Q: My doctor said my heavy periods were from fibroids –– is this the same thing as endometrial polyps? A: Polyps form from the mucous membrane (the lining) of the uterus, whereas fibroids are benign tumors that form in the muscular tissue of the uterus itself, so these are very different conditions.
Q: My doctor said my heavy periods were from fibroids –– is this the same thing as endometrial polyps?
A: Polyps form from the mucous membrane (the lining) of the uterus, whereas fibroids are benign tumors that form in the muscular tissue of the uterus itself, so these are very different conditions.
Fibroids are extremely common; they occur in up to three-quarters of all women at some point during their lifetimes. Fibroids are more common in African-American women, especially at younger ages. They are also more common in obese women and in women with a family history of them.
Most uterine fibroids do not cause any symptoms. These asymptomatic fibroids often go undetected; we only know how common they are from studies specifically looking for them. Sometimes asymptomatic fibroids are identified on a routine physical exam when a woman's health care provider feels them, or they may be discovered when an ultrasound is done for an unrelated reason.
The exact cause of fibroids is not known, but certain female hormones drive their growth. Since fibroids are almost always a benign condition (not associated with an increased cancer risk), and they often regress after menopause (when levels of certain female hormones drop), asymptomatic fibroids are not usually a clinical concern.
When not asymptomatic, the most common symptoms from fibroids are vaginal bleeding and/or complications from the physical size of the fibroid (which can grow to be inches in diameter). Fibroids are categorized by their location:
- Intramural fibroids grow in the middle muscle layers of the uterus.
- Submucosal fibroids grow right under the mucous membrane lining on the inside of the uterus. These are the type that may be responsible for causing heavy and very painful and/or prolonged menses. This type of fibroid can also cause problems with pregnancy. Some submucosal fibroids can be "stalk" shaped and may protrude from the uterus and even twist, which can cause acute pain.
- Subserosal fibroids are on the outer part of the uterus; if these are large enough, they can cause symptoms by pushing against other organs. For example, urinary symptoms can occur if a fibroid compresses the bladder, and in rare cases, urinary blockage may occur. They can also put pressure on the rectum, causing constipation and even lower back pain by pressing on spinal nerves.
Any fibroid can become large enough to "outgrow" its blood supply, possibly causing acute pain.
Symptomatic fibroids may be identified with an ultrasound (or other test) done to evaluate the symptoms, for example, during workup for abnormal periods.
The treatment strategy for fibroids is often "watch and wait," where intervention is made if/when symptoms require it. When intervention is indicated, the appropriate type depends on the severity of symptoms as well as other factors, such as if the woman wishes to become pregnant in the future.
Since female hormones play a factor in the development of fibroids, medications that target hormones may be used, especially if the woman's symptoms include heavy menstrual bleeding and/or pelvic pressure. This approach does not make the fibroids disappear, but it may shrink them and improve symptoms. There are many different medications that may be considered.
There are many other treatment options, too. For example, the blood supply to the fibroid can be blocked by a procedure called a uterine artery embolization, where small particles are injected into the artery that supplies blood to the fibroid. This procedure may shrink the fibroid and relieve symptoms. However, if the injected particles inadvertently block the blood supply to another organ, such as the woman's ovaries, the other organ's function can be compromised.
Other minimally invasive treatments include endometrial ablation, which uses energy to destroy the lining of the uterus and, therefore, can improve bleeding symptoms. Myolysis is another option in which electrical, laser or even "freezing" energy is used to destroy the fibroid.
Some patients benefit from surgical removal of the fibroid. There are different surgical approaches that may be utilized, including laparoscopic, hysteroscopic or open surgery; the best option depends on the location and size of the fibroid, as well as other factors.
A definitive approach to treating fibroids is a hysterectomy, or removal of the entire uterus. In fact, about a third of hysterectomies in white women and up to half of all hysterectomies in black women are done to treat fibroids.
A more recently developed treatment option is called magnetic resonance guided focused ultrasound. This is a non-invasive treatment where a specialized device uses MRI guidance to "aim" convergent high-energy ultrasound waves to destroy the fibroid. The size, blood supply and other factors in the patient must be considered to determine if this approach is appropriate.
Women with fibroids should be followed by their gynecologist who can work with them to determine what treatment, if any, is best for them.
Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.