Uterine fibroids are extremely common, affecting as many as 75% of women in the United States. In most cases, these small, noncancerous tumors are harmless and do not require medical treatment.

In some circumstances, however, uterine fibroids can grow quite large, leading to multiple issues. Even small fibroids can be problematic, depending on their location. At Yale Medicine, we specialize in treating uterine fibroids that lead to medical complications or fertility problems.

"When a woman comes to us for fibroids, our first priority is safety," says Linda Fan, MD, chief of Yale Medicine Gynecologic Specialties. "Are they bleeding? At risk for cancer? Do they have an infection or chance of affecting internal organs is the fibroid is very large? Once we make sure it is none of those things, we have a chance to personalize their care. We offer a whole array of treatments from medical and interventional radiology to minor and major surgical procedures."

Uterine fibroids are benign (non-cancerous) growths inside the uterus. When uterine fibroids become too large, too numerous or start pressing against another organ, a woman might experience severe pelvic pain or abdominal swelling, discomfort during sex, heavy menstrual bleeding, problems when urinating or defecating, anemia due to blood loss and even infertility, miscarriages and other pregnancy complications.

The greatest risk factor for uterine fibroids is being a woman of reproductive age. Other factors that may increase the risk are:

• Family history: A woman whose mother or sister had uterine fibroids is at greater risk of developing them herself.
• Race: African-American women are more likely to develop uterine fibroids at younger ages. They are also likely to develop complex fibroids.
• Unhealthy lifestyle: Women who eat more red meat, drink more alcohol and consume fewer fruits and vegetables are more likely to develop uterine fibroids. Vitamin D deficiency is also associated with increased risk of fibroids.

A woman with small fibroids may not experience any symptoms unless the fibroids are impinging on the uterine cavity, in which case abnormal uterine bleeding, infertility, or miscarriage may ensue. Women with larger fibroids may experience additional symptoms that include:

• Heavy, painful menstrual bleeding
• Enlargement of the lower abdomen
• Frequent urination
• Constipation
• Pain during sex
• Lower back pain

Uterine fibroids are typically detected during a standard pelvic exam. If a doctor finds any abnormal growths, follow-up tests may include:

• Ultrasound: By sending sound waves through the body, a doctor is able to get a fuller picture of fibroids in the uterus.
• Blood test: If your periods have been especially heavy, a doctor may check her blood to see if you are suffering from anemia (iron deficiency commonly associated with blood loss). A blood test can also rule out other conditions with similar symptoms such as thyroid problems.

Only 10 to 20% of uterine fibroid cases require treatment. There are many options available for these women. At Yale Medicine, we focus on each patient’s preferred outcome, whether it be retaining fertility or alleviating specific symptoms. For most women, surgery isn’t necessary. Some options include:

• Medication: For women with severe symptoms, medication may be an option. Pain relievers may work to reduce the pain of menstrual cramps; birth control pills and other hormonal methods can control heavy periods. In addition, women might be prescribed an intrauterine device that releases progestogen (a hormone) to reduce heavy bleeding. A class of drugs called gonadotropin-releasing hormone (GnRH) agonists will reduce the size of fibroids and halt menstrual bleeding. Because of side effects, GnRH agonists are typically used for up to six months, and fibroids will usually return to their previous size after the drug is stopped.
• Uterine Fibroid Embolization (UFE): This procedure is used to alleviate severe symptoms such as anemia, cramps or incontinence. Small particles are injected into the bloodstream around the fibroid, starving it of its blood supply and resulting in shrinkage.
• Endometrial Ablation: In this procedure, which is also intended to alleviate symptoms, a thin layer of the uterus is destroyed, greatly reducing menstrual bleeding. It can be done quickly in the doctor’s office.
• Magnetic Resonance Imaging: This technique has been shown to reduce severe symptoms in women with uterine fibroids. The MRI machine is used to direct ultrasound therapy to the fibroid.
• Surgery: For some women, surgery may be recommended. Uterine fibroids can negatively impact fertility, and their surgical removal, with a procedure called a myomectomy, may be an option for a woman who wishes to become pregnant. There are several different ways to perform a myomectomy. A surgeon may access the uterus by inserting a surgical instrument through the navel (laparoscopic), through the vagina (hysteroscopic) or through an incision in the abdomen (laparotomy). Robotic surgery is also used for the removal of certain fibroids while preserving fertility. In rare cases a doctor may recommend a hysterectomy, which is the removal of the uterus.

Although fibroids are benign, their impact on daily life should not be downplayed. At Yale Medicine we recognize that uterine fibroids can seriously impact physical and emotional well-being, and we work closely with patients to evaluate all possible treatment options.

"If the main concern is pain, we gear treatment to that. If it's fertility, we might explore surgery," Dr. Fan says. "We take a holistic approach to guide treatment and look at the big picture of what is best for the patient." 

The benefits of coming to an academic medical center such as Yale are many, she adds. "We have high-volume surgeons and physicians who see uterine fibroids frequently, and many of them have specialized training," she says. "Forty years ago, hysterectomies were the only option for fibroids, but now we have more alternatives, from new medical management strategies to minimally invasive surgery."