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How Do I Know If I Have Uterine Fibroids?

Often, fibroids are brought to your attention only when your physician feels them during a routine pelvic examination. To verify their presence, an ultrasound scan may be performed. Ultrasounds may be done transvaginally or abdominally. To further see if the fibroid is within the lining (endometrium) of the uterus, saltwater (saline) can be used with a transvaginal ultrasound to expand the cavity and delineate the location of the fibroid. A three dimensional ultrasound or an MRI can also be used for delineation of where the fibroids are (fibroid mapping) Patients often have a history of pressure, pain, urinary or rectal symptoms. Abnormal bleeding is common - usually heavy, prolonged periods, especially if the fibroid is within or next to the uterine cavity.

What Are the Treatments?

Treatment for fibroids varies and should be approached according to your specific medical situation. Hysterectomy (removal of the uterus), which is the only treatment that guarantees a cure, may not be necessary. If your fibroids are not causing you any problems, you may want to consider doing nothing. Not all fibroids grow. Even large fibroids may not cause any symptoms, and most fibroids shrink after menopause. But you should monitor their growth - especially if you develop symptoms such as bleeding or pain - by having frequent (every six months) examinations.

To help prevent further fibroid growth, your physician may recommend that you stop taking oral contraceptives or abandon any hormone replacement therapy programs, both of which supply the body with synthetic estrogen. However, oral contraceptives are also sometimes prescribed to help control the bleeding and anemia from fibroids even though certain forms of the pill may cause fibroids to grow.

Gonadotropin releasing hormone (GnRH) agonists may be prescribed as presurgical treatment to shrink fibroids, but these drugs are expensive and should not be taken for more than four months due to the risk of developing osteoporosis. Maximum fibroid shrinkage occurs within 4 months and since the women is in a pseudo menopause this gives her the opportunity, if she is anemic, to stop bleeding and decrease any existing anemia.

GnRH agonists may also be given with low-dose estrogen to avoid osteoporosis. Also, GnRH agonists may cause early symptoms of menopause, and once use of the drug is stopped, the fibroids regrow. Testing is currently underway on other hormone-like medications which would shrink fibroids while not triggering a menopausal state. And while estrogen and progesterone cause growth of fibroid, these new medications cause no growth (SERMs = selective estrogen receptor modulators).

To shrink a fibroid, your physician may recommend uterine fibroid embolization, in which polyvinyl alcohol (PVA) is injected into the arteries that feed the fibroid. The PVA blocks the blood supply to the fibroid, causing it to shrink. Uterine fibroid embolization is nonsurgical, but you may need to spend several nights in the hospital as nausea, vomiting, and pain may occur in the first few days following the procedure.

Fibroids may be removed surgically in a procedure known as a myomectomy. If a women desires to keep fertility as an option, a myomectomy may be recommended over other options. There should be a clear indication for surgery since myomectomy surgery can contribute to scarring which can cause infertility. This needs to be carefully discussed with the health care provider. Women are advised to wait 4-6 months after surgery before attempting to conceive. In the majority of patients, symptoms are completely relieved following the procedure, although fibroids do recur in one-quarter to one-third of patients. Success partially depends on the quantity of fibroids, and whether they were all removed.

At-Home Remedies

When fibroids grow on the outside of the uterus (subserous fibroids), you may become aware of a mass on your abdomen. Lying down and placing a hot pack or hot-water bottle on the lower abdomen lessens pain. The hot packs should be applied three times a week for at least 60 minutes each time.