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Fibroid
Information
General
Facts about fibroids
What are uterine fibroids?
Where do uterine fibroids grow?
What are the symptoms of uterine fibroids?
What causes uterine fibroids?
Does having uterine fibroids mean that a woman will be infertile
or unable to have children?
Does having uterine fibroids mean a woman will need a hysterectomy
(removing the uterus)?
Who gets uterine fibroids?
How do I know that I have uterine fibroids?
What are the treatments for uterine fibroids?
Do uterine fibroids lead to cancer?
Do uterine fibroids ever go away?
Is research being done to learn more about uterine fibroids?
Where can I go for more information about uterine fibroids?
References
General
Information about Fibroids
Number
of women affected:
At least 25 percent of women in the U.S. have clinically symptomatic
fibroids, which means they have symptoms that are typical of fibroids
(Crum 1999); estimates suggest fibroids could affect as many as
77 percent of women in the U.S. (Cramer & Patel 1990).
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Common symptoms: May include heavy periods, bleeding between
periods, pelvic pain or “fullness,” reproductive problems,
including infertility and multiple miscarriages.
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Common treatments: Some women do not receive treatment because
they do not have symptoms. Other treatments include: pain medication,
medical therapy, and surgery—myomectomy (pronounced my-oh-meck-toe-mee)—removes
just the fibroid, leaving the uterus; hysterectomy (pronounced hiss-ter-ekt-oh-mee)—removes
the entire uterus.
Doctors
are exploring less-invasive surgeries and hormone therapy as other
options.
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Does this disorder affect fertility/childbearing? In some
cases, fibroids can prevent a woman from getting pregnant naturally.
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Uterine
fibroids are the most common, non-cancerous tumors in women of childbearing
age. They are the cause of more than 200,000 hysterectomies
every year (Easterday et al 1983). They have no known cause and
only a few treatment options. Uterine fibroids not only affect the
women who have them, but they also impact the partners, spouses,
and families of these women, sometimes to a great degree. Despite
the fact that they may affect one-quarter of all the women in the
U.S., fibroids continue to baffle doctors and scientists.
The
National Institute of Child Health and Human Development (NICHD),
part of the National Institutes of Health (NIH), is trying to learn
more about uterine fibroids, through research into their causes
and treatments. As part of this research, NICHD scientists are exploring
genetics, hormones, the immune system, and environmental factors
that may play a role in starting the growth of fibroids and/or in
continuing that growth. This information could lead to a cure for
uterine fibroids that does not involve taking out the uterus. Someday,
doctors may even be able to prevent uterine fibroids from growing
at all.
What are uterine
fibroids?
Uterine
fibroids are tumors or lumps made of muscle cells and other
tissue that grow within the wall of the uterus. Fibroids may grow
as a single tumor or in clusters.
A
single fibroid can be less than one inch in size or can grow to
eight inches across or more. A bunch or cluster of fibroids can
also vary in size.
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Where do uterine
fibroids grow?
Most
fibroids grow within the wall of the uterus. Health care providers
put fibroids into three groups based on where they grow:
Submucosal
(pronounced sub-myou-co-sul) fibroids grow just underneath the uterine
lining.
Intramural (pronounced in-tra-myur-ul) fibroids grow in between
the muscles of the uterus.
Subserosal (pronounced sub-sir-oh-sul) fibroids grow on the outside
of the uterus.
Some fibroids grow on stalks (also called peduncles, pronounced
ped-uncles) that grow out from the surface of the uterus, or into
the cavity of the uterus.
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What are
the symptoms of uterine fibroids?
Many
women don’t feel any symptoms with uterine fibroids. But fibroids
can cause the following symptoms:
Heavy
bleeding or painful periods
Bleeding between periods
Feeling “full” in the lower abdomen—sometimes called
“pelvic pressure”
Urinating often (results from a fibroid pressing on the bladder)
Pain during sex
Lower back pain
Reproductive problems, such as infertility, multiple miscarriages,
and early onset of labor during pregnancy
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What causes
uterine fibroids?
Currently,
we know little about what causes uterine fibroids. Scientists have
a number of theories, but none of these ideas explains fibroids
completely. Most likely, fibroids are the end result of many factors
interacting with each other. These factors could be genetic, hormonal,
environmental, or a combination of all three. Once we know the cause
or causes of fibroids, our efforts to find a cure or even prevent
fibroids will move ahead more quickly.
