What are uterine fibroids (leiomyomas, fibromyomas)?

Uterine fibroids are very common growths that develop in the muscular wall of the female uterus. These non-cancerous (benign) growths can vary in size from a golf ball to a softball.  Most women who have fibroids have more than one.  Depending on the size and location of these fibroids, they may cause pain, heaviness, bloating, and/ or heavy bleeding.

Fibroids typically grow larger with age, and may become more symptomatic after 40 years of age.  However, once the level of estrogen decreases at menopause (age 50+), they typically shrink and no longer cause symptoms.  However, menopausal women who are taking supplemental estrogen (hormone replacement therapy) may not experience relief of symptoms.

​What are the various locations fibroids can develop in the uterus?

Submucosal Fibroids
Located just under the inside lining of the uterine cavity, these fibroids typically cause the most symptoms.  They typically can cause heavy bleeding, intermittent bleeding, and prolonged periods.  If not treated, these fibroids can prevent pregnancy.

Intramural Fibroids
These develop within the lining of the uterus and expand inward, increasing the size of the uterus, and making it feel larger than normal in a gynecologic internal exam. These are the most common fibroids. Intramural fibroids can result in heavier menstrual bleeding and pelvic pain, back pain or the generalized pressure that many women experience.

Subserosal Fibroids
These develop under the outside covering of the uterus and expand outward through the wall, giving the uterus a knobby appearance. They typically do not affect a woman's menstrual flow, but can cause pelvic pain, back pain and generalized pressure. The subserosal fibroid can develop a stalk or stem-like base, making it difficult to distinguish from an ovarian mass. These are called pedunculated. The correct diagnosis can be made with either an ultrasound or magnetic resonance (MR) exam.

Prevalence of Uterine Fibroids

Twenty to 40 percent of women age 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. Uterine fibroids are the most frequent indication for hysterectomy in premenopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, one-third are due to fibroids

Uterine Fibroid Symptoms

• Heavy, prolonged menstrual periods with clots
  
• Anemia
  
• Pelvic pain and pressure 
  
• Pain in the back and thighs 
  
• Pain during sexual intercourse 
  
• Bladder pressure leading to a frequent urge to urinate 
  
• Pressure on the bowel, leading to constipation and bloating 
  
• Abnormally enlarged abdomen 

How will the physicians at IVC determine if I have fibroids?

The presence of fibroids is determined initially by ultrasound imaging.  Once fibroids are visualized, the next step is to undergo a magnetic resonance imaging (MRI) study.  This will allow a better understanding of where the fibroids are located and the blood flow to each fibroid.  This will determine if the fibroids are causing your symptoms and whether you will benefit from a nonsurgical uterine fibroid embolization (UFE).  Before you undergo a hysterectomy, you should be offered a second opinion for alternative treatments of your fibroids.  We are more than happy to review your imaging and discuss whether our minimally-invasive procedure is right for you.

What are the surgical treatments of uterine fibroids?

Gynecologists perform hysterectomy and myomectomy surgery. Hysterectomy is the removal of the uterus and is considered major abdominal surgery, requiring several days of hospitalization with a recovery period is six weeks. Obviously, there is no chance for pregnancy after a hysterectomy.

Depending on the size and location of the fibroids, myomectomy can be an outpatient surgery or require 2-3 days in the hospital.  However, myomectomy is usually major surgery that involves cutting out the biggest fibroid or collection of fibroids and then stitching the uterus back together.  Most women have multiple fibroids, making the surgery not possible to remove all of them.

What is a uterine fibroid embolization (UFE) procedure?
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by our interventional radiologists.  After making a tiny nick in the skin in the groin,  a small tube ("catheter") is inserted into the femoral artery.  Using continuous, low-dose X-ray imaging, our physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor.  This blocks the blood flow to the fibroid tumor and causes it to shrink and die. 

What should I expect after undergoing a uterine fibroid embolization procedure?

Following the procedure, some patients require a hospital stay for one night to ensure proper pain control.  However, many of our patients are discharged the same day.  Our physicians will prescribe appropriate pain control medications and drugs that control cramping and swelling.  You should resume light activities in a few days and return to normal activities within one week. 

Over 95 percent of women who have had the procedure experience significant or total relief of heavy bleeding, cramping, pain and bulk-related symptoms.  The procedure is effective for multiple fibroids and large fibroids.  Once the embolization is performed, the fibroid will shrink and become a scar.  It will not return.

Uterine fibroid embolization has been performed for over 30 years!  You might be surprised that you have never heard of the procedure before.  It's not uncommon as many doctors fail to discuss the procedure with their patients; unfortunately, often because it would replace an expensive hysterectomy procedure.  Not only is a fibroid embolization more effective than a myomectomy procedure, it has been proven to have less overall complications and a significantly shorter recovery.  The embolic particles used for the procedure are completely safe and approved by the FDA specifically to treat uterine fibroid tumors.  They will cause no harm to your body long-term.


August 2008 Practice Recommendations From American College of Obstetricians and Gynecologists Say Uterine Fibroid Embolization Is "Safe and Effective," Based on Good, Consistent Level A Scientific Evidence