I have been diagnosing and treating problems associated with uterine fibroids for 39 years. Although the cause of uterine fibroids is still unclear, I have participated in numerous research trials investigating new technologies for treating both fibroids and the symptoms associated with them. Increasing information has improved the diagnosis and treatment of uterine fibroids.
Here are five quick facts you should know if you’re worried about fibroids.
1. Are fibroids causing your pelvic pain? Usually not.
In many cases, fibroids do not cause symptoms and women may be unaware they have them. Small fibroids (three to four inches or less) that are not inside the uterus usually pose no risk to the patient and do not require treatment.
Uterine fibroids rarely cause pain but can be associated with heavy menses, crampy menses and when they are large enough — pelvic pressure. They are completely unrelated to ovarian cysts, uterine polyps or other types of growths in the pelvis.
2. Imaging is necessary to make a proper diagnosis.
Fibroids are diagnosed by ultrasound and MRI, not by pelvic examination. A gynecologist may suspect that a patient has fibroids from a pelvic examination, but imaging is required to make the diagnosis.
3. Is my fibroid cancer?
Uterine fibroids are noncancerous growths. Uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. Only 0.1 percent of masses in the uterus that appears to be fibroids are actually cancer (leiomyosarcoma). These rare tumors usually occur in women in their mid to late 40’s or later.
4. Just because you have a fibroid (or fibroids), that absolutely does not mean you need surgery.
Treatment recommendations depend on a patient’s age, the size and location of the fibroids, her desire for pregnancy, her symptoms and her overall health. If you are told you need surgery for your fibroids, a second opinion is always a good idea.
5. There are a wide variety of treatment options available for fibroids.
There are a wide variety of treatment options available for women with fibroids if you are experiencing symptoms. Treatment options may include medical therapy, laparoscopic treatment, hysteroscopic treatment, no treatment, HIFU (high intensity focused ultrasound), myolysis, uterine artery embolization, endometrial ablation and hysterectomy. Your provider can help you make the best decision to treat fibroids based on your circumstances.
About the author
Dr. Johns is a fellow of the American Congress of Obstetrics & Gynecology and the American College of Surgeons. As a gynecologist and a surgeon, he has also authored 22 chapters in surgical textbooks, co-authored 32 peer-reviewed articles, lectured in 120 postgraduate courses, and performed over 8,500 surgical procedures. He has been named one of the “Best Doctors in America” since 1996. Dr. Johns is an OB/GYN on the medical staff at Andrews Women’s Hospital on the campus of Baylor Scott & White All Saints - Fort Worth. Dr. Johns has served as the Medical Director of Clinical Research at Baylor Research Institute - Fort Worth since 2006.