What are fibroids?
Fibroids, also known as leiomyomas or myomas, are very common smooth muscle fibrous growths that rarely become cancerous. In most patients, fibroids are incidental findings. This means they are present, but usually do not cause symptoms or problems. When fibroids cause pain, pressure, bleeding or increased frequency of urination, constipation, or affect other nearby organs, they require treatment. The diagram below illustrates the location of different fibroids.
Depending on where fibroids are located, different symptoms can be present.
- Pedunculated Fibroids. These fibroids are present on a stalk either on the inside or outside of the uterus. The blood supply to the fibroids is provided through this stalk. Most pedunculated fibroids located on the outside of the uterus do not cause problems unless they become very large. Occasionally these fibroids will twist on their stalk or “torse”, and will cause severe pain because the blood supply to the fibroid is decreased. Torsed fibroids need to be removed to alleviate the pain. Pedunculated fibroids on the inside of the uterus, also known as pedunculated submucous fibroids, can cause heavy bleeding or can “prolapse” or fall through the cervix. These fibroids usually need removal.
- Subserous or Intramural Fibroids. These are fibroids located within the muscle of the uterus. When these fibroids become large they can cause problems to the uterus and to organs close to the uterus. Large fibroids can cause infertility, can press on the bladder causing frequent urination, and can also cause constipation by pressing on the rectum. Often these fibroids cause pelvic pain and pressure due to their size. Very large fibroids can press on the ureter – the tube that transports urine to the bladder – and cause cause swelling of the kidney. When fibroids become this large, they often degenerate, causing pain. Degeneration of fibroids usually results due to loss of the blood supply to the fibroid.
- Submucosal Fibroids. These fibroids are present within the cavity of the uterus, and often cause heavy bleeding during menstrual periods. They may also cause abnormal bleeding or spotting between periods.
- Cervical Fibroids. Fibroids located at the opening of the uterus – the cervix – are rare. When enlarged, they can cause infertility, difficulty with delivery of the baby, bleeding, pain, and obstruction of the ureters.
Symptoms
Fibroids can cause heavy bleeding, pressure, pelvic pain, urinary frequency (urinate very often), constipation, and sometimes back pain. Patients with large fibroids can often feel them as a hard, firm mass above the pubic bone.
Diagnosis
Pelvic exam and abdominal exam can diagnose most fibroids. Pelvic ultrasound, both transvaginal and abdominal, can be helpful in determining the specific size of the uterus and each fibroid, the number of fibroids, and the location. Ultrasound can also be used to determine if the kidneys are swollen due to compression of the ureter by the fibroids. The ureter is the tube that drains urine from the kidney to the bladder. If the ureter is pressed on by the fibroid and compressed, urine can back up into the kidney and cause hydronephrosis or swelling of the kidney. MRI may sometimes be helpful for further characterization of fibroids. Note that MRI is much more expensive, and is not necessary for most patients with fibroids.
How are fibroids treated at WSC?
The Women's Surgery Center is a pioneer in minimally invasive treatmetns for fibroids. Please refer to Treatment Options for Fibroids for more information.