Fibroids - Uterine Leiomyomata
by Frederick R. Jelovsek MD
Fibroid Questions And Answers
Below are a list of common questions about Fibroids. Click on any question and get the answer you need to know about fibroids.
- Are fibroids hereditary?
- Submucosal fibroids and want to become pregnant
- Will Lupron® treatment cause ovarian cancer?
- Endometrial ablation for fibroids
- Can fibroids cause kidney pain and urine problems?
- Fibroid of the falopian tube
- Can a fibroid come thru or from the cervix?
- What other options than hysterectomy for fibroids?
- Ultrasound report on fibroids - what does it mean?
- Treating fibroids with birth control pills
- Concern about pedunculated fibroid
- Want a pregnancy but I have large submucosal fibroid.
- Do fibroids causing pain mean a hysterectomy?
- Submucosal fibroids and endometrial ablation
- Do hormone imbalances cause ovarian cysts or fibroids?
- Can fibroids cause urinary urgency?
- What to expect with a sonohysterogram for possible submucosal fibroids
- Can five months size fibroids be reduced for hysterectomy?
- Pain and bleeding - maybe not due to fibroids
- Pregnancy risks with fibroids
Are fibroids hereditary?
My mother had a complete hysterectomy at 45 because of fibroids. My sister 6 years younger than I, recently had a hysterectomy. She only had 1 fibroid but she said the lining was in pieces with ovaries o.k. Now I have the same problem, is this a hereditary problem?
As far as we know, fibroids are not hereditary. They do have a strange genetic pattern, however, in that many fibroids are monoclonal (derived from the same cell). In other words, if a woman has multiple fibroids, sometimes all of those fibroids come from a single cell as if that cell were cloned. This has led some people to postulate that a virus is involved in producing the fibroid cells that then grow and replicate like a cancer, but in a controlled, non-invasive fashion. If that is true, (we're really guessing) then people in the same family could be susceptible; not because of genetics, but because of exposure to the same virus.
Submucosal fibroids and want to become pregnant
I have 2 submucosal fibroids. I have been a very heavy bleeder for years but it's getting worse. I've heard of taking Lupron® and scraping the tops of the fibroids procedure, but I don't really want to take Lupron® (I've had 5 IVF cycles) anymore, and I hear the fibroids can just grow back. Should I just keep waiting and get a myomectomy later if needed or wait to see if arterial embolization becomes "the answer".
Are you sure the fibroids are submucosal? I assume this was diagnosed by hysteroscopy or by a saline sonohysterogram or a traditional hysterosalpingogram? I ask because some submucosal fibroids can be easily removed at hysteroscopy and D&C which is an outpatient procedure and I would recommend it.
Other fibroids are actually mostly in the muscle of the uterus (intramural) and by virtue of their size or position they "impinge" upon the endometrium and cause bleeding. Those are the ones which need to be "shaved" away and that is much more of a procedure than just removing ones that protrude into the endometrial cavity. I don't like arterial embolization for fibroids because I've seen major complications when blood vessels of the pelvis get embolized when they weren't supposed to during the procedure.
Lupron® doesn't shrink fibroids as much as it shrinks the surrounding uterine muscle so that total size is smaller. As far as I'm concerned it is never a long term solution for fibroids because of expense and because the estrogen deficiency it causes affects a long term increase in heart disease and osteoporosis in addition to its side effects of hot flashes, vaginal dryness and irritability. Lupron® can be useful in a temporary situation of 3- 6 months to:
Will Lupron® treatment cause ovarian cancer?
Also, is there a much increased risk of ovarian cancer with 5 IVF cycles?
There is no risk of ovarian cancer from using Lupron® that I know of. Also, risk seems zero to minimal with less than 12 cycles of ovulation induction during IVF.
Endometrial ablation for fibroids
I have prolonged periods due to 2 small fibroids. The doctor wants to remove the fibroids and then do an endometrial ablation. I know that bleeding is a sign of problems. If I have the ablation done, will this mask other potential problems?
If the fibroids are causing the bleeding, why have the ablation after removing them? We need more of the story.
Endometrial ablation can mask any endometrial abnormality that develops. During an ablation, only about 80% of the lining is removed. About 20% remains. If any abnormality develops in that 20%, it may go undiagnosed if the blood or tissue remains hidden in scarred uterine pockets.
I was told the fibroids are small and it was felt that they are not solely the cause of bleeding. (A crumbly lining?) The doctor did not want to just remove them and find out I still had prolonged periods and have to do a second surgery. My periods are not heavy since I took hormone medication, just long 10 to 14 days. I am a little bit hesitant about having the ablation.
