UTERINE FIBROIDS

Fibroids are abnormal growths that form in the muscle of the uterus. The uterus, also called the womb, is the part of the body that holds a baby when a person is pregnant.

People sometimes refer to fibroids as “tumors.” But fibroids are not a form of cancer.

Fibroids often cause no symptoms at all. When they do cause symptoms, they can cause:

• Heavy periods
• Pain, pressure, or a feeling of “fullness” in the belly
• The need to urinate often
• Too few bowel movements (constipation)
• Difficulty getting pregnant

There are several treatment options. Each option has its own risks and benefits. The right treatment for you will depend on:

• Your symptoms
• Your age (most fibroids shrink or stop causing symptoms after menopause, which is when monthly periods stop)
• Whether you want to get pregnant in the future
• Whether your fibroids cause so much bleeding that you have a condition called anemia
• The size, number, and location of your fibroids
• How you feel about the risks and benefits of the different options

If you are thinking about treatment, ask your doctor or nurse which treatments might help you. Then ask what the risks and benefits of those options are. Ask, too, what happens if you do not have treatment. And be sure to mention whether or not you would like to get pregnant in the future.

Here are the options:

• Medicine – The pills, patches, vaginal rings, injections, and implants used for birth control can all reduce how much you bleed during your period. Some types of intrauterine devices, or “IUDs,” can also make your periods lighter.
  Besides birth control, there are also other medicines that can reduce heavy bleeding. If bleeding is your main symptom, your doctor might prescribe one of these medicines.
• Surgery to remove the fibroids – This is called “myomectomy.” During this operation, the doctor removes the fibroids but leaves the uterus in place. It is effective, but it is not always a permanent fix, because fibroids can come back. Myomectomy is often a good choice for people who might want to get pregnant in the future.
• Treatment to cut off the blood supply to the fibroids – This is called “uterine artery embolization” or “uterine fibroid embolization.” During this procedure, the doctor inserts a thin tube into an artery in the leg and threads it up to the uterus. Then they use tiny plastic beads to block the artery that brings blood to the fibroid. After the procedure, the fibroid no longer gets blood, so it shrinks. This procedure is not appropriate for people who might want to get pregnant.
• Treatment to destroy the lining of the uterus – This is called “endometrial ablation.” During this procedure, the doctor inserts a thin tube into the vagina, through the cervix and into the uterus. Then they use tools inserted through that tube to destroy the lining of the uterus. This procedure reduces bleeding from heavy periods. But it is not an option for everyone. It is also not appropriate for people who might want to get pregnant.
• Surgery to remove the uterus – This is called “hysterectomy.” This surgery gets rid of fibroids and the problems they cause forever. If you have a hysterectomy, your fibroids cannot come back. But you will also not be able to get pregnant in the future.

Your doctor will work with you to help you understand the different treatment options and how each would affect you. Then the two of you work together to choose the option that’s right for you.

You will need to consider how invasive each surgery is and whether you prefer surgery over taking medicines. You will also want to think about:

• Whether you want to get pregnant in the future – If you might want to get pregnant, medicines or myomectomy is often the best choice. If you do not want to have children, or if you are done having children, you can often choose from all the options.
• How soon you are likely to go through menopause – Fibroid-related symptoms often go away with menopause, so your age might affect your decision about treatment.