Summary

Putting It All Together

Here is a summary of the important facts and information related to fibroids.
  • Fibroids are growths of tissue that are usually found in the wall of the uterus. They can be as small as a pinpoint or as large as a basketball.
  • Although they are called tumors, fibroids are not cancerous.
  • More than half of women with fibroids do not know they have them until their doctor tells them so.
  • The most common problems caused by fibroids are heavy or long menstrual periods, pressure on other organs, and pain in the pelvis. For many women, however, fibroids cause no problems.
  • In most women, fibroids do not lead to cancer.
  • If fibroids are not causing problems, regular checkups may be the only management they need.
  • Surgery is the standard treatment for fibroids that are causing problems. The two kinds of surgery most commonly performed are hysterectomy (removal of the uterus) or myomectomy (removal of fibroids without removing the uterus).
  • Several new procedures offer alternatives to hysterectomy or myomectomy, especially for the removal of smaller fibroids. In some cases, fibroids may also be treated with medication.
  • Fibroids usually shrink after menopause.
  • New fibroids do not develop before puberty or after menopause.

Medical Therapy

Currently, the medical treatments available for fibroids can make symptoms better temporarily but they do not make the fibroids go away. For women with heavy bleeding, it is worth trying a medical treatment before undergoing a surgical procedure. Women with pressure symptoms caused by large fibroids will not benefit from any medicines currently available. On the horizon are several promising, new drugs that will treat the fibroids themselves not just the symptoms.

Oral contraceptive pills and
Progestational agents (Provera®, medroxyprogesterone acetate)

Women with heavy menstrual periods and fibroids are often prescribed hormonal medications to try to reduce bleeding and regulate the menstrual cycle. The medications will not cause fibroids to shrink nor will it cause them to grow at a faster rate. If the medication has not improved your bleeding after three months, consult with your doctor. Women over the age of 35 who smoke should not use oral contraceptive pills.

GnRH agonists (Lupron®)

GnRH agonists are a class of medications that temporarily shrinks fibroids and stops heavy bleeding by blocking production of the female hormone estrogen. Lupron is the most well known of these drugs. Although Lupron can improve fibroid symptoms, it causes unpleasant, menopausal symptoms such as hot flashes and, with long-term use, leads to bone loss.

Lupron should be recommended only in very specific circumstances. For example, a woman with very heavy bleeding and profound anemia will likely need a blood transfusion at the time of surgery. However, if she uses lupron for 2-3 months before surgery to make her periods temporarily stop and an iron supplement, the anemia will improve and the need for a blood transfusion will be reduced. In rare instances, a woman with huge fibroids(>10-12 cm) may be encouraged by her doctor to use lupron prior to surgery. Importantly, lupron should not be used solely for the purpose of shrinking fibroids unless surgery is planned because the fibroids will re-grow to their original size and symptoms will return as soon as the lupron is discontinued.

Intrauterine Devices (IUD)

Although IUD's are typically used to prevent pregnancy, they have non-contraceptive benefits as well. An IUD that releases a small amount of hormone into the uterine cavity has been shown to decrease bleeding related to uterine fibroids. An IUD can be inserted during a routine office appointment. Ask you doctor for more information about this option.