How old are you? the reason I ask is to gage the probability of a mechanical cause of the prolonged bleeding other than fibroids such as polyps, cancer, submucosal fibroids. Over 40 these would be more likely and under 40 endocrine/ovulatory dysfunction would be most common.
Have you had an endometrial biopsy in the office?
Does the ultrasound suggest the fibroids are distorting the endometrial cavity?
Are you taking any medicines that might affect coagulation such as aspirin, coumadin other pain meds or hormones?
Have you had a trial with hormonal therapy such as BC pills or progestins to regulate the flow?
All of these things and others are pertinent to your decisional dilemma.
I did have all of those tests you mention. The blood work is normal, the biopsy was normal, there are no clotting problems, hormones normal, nor was I on any medication that would cause this. I did try the BC pills as well as the progesterone. The pills cause chest pain possibly due to a heart murmur. (Will Lupron® cause this too?)
Provera is known to cause chest pain in some women. BC pills don't usually do that but it's possible.
The bleeding did get lighter but the duration went from 10 to 14 days. The bleeding that continues past the normal period length is light then spotting. The sonohysterogram notes 2 "adjacent hypoechoic myometrial areas...anterior submucosal fibroids, about 12mm in diameter. There is mild impression in the endometrial stripe." I'm 36 and the first doctor I went to wanted to do a hysterectomy.
The best chance to resolve the bleeding would be the hysteroscopy with resection/shaving of fibroids. Those are relatively small but poorly located (for you). An outpatient procedure from which you should recover in 2-3 days seems preferable to putting up with that bleeding assuming you are in good health in general. Chances of curing problem I would estimate at 80-90%.
No endometrial ablation?
Correct. No endometrial ablation. Since the bleeding is mechanical, i.e., fibroids, ablation will be unlikely to help. Either you cure the bleeding by removing the fibroids. Or if you don't, you don't want bleeding from the fibroids "behind" the endometrial ablation. Endometrial ablation is mainly for dysfunctional, endocrine based bleeding rather than anatomical/mechanical bleeding. It's possible you could have both problems, but the evidence points to mechanical (fibroids) as I understand it.
Can fibroids cause kidney pain and urine problems?
I know I have fibroid tumors. During a laparoscopy in 1991 they were noted but not removed. During the last four months I have had increased flow and large blood clots as well as delayed start (5 days). During the past month I have been taking Arthrotec® (new arthritis drug) which I stopped on Saturday. Beginning Sunday I noticed increased frequency of urinating as well as tremendous pain right before but not during urination. I thought it might be a kidney problem, but Dr. said no based on quick urinalysis. He thought maybe fibroid tumor problem. Since I don't have much confidence in him, I would like to know if that is reasonable?
I should have mentioned that the pain is in my kidney/flank area only.
Fibroids can cause urinary frequency if they are putting pressure on the bladder. Usually it is not an acute process however. The quick urinalysis that you mention is probably a dipstick test for nitrites and white blood cells. It is pretty good but it can be wrong. If you have upper tract disease (in kidney [flank] not in bladder) it is less reliable.
Sometimes I use nocturia (having to get up at night to void as a differentiator. Urine infections almost always cause one to get up 2 or 3 or more times at night (other things can cause that too). If the frequency is only during waking hours, it may be due to pressure on the bladder.
In any case, if symptoms of pain and frequency keep up over next day or two, don't hesitate to return to doctor to have it checked again.
Fibroid of the fallopian tube
Is it possible to have a fibroid in the fallopian tube. I was looking over my report from a lap done over 10 yrs ago(on its way to new doc) and it said that my right tube was blocked close to where the tube meets the uterus, and that the tube appeared bulbous in that area....he listed the causes as either a fibroid or salpingitis. I have done some reading, and according to that it said that salpingitis is almost always associated with PID or some other infection, which I did not have. I actually had no other abnormal finding at that time (except for the comment about a possible bicornuate uterus, on HSG report). I remember the doctor remarking also that I could have been born that way....but can not find any information on tubal fibroids...or congenital malformations of the fallopian tubes.
Fibroids of the fallopian tube are rare. Its more likely that there could have been a fibroid in the uterus close to the insertion of the tube into the uterus.
Actually the report said it was in the tube. Only about 1/2cm away from the uterus.
[editor note - this problem turned out to be a congenital uterine anomaly in which the right horn of the uterus was not developed and the "fibroid" was actually uterine muscle that was incompletely developed. ]
Can a fibroid come thru or from the cervix?
Is it possible for a fibroid to protrude past the cervix into the vagina or to actually grow from the cervix?