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Does having
uterine fibroids mean that a woman will be infertile or unable to
have children?
In
some cases, fibroids can prevent a woman from getting pregnant through
natural methods. However, advances in treatments for fibroids and
infertility have greatly improved the chances for a woman to get
pregnant, even if she has uterine fibroids.
Researchers
are still looking into what role, if any, uterine fibroids play
in infertility. Currently, though, there are few answers. One study’s
results suggest that only submucosal fibroids have a negative impact
on fertility (Pritts 2001), but these results are not yet confirmed.
The relationship between fibroids and infertility remains a very
active research area.
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Does having
uterine fibroids mean a woman will need a hysterectomy (removing
the uterus)?
Hysterectomy
is not the best option for every woman with uterine fibroids. If
a woman wants to have children, then she would want to avoid this
treatment. Likewise, if a woman isn’t showing symptoms of uterine
fibroids, or her fibroids are small, she may have better results
from pain medications or hormone treatments. Doctors are also exploring
less-invasive surgical treatments for fibroids that save the uterus.
See the What are the treatments for uterine fibroids? section of
this fact sheet for more information about less-invasive treatments.
In
some cases, though, a hysterectomy is the best method of treatment.
If you have uterine fibroids and are thinking about having a hysterectomy,
make sure you talk over all features of the surgery with your doctor
and your family. Having a hysterectomy means that you will no longer
be able to have children. This process cannot be reversed, so be
certain about your choice before having the surgery.
Keep
in mind that the physical scars of the procedure may heal quickly,
but some of the effects of hysterectomy are long-lasting. You may
want to talk to women who have had the procedure before you decide
to have your surgery. Many health care centers, women’s clinics,
and hospitals offer support groups for women who have had, or are
in the process of having a hysterectomy.
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Who gets uterine
fibroids?
Most
of the time, fibroids grow in women of childbearing age. Research
studies estimate that doctors diagnose up to 30 percent (Newbold
et al 2000) of women of childbearing age with uterine fibroids;
but, because some women show no symptoms of fibroids, as many as
77 percent of women of childbearing age could have the condition,
without knowing it (Cramer & Patel 1990). We don’t know
exactly how many new cases of fibroids occur in a year, nor do we
know how many women have fibroids at any one time.
There
have also been reports of rare cases in which young girls who have
not yet started their periods (pre-pubertal) had small fibroids.
Researchers
now recognize several risk factors for uterine fibroids.
Current
statistics place African-American women at three-to-five times greater
risk than white women for fibroids.
Women who are overweight or obese for their height (based on body
mass index or BMI*) are also at slightly higher risk for fibroids
than women who are average weight for their height.
Women who have given birth appear to be at lower risk for uterine
fibroids.
But, because we don’t know what causes fibroids, we also don’t
know what increases or reduces their growth.
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How do I know
that I have uterine fibroids?
Unless
you start to have symptoms, you probably won’t know that you
have uterine fibroids.
Sometimes,
health care providers find fibroids during a routine gynecological
exam.
During
this exam, the health care provider checks out the size of your
uterus by putting two fingers of one hand into the vagina, while
applying light pressure to your abdomen with the other hand.
If you have fibroids, your uterus may feel larger-than-normal; or,
if you have fibroids, your uterus may extend into places it should
not.
If your health care provider thinks that you have fibroids, he or
she may use imaging technology—machines that create a “picture”
of the inside of your body without surgery—to confirm the diagnosis.
Some common types of imaging technology include:
Ultrasound,
which uses sound waves to form the picture;
Magnetic resonance imaging or MRI, which uses magnets and radio
waves to build the picture;
X-rays, which use a form of electromagnetic radiation to “see”
into the body; and
CT or “cat”-scan, which takes x-rays of the body from
many angles to provide a more complete image.
Sometimes, health care providers use a combination of these technologies.
Sometimes,
however, the only way to confirm the presence of uterine fibroids
is through surgery.
Laparoscopy
(pronounced lapp-are-ah-skoe-pee)—In this procedure, the surgeon
makes a small cut into the abdomen, after inflating it with a harmless
gas; then, using a small viewing instrument with a light in it,
the doctor can look for fibroids.
Your health care provider may suggest a procedure called a hysteroscopy
(pronounced hiss-tur-ah-skoe-pee), which involves inserting a camera
on a long tube through the vagina directly into the uterus to see
the fibroids.
