Uterine Fibroids (Leiomyomas)

Learn about uterine fibroid embolization, an effective, non-surgical way to get rid of your fibroids.

fibroids doctor
Dr. Eric DePopas, MD

Dr. Eric DePopas, MD

PainTheory Chief Medical Officer
Vascular & Interventional Radiologist

Fibroids can be a severe detriment to your life. If you’re here, you’ve probably either experienced the negative impact of fibroids or are looking to learn more about their symptoms: abdominal pain, urinary issues, and heavy periods are all common ones. You’re not alone–fibroids are present in anywhere from 50-70% of women and are one of the most common medical issues for women under 50. Source

DID YOU KNOW?

About 50% of women diagnosed with uterine fibroids do not suffer from any symptoms. Only fibroids that are causing issues need to be treated. Source

Table of Contents

What are uterine fibroids?

Uterine fibroids are benign (non-cancerous) tumors that arise from the lining of the uterus. Other examples of benign tumors include skin moles, certain colon polyps, and skin tags.

Although fibroids are benign, they can still cause many problems in some women due to their size and location.

Large fibroids can compress other structures within the abdomen and pelvis, consequently causing pain and urinary issues.

Unfavorably located fibroids can grow close to the uterine canal and cause excessive bleeding, especially during menstruation.

 PHYSICIAN INSIGHT

Among patients with symptomatic uterine fibroids, 56.4% reported heavy periods, 32.3% reported passage of clots, 26.4% reported spotting between periods, 25.8% reported constipation/bloating/diarrhea, and 20.4% reported pelvic pressure. Source

What symptoms do fibroids cause?

The most common symptoms caused by uterine fibroids are:

Heavy periods

Severe menstrual cramping

Frequent urination or inability to control urination

Pelvic pressure, discomfort, or excessive bloating

Abdominal wall distortion caused by large fibroids

Pain with sexual intercourse

How are fibroids diagnosed?

Uterine fibroids are usually diagnosed during a routine gynecological examination. Doctors can generally feel the enlarged fibroids during a pelvic exam. If a mass is felt during an exam, your doctor will order an ultrasound to confirm that what they are feeling is a uterine fibroid, as opposed to other types of gynecological masses.

Once you’ve been diagnosed with fibroids, your doctor will ask you a series of questions to see if the fibroid(s) are causing problems.

Not having problems: Your doctor will likely schedule a follow-up clinic appointment in 6 months to make sure you’re still asymptomatic.

Having problems: Your doctor may order an MRI, which gives excellent detail regarding the number and size of the present fibroids. Depending on your symptoms, your doctor may perform additional tests. For example, a pap smear or an endometrial biopsy can ensure that fibroids are the cause of your symptoms.

What types of fibroids are there?

types of uterine fibroids
https://www.fibroids.net/fibroids.html

There are three types of uterine fibroids which differ based on their location within the uterus. We will discuss the types of fibroids and the layers of the uterus together.

Submucosal Fibroids

Location: Endometrium

The first layer of the uterus is the endometrium, the innermost layer closest to the uterine canal. The endometrium is the layer that grows every four weeks in preparation for pregnancy.

Fibroids located close to the endometrium are termed submucosal fibroids. Submucosal fibroids are the rarest type of uterine fibroid and can sometimes distort the size of the uterine cavity. It is also possible for large submucosal fibroids to block the fallopian tubes, which can impair pregnancy.

Symptoms of submucosal fibroids include:

Excessive, very heavy menstrual bleeding

Prolonged menstruation

Passing of blood clots during menstruation

Anemia and/or fatigue related to excessive bleeding

Intramural Fibroids

Location: Myometrium

The second layer of the uterus is the myometrium, which is the middle layer. The myometrium is the muscular layer of the uterus and is the primary layer responsible for uterine contractions.

Fibroids that develop within the myometrium are called intramural fibroids and are the most common fibroid type. When an intramural fibroid expands, it distorts the shape of the uterus, causing it to feel larger than usual. Intramural fibroids often cause “bulk symptoms” or symptoms related to the enlarged uterus pushing on adjacent structures; they can also cause excessive bleeding.

Symptoms of myometrial fibroids include:

Pelvic pain and pressure

Frequent urination or urinary urgency

Excessive bloating

Heavy menstrual bleeding

Subserosal Fibroids

Location: Serosa

The third layer of the uterus is the serosa, which is the outermost layer. This is a thin layer that secretes a lubricating substance to reduce friction between the uterus and nearby structures like the bladder and colon.

Fibroids that grow in or around the serosa, near the outer lining of the uterus, are termed subserosal fibroids. These fibroids are also referred to as pedunculated fibroids because they often grow on a stalk. Subserosal fibroids cause symptoms related to pressure on adjacent structures. Sometimes the stalk of a subserosal fibroid can twist and cause severe pain.

Pelvic pressure or pain

Frequent urination

Difficulty emptying the bladder

Constipation

Backache or leg pains

Can fibroids be cancerous?

Uterine fibroids are almost always benign, meaning non-cancerous. It is vital to note that doctors do not think benign fibroids become cancerous. In other words, if a fibroid is benign, it will probably always be benign. In less than 1 in 1000 patients, uterine cancer may look similar to a benign fibroid. Source

Therefore, having benign fibroids does not increase the risk of developing uterine cancer, also called leiomyosarcoma. Doctors can usually determine if a fibroid is benign or cancerous based on your medical history and medical imaging, like an MRI. Because uterine cancer is so uncommon, doctors rarely perform fibroid biopsies before treatment.