Neither are common but more likely to be prolapsed thru the cervix into the vagina from the uterine fundus than from the cervix directly. They can usually be easily removed without hysterectomy but it is performed in an outpatient surgery setting because of possible bleeding.
What other options than hysterectomy for fibroids?
I was diagnosed with a fibroid today. The doctor says hysterectomy. Are there any options?
Fibroids of the uterus are present about 25% of women. They actually require no treatment in most cases. The only times they require any therapy at all are:
Treatments can vary from just removing the fibroid(s) (myomectomy or submucosal resection) to hysterectomy. There are some medicines to help shrink uterine muscle and fibroids but they are only temporary treatments.
How many fibroids can they see on scan?
There is just one fibroid. I'm not sure about the size. Doctor said small, but size is relative. I didn't know to ask.
I haven't had any treatments yet. As far as symptoms go, I have severe pain, very heavy bleeding, irregular periods, fatigue, frequent urination, pressure, and fertility problems (not sure if all are because of fibroid).
Irregular periods and fatigue shouldn't be symptoms of fibroids. The pain depends. If you are trying to get pregnant, I certainly wouldn't undergo hysterectomy. You may need to see a reproductive endocrinologist to get more information about whether the fibroid is causing infertility. Other studies may need to be done such as sonohysterogram, hysteroscopy, laparoscopy etc., if these have not been done.
Ultrasound report on fibroids - what does it mean?
I had an ultrasound showing fibroids and don't completely understand the results. Uterine length 11.4 cm, anteroposterior diameter - 6.4cm, transverse - 6cm., largest fibroid occupies fundus - 7 cm. A smaller 2 cm X 3 cm fibroid located in the posterior aspect of the fundus and a third in the posterior body. The latter measures 4.3X3.0, 7X4.3cm. The endometrial stripe is distorted. No intrauterine fluid collection. Ovaries normal in size and configuration. The right ovary is 3.1 cm, with a 1 cm cyst. Left is 3.1 cm long with 1 cm follicular cyst.
This report indicates the uterus is enlarged in size to 6X6.4X11.4 cm, Normal size is about 4X5X8cm. The enlargement is due to at least 3 fibroids, one in the top of the uterus (fundus) measuring 7 cm., one in the back top measuring 2X3 cm., and third one in the back of the uterus measuring 3.0X4.3X7 cm.
The fibroids are big enough to impinge upon the endometrial cavity which may explain any abnormal bleeding. If you were trying to get pregnant or had had miscarriages, this distortion of the cavity would also explain that. The cavity is not blocked (no fluid collection) by the fibroids.
The ovaries are both normal size and have normal size follicles (eggs).
Treating fibroids with birth control pills
Would like to know of anyone who is on the pill for fibroids. I was just diagnosed with these. I have several of these and they are really affecting my life. I run a low grade fever as well as all the pain and severe clotting that comes with this. Can a woman be treated successfully with the birth control pill? I'm a 36 yr old and would like to know if anyone out there shares this problem. Maybe some input from a doctor would be helpful.
Fibroids are very rich in estrogen receptors and may get bigger with BC pills. The pills can decrease the heaviness of bleeding but not the prolonged bleeding pattern. It is not be a good idea to take BCPs if your fibroids are getting bigger and causing more pain. The low grade fever can indicate degeneration of one or more fibroids. If the fibroids are "submucosal" the heavy bleeding will continue and you may need a saline hysterosonography to diagnose this.
The sum of your symptoms indicates you should strongly consider surgical removal of the fibroids by myomectomy or hysterectomy. Medical therapy can be used but right now it is not a good long term treatment.
Concern about pedunculated fibroid
Two days ago my doctor told me that I have an 8cm long, 4cm tall, 6cm wide fibroid. What's most bizarre about this growth is that it isn't in the uterine lining or in the uterus, but it's attached to the outer part of my uterus by a stalk. I am going for more tests to monitor it, and am quite freaked out by this stalk (medical term is "pedunculated"). Does anyone out there have any information, comments, advice or messages to send my way.
Pedunculated fibroids are not as common as ones in the main uterine muscle but in a way they are less of a problem. The fibroid is a benign muscle growth, usually one cell that has just replicated itself over and over. Its a not a malignant or invasive process altho sometimes they can grow quite big. The pedunculated ones generally do not cause abnormal bleeding because they are remote from the uterine lining sloughed each month during menses. The pedunculated ones can occasionally twist (torsion) and cause severe pain. For the most part though, they don't usually produce many symptoms unless they are big enough to just cause abdominal fullness like a pregnancy feeling. A fibroid the size you describe may well be able to be removed laparoscopically alone or laparoscopically with a vaginal incision to deliver the fibroid rather than a major abdominal incision.
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