Keep in mind that because these are surgical procedures, you will
need time to recover from them. However, the amount of recovery
time you’ll need may vary.
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What are
the treatments for uterine fibroids?
Health
care providers consider a number of things when recommending treatment
for fibroids, including:
Does
the woman have symptoms of uterine fibroids?
Does
she want to become pregnant?
How
large are the fibroids?
What
is the woman’s age?
If
a woman has uterine fibroids, but shows no symptoms or has no problems,
she may not need any treatment. The provider will check the
fibroids at a woman’s routine gynecological exam to see if
they have grown.
If
a woman has pain now-and-then or feels mild symptoms, her health
care provider may suggest pain medication, ranging from over-the-counter
remedies to strong prescription drugs.
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Medical Therapy
If
a woman has many symptoms or feels pain often, she may benefit from
medical therapy—that is, therapy using certain medications
rather than surgery. Keep in mind that many medications have side
effects, some of them serious.
One
way to reduce symptoms of uterine fibroids is using one of a group
of hormones called gonadotropin releasing hormone agonists (GnRHa).
These hormones block the body from making the hormones that cause
women to menstruate or have their periods. If you have symptoms,
have health conditions that make surgery less advisable, and are
near menopause or do not want children, you may receive GnRHa therapy
to treat your fibroids.
Antihormonal agents, like mifepristone, also slow or stop the growth
of fibroids.
Medical therapy is often used before a woman has surgery for her
fibroids.
This therapy offers only temporary relief
from the symptoms of fibroids; once a woman goes off the therapy,
her fibroids often grow back.
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Surgical Therapy
If
a woman has moderate symptoms of fibroids, surgery may be the best
form of treatment.
Myomectomy
removes only the fibroids and leaves the healthy areas of the uterus
in place. This procedure can preserve a woman’s ability to
have children.
Hysterectomy is used when a woman’s fibroids are large, or
has heavy bleeding, and she is either near or past menopause, or
doesn’t want children. Hysterectomy is the only sure way to
cure uterine fibroids. In general, recovery time from a hysterectomy
is one to two months. Health care providers now have hysterectomy
options that differ in how invasive they are.
Abdominal hysterectomy is a procedure that involves a cut into the
abdomen to remove the uterus.
Vaginal hysterectomy is less invasive because the doctor reaches
the uterus through the vagina, instead of making a cut into the
abdomen. This procedure may not be an option if the fibroids are
very large.
Are there any developing treatments for
uterine fibroids?
Currently,
researchers are looking into other methods of treating uterine fibroids.
Keep in mind that these methods are not yet standard treatments
for uterine fibroids, which means your health care provider may
not offer them, or your insurance company may not pay for them.
But, it’s possible that research to confirm the safety and
effectiveness of these “experimental” treatments will
advance our ability to treat uterine fibroids. These developing
treatments include:
In
cryomyolysis (pronounced cry-oh-my-oh-lie-sis), the health care
provider puts a freezing agent directly on the fibroids to make
them shrink.
Uterine Artery Embolization (UAE) cuts off the blood supply to the
uterus and the fibroids, which makes them shrink. Recovery time
for UAE is much shorter than for hysterectomy. But, this option
limits a woman’s ability to have children.
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Do uterine
fibroids lead to cancer?
Uterine
fibroids are not cancerous. Fibroids are not associated with cancer;
they rarely develop into cancer (in less than 0.1 percent of cases).
Having fibroids does not increase your risk for uterine cancer (Levy
et al 2000).
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Do uterine fibroids
ever go away?
For the most part, fibroids stop growing or shrink
once a woman passes menopause. However, this is not the case for
all women. Some studies suggests a relationship between hormone
replacement therapy or HRT, used to reduce the symptoms of menopause,
and uterine fibroids, but the nature of this relationship is still
unclear (Schwartz et al 2000). More research is needed in this area.
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Is research
being done to learn more about uterine fibroids?
The
NICHD continues to study and learn about uterine fibroids. The NICHD
established a Reproductive Medicine-Gynecology Program within its
Reproductive Sciences Branch to support research on women’s
health conditions that aren’t cancerous, including uterine
fibroids. In 1998, the NICHD established 12 Women’s Reproductive
Health Research Career Development Centers. These Centers support
obstetricians and gynecologists in becoming researchers, so that
they can study topics on women’s health. Eight additional Centers,
started in 1999, will allow this important program to continue.
