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Mature Women's Centre Victoria General Hospital

Hysterectomy Alternatives Program (HAlt)

Common Diseases of the Uterus

Fibroids

Uterine fibroids (also called leiomyomas or myomas) are benign masses of the uterine muscle. They can be very small, just a few centimeters or grow up to be 15 centimeters in diameter. Some women have only one fibroid but most often there are more than one. In many cases, fibroids are not bothersome and many women do not even know they have them. Fibroids are very common: modern imaging techniques suggest that about 75% of all women have fibroids.

The cause of fibroids is unknown but it is certain that they are influenced by 2 hormones - estrogen and progesterone. Women who have mothers or sisters with fibroids are more likely to have fibroids as well. The incidence of fibroids in Black women is higher than in other racial groups. Fibroids are also slightly more common in women who have never been pregnant.

Fibroids occur in different parts of the uterus. There are three layers to the uterus: serosa, mural, and mucosa.

Fibroids can be described by their location in the uterus - subserosal, intramural and submucosal. Some fibroids grow on a stalk and are called pedunculated.

Illustration of subserosal, intramural and submucosal fibroidsIllustration of locations of subserosal, intramural and submucosal fibroids

Since the location of the fibroid is extremely important in the management of fibroids it is important for women to have a thorough evaluation of the symptoms (physical exam, hysteroscopy in some cases) and diagnostic imaging tests prior to considering treatment.

Signs and symptoms of fibroids vary greatly from woman to woman. Some women have no symptoms at all but may learn that they have them after a pelvic exam. A fibroid uterus is larger than normal so when a physician performs a bi-manual pelvic examination, he/she may suspect fibroids even if no untoward symptoms exist. In many cases, women do have bothersome symptoms of uterine fibroids. Such symptoms are heavy menstrual bleeding, pelvic discomfort or painful periods and/or bulk symptoms. Other symptoms are urinary pressure, urgency or frequency. A detailed discussion of symptoms will provide important clues as to the location of the fibroids. For example, if women have extremely heavy bleeding (flooding), and labour-like cramps it is very likely that there is Submucosal fibroid. This fibroid within the uterine cavity is interfering with the uterus’s natural ability to contract and constrict bleeding into the cavity. On the other hand, a fibroid that exists in a subserosal location may not produce any bleeding problems, but instead, cause pressure on the bladder, resulting in urinary frequency or urgency.

Once it is determined that certain symptoms exist, different diagnostics tests are performed. Pelvic ultrasound is the most common and reliable way to diagnose fibroids.

If a submucousal fibroid is suspected, hysteroscopy is often performed.

There are many different treatment options for fibroids. Sometimes, there is no need to treat them at all. Since fibroids are often asymptomatic (causing no symptoms) it is not necessary to remove them. It is expected that fibroids will shrink in the post menopausal years so many women choose to “wait and see”. Medical options are safe and effective for reducing the size of fibroids and/or controlling bleeding. Surgical options consist of

hysteroscopic resection, endometrial ablation, uterine artery embolization, myomectomy and in some cases, hysterectomy. Often more than one treatment option is useful in the management of fibroids.