If you or a loved one were recently diagnosed with fibroids, you may have found yourself wondering, "What are fibroids?" If so, this article is for you. Here you'll find answers to that and other basic questions, provided by Mona Orady, MD, FACOG, gynecologist and minimally invasive and robotic surgeon at Dignity Health Medical Group - St. Francis/St. Mary's, a service of Dignity Health Medical Foundation.
Fibroids are bundles of tissue that sometimes appear in the uterus. Unlike the normal muscle of the uterus, which is somewhat smooth and soft, fibroids are tough. There are three main types of fibroids, all named based on their location. Submucosal fibroids invade the uterine cavity, occupying the same space a child would develop during pregnancy. Intramural fibroids form inside the lining of the uterine wall, within the muscle. Subserosal or extramural fibroids grow on the outside surface of the uterus. Other types of fibroids include peduncuated fibroids, cervical fibroids, broad ligament fibroids, or parasitic fibroids, which are further away from the uterine body.
Many fibroids are small — the size of peas. However, they can also grow so large that they bulge into the uterus and press on nearby organs, causing pain and other symptoms. While they aren't a functional part of the uterus, fibroids are not a type of cancer. They may not be life-threatening, but a large-enough fibroid can make life difficult during menstruation and between cycles. There are, however, some malignancies, such as uterine sarcoma, that can appear similar to fibroids and are more common in women with fibroids. Women who have fibroids, especially older women, should be monitored closely to make sure they do not have signs of sarcoma.
Studies have shown that African-American women are more likely to develop fibroids than Caucasian women; nearly one in five African-American women will receive a fibroid diagnosis at some time in her life.
Though no one has determined what exactly causes fibroids, it's known that fibroids respond to hormones. Menstruating women in their late 20s, 30s, and 40s are the most likely to get fibroids. There's also a genetic factor. If the women in your family are known to have fibroids, you and your daughters are more likely to develop them.
What happens when someone develops a fibroid depends on the size and locations of the fibroids. Submucosal fibroids can cause long-term issues like infertility and miscarriage, and they can present the most severe day-to-day symptoms. "These are the fibroids that people come in with and have to get a blood transfusion because they're really anemic," Dr. Orady says.
When it comes to intramural and extramural fibroids, symptoms develop more gradually. Giving an example, Dr. Orady says, "It's the patient that comes in and says, 'You know, over the last five to six, maybe seven, years, my periods have just been getting really, really awful. They used to be fine, but they're just slowly getting worse and worse. The ones that have to pee frequently because a fibroid is sitting on their bladder, or the patients that have really bad constipation and take stool softeners because they have a fibroid pressing on their rectum."
Regardless of location, larger fibroids can cause a sense of fullness or heaviness in the lower abdomen. Large extramural fibroids can even cause back pain. With the more extreme cases, the uterus might bulge out, causing the sufferer to look pregnant. But tiny fibroids cause few, if any, symptoms.
The best treatment for these tough balls of tissue is determined by the symptoms. If fibroids are small and asymptomatic, the best choice may be to simply keep a careful eye on them. Fibroids can remain for years without causing symptoms and may shrink after menopause. But there are a number of options for fibroids that require treatment. Fibroids can be removed surgically, and submucosal fibroids are the easiest to remove. "I actually get really excited when I see submucosal fibroids," Dr. Orady says, "because it's like 'Oh! I can treat that really easily.'" Sometimes, if it's in the right place, a doctor can shrink the fibroid or cut off its blood supply, helping restore or preserve fertility in women who are looking to start a family. If the patient isn't actively seeking pregnancy, symptoms can often be controlled with hormones that shrink the fibroids and help reduce pain and bleeding. Alternatively, fibroids can be removed using minimally invasive surgical techniques, such as robotic surgery, with uterine reconstruction, which can allow a patient to preserve her uterine functions and get pregnant.
Ultimately, Dr. Orady wants to stress that there's no need to live with the pain and uncertainty fibroids cause. Because the development of fibroids is slow, she believes women often ignore symptoms so they can focus on their busy lives. "I always say 'Women run the world.' We take care of everything — work, home, family, parents. We don't really pay attention to our own selves," Dr. Orady says. "We keep putting it off until it gets really, really bad and it's like 'Oh boy! I really need to get something done, and I need to get it done quick." With a simple history, physical, and ultrasound, a doctor can discover if you have fibroids and begin to discuss treatment options.
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