In
addition to these Centers, the Reproductive Sciences Branch of the
NICHD also supports research on uterine fibroids and on other topics
that affect women’s health, including research on genetics,
diseases, and environmental factors that affect the reproductive
health of men and women.
The
Division of Intramural Research (DIR) at the NICHD also supports
research on these topics. DIR scientists are studying the basic
causes of uterine fibroids, as well as the potential of certain
drugs in treating the disease. The efforts of the NICHD, NICHD-supported
scientists, and other researchers will continue until we know the
causes, treatments, and, someday, the cures for uterine fibroids.
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In
October 1999, researchers from the NICHD joined scientists from
the National Institute of Environmental Health Sciences, the U.S.
Department of Health and Human Services’ Office of Women's
Health, the Society for Women’s Health Research, and Wyeth-Ayerst
Pharmaceuticals to hold a conference on uterine fibroids. The conference
addressed our current knowledge about fibroids: what we know, what
we think, what we need to learn, and how we might learn these things.
The panel of experts who spoke at this conference wrote their conclusions
and published them as a supplement to the journal, Environmental
Health Perspectives. The report, titled Women’s Health and
the Environment: The Next Century—Advances in Uterine Leromyoma
Research (2000), is available at http://ehpnet1.niehs.nih.gov/docs/2000/suppl-5/toc.html.
In
addition, the Agency for Healthcare Research and Quality issued
an evidence-based report about managing uterine fibroids in 2001.
This report reviewed the available literature on the benefits, risks,
and costs of uterine fibroid treatments in the United States and
provided recommendations for future research (AHRQ 2001). These
expert opinions will help to direct NICHD research on uterine fibroids
into the next century. This report is available at http://www.ahrq.gov/clinic/epcsums/utersumm.htm.
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Where
can I go for more information about uterine fibroids?
The
NICHD supports and conducts research on topics related to the health
of children, adults, families, and populations, including uterine
fibroids. The mission of the NICHD is to ensure that every person
is born healthy and wanted, that women suffer no harmful effects
from the reproductive process, and that all children have the chance
to fulfill their potential for a healthy and productive life, free
of disease or disability. You can contact the NICHD at:
NICHD
Information Resource Center
P.O. Box 3006
Rockville, MD 20847
1-800-370-2943
Fax: (301) 984-1473
E-mail: NICHDClearinghouse@mail.nih.gov
Internet: www.nichd.nih.gov
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References
Crum. The Female Genital Tract. (1999)
In: Pathologic Basis of Disease. (Cotran, Kumar, and Collins, Eds.)
Philadelphia: WB Saunders.
Cramer and Patel. The Frequency of
Uterine Leiomyomas. (1990) American Journal of Clinical Pathology.
94:435-438.
Easterday, Grimes, and Riggs. Hysterectomy
in the United States. (1983) Obstet Gynecol. 62:203-212.
Pritts, EA. Fibroids and Infertility:
a systematic review of the evidence. (2001) Obstet Gynecol Surv.
Aug; 58(8):483-91.
Newbold, DiAugustine, Risinger, Everitt,
Walmer, Parrott, and Dixon. Advances in Uterine Leiomyoma Research:
Conference Overview, Summary, and Future Research Recommendations.
(2000) Environ Health Perspect. 108(suppl 5):769-773.
Levy B, Mukherjee T, Hirschhorn K.
Molecular cytogenetic analysis of uterine leiomyoma and leiomyosarcoma
by comparative genomic hybridization. (2000) Cancer Genet Cytogenet.
Aug;121(1):1-8.
Schwartz S, Marshall L, Baird D. Epidemiologic
contributions to understanding the etiology of uterine leiomyomata.
(2000) Environ Health Perspect. 108(Suppl 5):821-7.
Women’s Health and the Environment:
The Next Century—Advances in Uterine Leiomyoma Research. (2000)
Environ Health Perspect. 108(suppl 5): 767.
Management of Uterine Fibroids. (2001)
Summary, Evidence Report/Technology Assessment: Number 34. AHRQ
Publication No. 01-E051. Agency for Healthcare Research and Quality.
http://www.ahrq.gov/clinic/epcsums/utersumm.htm
National Institute
of Child Health and
Human Development NIH Pub. No. 02-7103
June 2002
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