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Fibroids: What to do about them and when to do it

Uterine fibroids (“leiomyomas” in medical terms) are very common benign tumors of the uterus. They are not cancer and don’t become cancer. At least 50% of all women will have fibroids by age 50, and that percentage may be as high as 80% among black women.

These tumors are ONLY in the uterus but can vary in location. They may be on the outside of the uterus (subserosal), within the muscle layer of the uterus (intramural) or within the lining of the uterus (submucosal). Usually, women have multiple fibroids, and they may even be present in all three locations within the uterus!

How do I know if I have fibroids and how do I know if I need treatment?
Depending on their size, fibroids may be found during a pelvic exam with your gynecologist or seen on a pelvic ultrasound. Typically fibroids only require treatment if they are causing symptoms. The most common symptoms caused by fibroids are heavy menstrual periods, pelvic pain or pressure (especially during menses and/or sex), and frequent urination. Depending on their location and size, though, they may cause difficulty urinating, difficulty with bowel movements, an enlarged abdomen, difficulty getting pregnant or miscarriages. Some women even have anemia (low blood count) from months or years of heavy periods.

What if I want to have children in the future?
Whether fibroids cause problems with infertility or miscarriages depends on their location within the uterus. Generally, only fibroids that are submucosal (within the uterine lining) cause a problem for pregnancy. Women with submucosal fibroids who hope to have children in the future should almost always have them removed. Although there are multiple options for managing fibroids, removing them (called a myomectomy), is the only procedure that has been shown to be safe for future pregnancy. A myomectomy may be done in different ways, based on how many fibroids there are, and where they are located. Unfortunately, after fibroid removal, it is common for new fibroids to grow again.

If I don’t want to have children right now (or ever) what are my options for treatment?
There are multiple treatment options for managing fibroids but the most common are:

1. Hormonal therapy – can include birth control (in the form of pills, a shot, a patch, a vaginal ring, or an intrauterine device) or progesterone therapy. Although hormones will improve the heavy periods, they will NOT remove or shrink the fibroids. This is a good option for women whose fibroid symptoms are mild, or who desire pregnancy in the future.

2. Endometrial ablation (burning the lining of the uterus). This will often improve heavy periods, but will NOT remove or shrink the fibroids themselves. The improvement in bleeding can wear off over time though, and some women with fibroids have no improvement at all.

3. Uterine fibroid embolization (UFE or UAE) is a procedure performed by radiologists to shrink fibroids. It will often improve the pressure and urinary frequency associated with fibroids, but may not improve heavy periods. Also, the fibroids may regrow again over time.

4. Hysterectomy (removing the uterus) is the only procedure that will cure fibroids forever. It is not the right answer for everyone, but it is a permanent solution to the heavy bleeding and pain associated with fibroids. Endometrial ablation, uterine fibroid embolization, and hysterectomy are not recommended for women who would like to get pregnant in the future. 

There are other less commonly used treatment options. Your gynecologist can help you decide which treatment is right for you.

For more information, or to schedule an appointment at Gwinnett Gynecology and Maternity, please visit or call (770) 972-6464.

Dr. Janice Pressley Gynecologist
Gwinnett Gynecology & Maternity
1800 Tree Lane, Suite 300
Snellville, GA 30078
(770) 972-6464