Uterine Fibroids

Uterine fibroids (leiomyomas) are the most common conditions affecting the female reproductive system. As many as 26 million U.S. women experience uterine fibroids prior to menopause. Many never know it, as symptoms can be mild or totally absent. When fibroids do cause symptoms, they can affect fertility, daily comfort and quality of life. Houston Methodist’s OB-GYN specialists are experts in finding the least invasive and most effective treatments to fit each patient’s needs.

What Are Uterine Fibroids?

Uterine fibroids, also called leiomyomas or myomas, are noncancerous growths that develop in or on the uterus. They form from the muscle tissue of the uterine wall and can grow alone or in clusters. Fibroids range in size from as small as a seed to as large as a grapefruit, and they rarely turn into cancer. Fibroids can be treated with medication, minimally invasive procedures or surgery, depending on their size, location and the symptoms they cause.

Why Choose Houston Methodist for Uterine Fibroid Care

Uterine fibroids affect every woman differently, so treatment should be customized for the individual. Houston Methodist's team of OB-GYN specialists and experts collaborate on every case to build a treatment plan around each patient’s symptoms, goals and future fertility plans.

The right specialist will listen to your symptoms, walk you through every treatment option and support your goals, including future pregnancy. Our team works closely with interventional radiologists and fertility specialists so your care is personal, customized and comprehensive.

Common Causes and Risk Factors of Uterine Fibroids

Doctors do not know the exact cause of uterine fibroids, but there are several factors that have been identified as contributing to increased risk:

• Hormones: Estrogen and progesterone stimulate fibroid growth, which is one reason fibroids often shrink after menopause.
• Family history: Women whose mothers had fibroids are much more likely to develop them.
• Race: African American women are more likely to develop uterine fibroids than white women. Black women frequently develop them at a younger age and have more severe symptoms.
• Obesity: Women who are significantly overweight are typically several times more likely to develop fibroids.
• Age: Fibroids are more common throughout a woman’s 30s and 40s, but the risk declines around the start of menopause.

Types of Uterine Fibroids

Fibroids are classified by where they grow in or around the uterus. These location-based forms of fibroids include:

• Submucosal fibroids: Grow into the uterine cavity and are more likely to cause heavy bleeding and issues with fertility
• Intramural fibroids: Grow within the muscular wall of the uterus and are the most common type
• Subserosal fibroids: Grow on the outer surface of the uterus and can press on nearby organs

Signs and Symptoms of Uterine Fibroids

• Heavy or prolonged menstrual bleeding: Heavy menstrual bleeding is the most common symptom of uterine fibroids. Some women also notice bleeding between periods or vaginal bleeding that is heavier or longer than usual. Over time, blood loss during menstruation can lead to anemia, which causes fatigue and weakness.
• Pelvic pain and pressure: Fibroids may cause pelvic pain, painful periods or a feeling of pressure and heaviness in the lower abdomen. Larger fibroids may also cause pain during sex.
• Frequent urination or difficulty emptying the bladder: A fibroid that presses on the bladder can cause frequent urination or make it difficult to fully empty the bladder.
• Constipation and rectal pressure: Fibroids that press on the bowel can cause constipation or a feeling of pressure in the rectum.
• Abdominal enlargement: Large fibroids can cause the abdomen to appear enlarged or swollen. Some patients notice a change that is similar to early pregnancy.
• Fertility challenges: Fibroids, especially submucosal fibroids that distort the uterine cavity, can contribute to infertility, recurrent miscarriages or difficulty conceiving.

How Uterine Fibroids Are Diagnosed

Diagnosis usually starts with a conversation about symptoms and family history, followed by one or more tests, which may include:

• Pelvic exam: A physician can often feel changes in the shape of the uterus during a routine pelvic exam
• Ultrasound: Sound waves create an image of the uterus to confirm the size and location of the fibroids
• Magnetic resonance imaging (MRI): Provides a detailed picture of the fibroids and helps rule out leiomyosarcoma, a rare cancerous growth that can resemble a fibroid
• Hysteroscopy: A thin, lighted scope is passed through the cervix to view submucosal fibroids inside the uterine cavity
• Sonohysterography: Saline is used to expand the uterus during an ultrasound for a clearer view of the uterine cavity
• Computed tomography (CT) scan: Sometimes used to evaluate the pelvis when other conditions are also suspected

Treatment Options for Uterine Fibroids

Treatment depends on the size and location of the fibroids, the severity of symptoms and whether a woman hopes to have children in the future. Most physicians start with the least invasive option and move toward surgery only when needed.

Non-Surgical Treatment

Non-surgical treatments for uterine fibroids may include:

• Birth control pills or an intrauterine device (IUD) to help control heavy menstrual bleeding
• GnRH agonists (gonadotropin-releasing hormone agonists) to temporarily shrink fibroids by lowering estrogen and progesterone levels
• Tranexamic acid or ibuprofen to reduce heavy bleeding and pain during periods
• Watching and waiting for small fibroids that aren’t causing symptoms

Surgical Treatment

Surgical treatments for uterine fibroids may include:

• Myomectomy to surgically remove the fibroids and preserve the uterus
• Uterine artery embolization (UAE), also called uterine fibroid embolization, in which an interventional radiologist blocks the blood supply to the fibroids, causing them to shrink
• Radiofrequency ablation, which uses heat delivered via laparoscopy to shrink the fibroid tissue
• Hysterectomy, a surgical removal of the uterus, typically considered when other treatments haven’t worked or a woman does not wish to preserve fertility