Uterous Fibroids

Most fibroids, even large ones, produce no symptoms. These masses are often found during a regular pelvic examination.

When women do experience symptoms, the most common are the following:

• an increase in menstrual bleeding, known as menorrhagia, sometimes with blood clots;
• pressure on the bladder, which may cause frequent urination and a sense of urgency to urinate and, rarely, the inability to urinate;
• pressure on the rectum, resulting in constipation;
• pelvic pressure, “feeling full” in the lower abdomen, lower abdominal pain;
• increase in size around the waist and change in abdominal contour (some women may need to increase their clothing size but not because of a significant weight gain);
• infertility, which is defined as an inability to become pregnant after 1 year of attempting to get pregnant; and/or
• a pelvic mass discovered by a healthcare practitioner during a physical examination.

If a woman has any questions about her uterine health, seek medical assistance as soon as possible. If a woman has any of the following, she should notify her health care practitioner:

• Irregular or heavy menstrual cycle, bleeding between periods
• Pelvic or abdominal pain
• Fever or night sweats
• Increasing abdominal girth
• Concerns about pregnancy or inability to become pregnant

If a woman has any of the following signs or symptoms she should contact a healthcare practitioner immediately or go to a hospital’s emergency department.

• Menstrual bleeding soaking through more than 3 pads per hour
• Severe or prolonged pelvic or abdominal pain
• Dizziness, lightheadedness, shortness of breath, or chest pain associated with vaginal bleeding
• Vaginal bleeding associated with pregnancy or possible pregnancy

A woman’s health care practitioner will discuss her medical history and conduct a physical examination that includes a pelvic exam. Often a doctor can feel an irregularly shaped uterus when fibroids are present.

If further studies are indicated, the doctor may choose one of the following tests to help decide if the patient has fibroids and to exclude other and potentially more serious causes of ongoing symptoms:

• An abdominal, transvaginal or pelvic ultrasound can help identify the number, size, and shape of most fibroids. These test uses sound waves to give doctors an image of the pelvic area. A wand is passed over the abdomen (abdominal ultrasound) for one type of view. Another probe (or wand) may be inserted into the vagina to obtain additional views (pelvic or transvaginal ultrasound).
• An endometrial biopsy is performed by taking a tissue sample from the uterus. A small instrument is passed through the cervical opening to “grab” small samples of tissue inside the uterus. It can be performed at a doctor’s office.
• A hysteroscopy looks inside the uterus by passing a small fiberoptic camera through the opening of the cervix.
• Hysterosalpingography involves an injection of dye into the uterus and Fallopian tubes, which is then X-rayed to identify the anatomy of these structures.
• Laparoscopy is a surgical procedure. The surgeon will insert a small fiberoptic camera into the abdomen through small abdominal incisions to look directly at internal organs.

Treatment for fibroids depends on the symptoms, the size and location of the fibroids, age (how close the person is to menopause), the patient’s desire to have children, and the patient’s general health.

No specific self-care is available for fibroids. However, if a woman has abnormal or heavy menstrual bleeding, she should keep a diary of her menstrual cycle in order to provide the information to her health care practitioner.

In most cases, treatment is not necessary, particularly if the woman has no symptoms, has small tumors, or has gone through menopause. Abnormal vaginal bleeding caused by fibroids may require surgical scraping of the uterine cavity in a procedure known as a dilation and curettage (D&C). If no malignancy (cancer) is found, this bleeding often can be controlled by hormonal medications. The following treatment options should be discussed with a healthcare practitioner.

Observation

The woman’s doctor may follow the size and growth of the fibroids over time to make sure no indicators of cancer are present. If the person does not have symptoms such as vaginal bleeding or pelvic pain, and if the fibroid is not growing rapidly, no treatment may be needed. Some patient may, however, require more frequent pelvic exams, such as every 6 months, to check on changes with the fibroid(s).

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