Another way doctors ensure uterine cancer is not present is by closely monitoring your symptoms and imaging over time. For example, if your fibroid was treated due to frequent heavy menstrual bleeding and pelvic pain, but your symptoms did not resolve after treatment, and an MRI afterward showed that the fibroid had grown in size rather than shrunk, then your doctor would consider alternate diagnoses such as uterine cancer. The good news, uterine cancer is very rare and with precise imaging and close monitoring, it is usually easy to detect.

What treatments for fibroids are there?

Hormone Therapy

Birth control pills and other hormone therapies like GnRH analogs can effectively treat uterine fibroid symptoms. Unfortunately, these treatments may not be enough to completely manage symptomatic uterine fibroids and some women have adverse side effects related to hormone therapy. Specific hormone therapies, like birth control pills, do not reduce fibroid growth or shrink fibroids. However, intrauterine devices (IUDs) that slowly release hormones can effectively decrease heavy menstrual bleeding related to fibroids. Source

Pros
No procedure required

Cons
50% of women notice no improvement in symptoms

Hot flashes occur in 45% of women

Sweating occurs in 35% of women

Vaginal infection occurs in 10% of women

Myomectomy

Myomectomy is a surgical procedure where fibroids get cut out of the uterus. There are multiple ways to perform myomectomy, including abdominal myomectomy, where a 3-4 inch incision is made along the abdominal wall; hysteroscopic myomectomy, where a scope is inserted through the vagina into the uterine canal; as well as laparoscopic myomectomy, where four small incisions are made in the abdominal wall.

Although the data is limited, myomectomy does have the most data supporting fertility preservation for women that desire future pregnancy. Myomectomy is highly effective at treating symptomatic uterine fibroids with a success rate of over 90%. Unfortunately, when fibroids are numerous or large, myomectomy can be challenging. This is due to an increased risk of blood loss and incomplete treatment. About 50% of the time, an abdominal myomectomy is required, which is also associated with longer hospital recovery times. Still, myomectomy is a highly effective treatment for symptomatic uterine fibroids.

Pros
Fertility preserving

Less invasive than hysterectomy

Preserves the uterus

Highly effective at reducing symptoms

Cons
Less effective when there are numerous fibroids Source

10% chance of requiring blood transfusion Source

2-6 week recovery time Source

Usually requires a hospital stay

Chance of fibroid recurrence

Hysterectomy

Hysterectomy or complete surgical removal of the uterus is a highly effective method for treating symptomatic uterine fibroids because the entire uterus and all of the fibroids are removed. Having a hysterectomy ensures that no fibroids will grow back due to the uterus being permanently removed. However, a hysterectomy is a major surgery that usually requires 3-5 days in the hospital and 6-8 weeks of recovery. Hysterectomy has also been associated with an increased risk of heart disease and mental health conditions later in life. It is also not an option for women looking to preserve their uterus or for women who want to bear children in the future.

Pros
No chance for fibroid recurrence

Highly effective at reducing symptoms

Cons
Major surgery

3-5 day hospital stay

6-8 week recovery

13% chance of requiring blood transfusion Source

Increased risk of heart disease Source

Increased risk of mental health conditions Source

Uterine Fibroid Embolization (UFE)

Uterine fibroid embolization (UFE) — also referred to as uterine artery embolization (UAE) — is a same-day, minimally-invasive, non-surgical procedure for treating uterine fibroids. During the procedure, doctors inject tiny particles into the uterine arteries that are ‘feeding’ the fibroids to block their blood supply. Without a blood supply, the fibroid will slowly shrink over a few weeks to months as the body heals naturally. Uterine fibroid embolization is an option for patients who want to avoid surgery and keep their uterus. Additionally, UFE is a good option for women who want the quickest recovery times possible.

Pros

Highly effective at reducing symptoms

Minimal blood loss (1% chance of requiring blood transfusion) Source

No hospital stay required

Fertility and uterus preserving

Same day, outpatient procedure

3-7 day at home recovery

Does not require general anesthesia

Cons
Chance of fibroid recurrence

How to pick the best treatment strategy for fibroids?

The best treatment strategy for fibroids is personalized for each patient based on various patient-specific factors and fibroid-specific factors.

To assess patient-specific factors, consider the following questions: 

  • Do you still want to have children?
  • Do you want to keep your uterus?

If the answer to either of these questions is “Yes,” then hysterectomy is usually not a good first treatment. However, there are excellent uterine-sparing and fertility-sparing treatment options available. 

The next question to answer is:

  • Do you want to start with the most minimally invasive treatment option available? 

If the answer is “Yes,” then uterine fibroid embolization can be an excellent first-line treatment.

Start as minimally-invasive as possible.

Many patients choose to start with a minimally-invasive treatment (fast recovery) before escalating to more invasive treatment strategies that require longer recovery times. In practice, medications are often attempted first because no procedure or surgery is needed. However, medication management is frequently ineffective. Other patient-specific factors that will be discussed between you and your doctor are co-existing medical conditions, history of prior surgeries, and menopausal status.

The size, number, and location of fibroids must also be considered. Uterine fibroid embolization can be an excellent first-line treatment when fibroids are large or numerous. Hysteroscopic myomectomy can be an ideal first-line treatment for women with small to medium-sized submucosal fibroids that protrude into the endometrial canal. Alternatively, hysterectomy can be an excellent treatment if your symptoms did not fully resolve after UFE or myomectomy.

Regardless of your situation, your doctor will help you understand fibroid-specific factors that impact treatment decisions.

Dr. Eric DePopas, MD

Dr. Eric DePopas, MD

PainTheory Chief Medical Officer
Vascular & Interventional Radiologist

Now that you know more about fibroids, keep reading to find out if you could be a good candidate for uterine fibroid embolization!

Find out what uterine fibroid embolization is all about. Uterine fibroid embolization

Uterine fibroid embolization can offer lasting pain relief when other treatments haven’t worked. Check out our comprehensive guide to learn more.

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