Women's Health: Uterine Fibroids
Fibroid Q&A: Causes, Risks & Treatment
- What causes fibroids?
The exact cause of uterine fibroids remains unknown. Hormones, most
notably estrogen, stimulate the growth of fibroids. Lack of such
hormones will often cause fibroids to shrink. This explains the
tendency for fibroids to enlarge during the years of menstruation
(when estrogen levels are high) and to decrease in size after
menopause (when estrogen levels are low). Since fibroids are sensitive
to hormones, medications that alter hormone levels may be used as
treatment. Such medications include oral contraceptives and GnRH
agonists.
- Who is most likely to have fibroids?
Any woman may have fibroids. The overall likelihood of having
fibroids increases with age. Approximately 20% of women in their 20's
have fibroids, 30% of women in their 30's, and 40% of women over age
40. Fibroids are known to be more common in African-American women and
as many as 50% will have significant fibroids. Fibroids also tend to
be familial, meaning that they are more common in certain families.
- What problems can fibroids cause?
Most women with fibroids will have little or no symptom related to
them. Unfortunately, 20-40% of women do have significant symptoms
related to fibroids. These symptoms vary according to the size and
location of the fibroid (see previous discussion). The most common
symptom is heavy, prolonged, or irregular menstrual bleeding. This
bleeding often results in iron-deficiency anemia. Pelvic pain and a
sensation of pelvic fullness or bloating are also very common
symptoms. Some women report that their clothes no longer fit because
fibroids have caused such enlargement of their uterus. Less commonly,
fibroids can result in frequent urination, painful intercourse, and
inability to achieve or sustain pregnancy. Other conditions, such as
endometriosis, can often mimic the symptoms produced by fibroids or
coexist with fibroids in the same woman. This fact makes it imperative
that a woman has a complete physical examination and full imaging
evaluation prior to any planned treatments.
- What should I do if I think I may have fibroids?
First, talk with your primary care physician. In most cases this will
be an internist, family doctor, or gynecologist. He or she will
carefully review your current symptoms along with your medical history
and will most likely perform a pelvic exam to evaluate your uterus. If
your doctor does not provide gynecological services he or she will
refer you to a qualified physician who does. A pap smear will be
performed for most women, especially those with bleeding problems.
More extensive evaluation of the uterine lining (such as endometrial
biopsy) will vary according to a woman's history and age. Most women
will require a study to examine the appearance of the uterus, ovaries,
and pelvic structures. Ultrasound or MRI may be used to accomplish
this. Both tests are performed on an outpatient basis and cause
minimal discomfort. Your doctor will help decide which test is best
for you.
What treatments are available for fibroids?
Information
in this section is provided by Rhode
Island Hospital's department of radiology, which offers a complete
range of diagnostic and interventional procedures for women, including
uterine artery embolization, a leading treatment for fibroid tumors.
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