Risk factors for fibroids include nulliparous (no pregnancies), early start of menstrual flow, exposure to DES, obesity, a diet consisting of beef and red meats, vitamin D deficiency, and alcohol consumption. A personal history of hypertension as well as high stress can increase fibroid risks. There also appears to be a hereditary risk for fibroid development.

Fibroids can be found in different locations within the uterus. Each of these locations can result in different symptoms. A fibroid located within or affecting the uterine cavity most commonly can result in heavy or abnormal periods, pain, and infertility. A fibroid located within the uterine wall generally causes pressure, bloating, and pain. Additionally, fibroids can extrude from the uterus and be connected by a stalk. These fibroids can sometimes twist on the stalk, resulting in significant pressure and pain. With significant size, fibroids can cause adverse bladder symptoms, back pain, anemia, and even compression of blood vessels called “venous compression.” Fibroids can also result in painful intercourse. Fibroids can grow to significant sizes over time and are stimulated by hormonal changes. Over time, fibroids can degenerate, resulting in tissue death, and result in severe pain or infection. All these symptoms can negatively affect quality of life.

Fibroids are often discovered when providing a personal medical history, physical exam, and pelvic ultrasound. With further evaluation, MRI studies can help locate the exact location of fibroids to better determine best treatment options. Laboratory testing is also extremely helpful to better evaluate anemia, pregnancy, or malignancy. Other testing for uterine fibroids includes injecting saline into the uterine cavity for visualization under ultrasound guidance and hysteroscopy.

Findings commonly seen with fibroids include adenomyosis and endometriosis. Approximately 1/2000 women being evaluated for uterine fibroids will have a malignancy called a leiomyosarcoma. It is important to have a thorough workup before deciding on the best treatments.

Treatments for uterine fibroids include nonsurgical and surgical options. Hormonal therapies include hormonal birth control pills and progestin therapies. Progesterone-containing IUDs can effectively treat heavy bleeding. Newer medications such as Elagolix and Relagolix block hormonal production and can temporarily decrease the size, reduce “bulk symptoms," and provide symptom relief for uterine fibroids.

Nonhormonal options commonly include NSAIDS, like ibuprofen, which work as an anti-inflammatory to reduce pain and symptoms. In higher doses, NSAIDS can also reduce bleeding and menstrual flow. Tranexamic acid is a nonhormonal treatment that is used with the start of menses and can temporarily stabilize the uterine lining to decrease menstrual flow.

Other nonsurgical options include lifestyle and dietary changes, acupuncture, herbal supplements, and even exercises that reduce stress, such as yoga, meditation, and other physical activities.

In recent years, surgical options have become more diverse, providing minimally invasive options for women suffering from uterine fibroids. Women who do not respond to initial nonsurgical options now have more choices for best treatment of their fibroids.

Uterine artery embolization (UAE) is performed at a radiology center and involves blocking the blood supply to the uterus and fibroids. This is generally performed under sedation and has a short recovery. However, women seeking fertility are not candidates for UAE.

Hysteroscopy resection of uterine fibroids is a treatment for uterine fibroids that are inside the uterine cavity. A small camera is inserted into the uterus, and the uterine fibroid is seen under direct visualization. Several instruments are available that can then resect the fibroids.

For smaller fibroids impacting the cavity, an endometrial ablation procedure may be an option for premenopausal women with heavy bleeding. Endometrial ablation is a procedure where the uterine lining is treated, resulting in scar tissue in the cavity, which results in decreased flow or lack of periods (amenorrhea).

Myomectomy is the surgical removal of uterine fibroids. This can be performed with hysteroscopy, laparoscopy, or with an open surgical procedure, depending on size and location. A myomectomy is the preferred choice for women wishing to maintain fertility. However, this surgery may have potential risks or significant recovery times requiring detailed discussion with a medical provider. Additionally, a myomectomy does not guarantee that all fibroids will be removed.

Radiofrequency ablation (RFA) of uterine fibroids is a more advanced and new option available. The two current surgical RFA options include ACCESSA or SONATA. ACCESSA is a laparoscopic procedure where a radiofrequency probe is placed into the uterine fibroid using ultrasound technology. Sonata is a procedure where an ultrasound is placed in the uterine cavity and the radiofrequency probe is placed into the fibroids without any incisions or laparoscopy. Both treatments have minimal surgical recovery and are short outpatient procedures done in an OR setting. These procedures ablate the uterine fibroid so the density and bulk symptoms from fibroids decrease and the blood supply is destroyed.

A hysterectomy is the removal of the uterus. It is the most common procedure for uterine fibroids and offers definitive treatment. There are patients who may not be good candidates for the other treatments or have failed prior hormonal or other minimally invasive options. A hysterectomy is commonly performed as a minimally invasive procedure with laparoscopy, robotic laparoscopy, or vaginal techniques.

Ultimately, if you are suffering from uterine fibroids, it is important to have an educated discussion with your healthcare provider to decide which treatment might be right for you!

Written by Rachel Spieldoch MD

Dr. Rachel Spieldoch is an expert in fibroid care and advanced minimally invasive techniques. She has been practicing the latest advancements in fibroid care for over 20 years. If you are suffering from uterine fibroids and would like to discuss options, please call to schedule a consultation with Dr. Rachel Spieldoch at (480) 483-9011. We look forward to caring for you!