Uterine Fibroids

What Are Uterine Fibroids?

Uterine fibroids (also called leiomyomas or myomas) are noncancerous (benign) growths that develop in the muscular wall of the uterus. They are extremely common — up to 80% of women develop fibroids by age 50, though many never experience symptoms [1]. When fibroids do cause problems, they can significantly impact quality of life, leading to heavy menstrual bleeding, pelvic pain and pressure, and reproductive complications.

Fibroids range in size from tiny seedlings invisible to the naked eye to large masses that can distort the shape of the uterus. Some women have a single fibroid, while others develop multiple growths. The location and size of fibroids largely determine whether they cause symptoms and what treatment options are most appropriate.

Types of Uterine Fibroids

Fibroids are classified by their location within the uterus:

• Subserosal fibroids grow on the outer wall of the uterus and can press on surrounding organs, causing pelvic pressure and pain.
• Intramural fibroids develop within the muscular wall of the uterus and are the most common type. Large intramural fibroids can distort the uterine cavity and outer surface.
• Submucosal fibroids grow into the inner cavity of the uterus and are the least common type but often cause the most severe bleeding symptoms.
• Pedunculated fibroids are attached to the uterus by a stalk and can grow either inside or outside the uterine cavity.

Your physician will determine the type, size, and location of your fibroids to recommend the most effective treatment approach.

What Causes Uterine Fibroids?

The exact cause of uterine fibroids remains unknown, but researchers have identified several contributing factors:

• Genetic changes: Fibroids often contain genes that differ from those in normal uterine muscle cells. These genetic alterations may promote abnormal cell growth.
• Hormones: Estrogen and progesterone — the hormones that stimulate the uterine lining during each menstrual cycle — appear to promote fibroid growth. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells, which is why they tend to shrink after menopause when hormone levels decrease.
• Growth factors: Substances like insulin-like growth factor may contribute to fibroid development by promoting cell growth.
• Extracellular matrix (ECM): Fibroids have increased ECM, which makes them fibrous and stores growth factors that cause cell changes.

Risk Factors

All women of reproductive age are at risk for developing uterine fibroids. However, several factors may increase your risk:

• Race: Black women are significantly more likely to develop fibroids than women of other racial groups. They also tend to develop fibroids at a younger age, have more fibroids, and experience more severe symptoms.
• Family history: Having a mother, sister, or grandmother with fibroids increases your risk two to three times.
• Early onset of menstruation: Starting your period before age 10 is associated with higher fibroid risk.
• Obesity: Women who are overweight have a higher risk, as excess body fat increases estrogen levels.
• Vitamin D deficiency: Low levels of vitamin D have been linked to increased fibroid risk.
• Diet: A diet high in red meat and low in fruits, vegetables, and dairy may increase risk.
• Alcohol consumption: Studies suggest that alcohol, particularly beer, may increase fibroid risk.

Symptoms of Uterine Fibroids

Many women with fibroids have no symptoms and may not even know they have them. For those who do experience symptoms, the severity often depends on the size, number, and location of the fibroids. Common symptoms include:

• Heavy, prolonged menstrual periods — often with blood clots, lasting seven or more days
• Anemia — fatigue, weakness, and shortness of breath due to chronic blood loss
• Pelvic pain or pressure — a persistent feeling of fullness or heaviness in the lower abdomen
• Pain during sexual intercourse
• Frequent urination — fibroids pressing on the bladder can cause urgency and frequency
• Difficulty emptying the bladder completely
• Constipation or bloating — fibroids pressing on the rectum
• An enlarged abdomen — large fibroids can cause noticeable abdominal swelling
• Back or leg pain — fibroids pressing on nerves
• Reproductive problems — including difficulty conceiving, recurrent miscarriages, or complications during pregnancy

If you are experiencing any of these symptoms, it is important to seek evaluation. While fibroids are not cancerous, their symptoms can significantly affect daily life and overall health.

How Are Uterine Fibroids Diagnosed?

Because fibroids often don’t cause symptoms, many are discovered incidentally during a routine pelvic exam or prenatal ultrasound. When fibroids are suspected, several imaging tests may be used to confirm the diagnosis and map the size and location of the growths:

• Pelvic Ultrasound: The most commonly used initial imaging test. Sound waves create a picture of the uterus, revealing the presence, size, and location of fibroids.
• MRI (Magnetic Resonance Imaging): Provides detailed images that can precisely map the number, size, and exact location of fibroids. MRI is particularly useful for planning treatment.
• Hysterosalpingogram (HSG): An X-ray procedure using contrast dye to visualize the inside of the uterus and fallopian tubes.
• Sonohysterogram: An ultrasound performed after injecting sterile water into the uterus, providing enhanced imaging of the uterine cavity.
• CT Scan: May be used in certain cases to obtain cross-sectional images.

Treatment Options

Treatment for uterine fibroids depends on the severity of symptoms, the size and location of fibroids, your age, and your plans for future pregnancies. At Preferred Vascular Group, we specialize in minimally invasive, uterus-preserving treatments.

Watchful Waiting

If fibroids are small and not causing symptoms, your doctor may recommend monitoring them with periodic ultrasounds. Many fibroids remain stable or shrink on their own, particularly after menopause.

Medication

Medications can help manage fibroid symptoms but do not eliminate the fibroids themselves:

• Hormonal therapies to regulate menstrual bleeding
• GnRH agonists to temporarily shrink fibroids
• Iron supplements to treat anemia caused by heavy bleeding
• NSAIDs for pain management

Uterine Fibroid Embolization (UFE)

Uterine Fibroid Embolization is a minimally invasive, uterus-preserving procedure performed by our interventional specialists. UFE is an excellent alternative to hysterectomy for women who want to keep their uterus.

During the procedure:

• You receive sedation medication but remain conscious throughout
• An interventional radiologist inserts a thin catheter through a small puncture in the upper thigh or wrist to access the artery
• Using real-time imaging guidance, the catheter is navigated to the uterine arteries that feed the fibroids
• Tiny, round microspheres — each about the size of a grain of sand — are injected to block blood flow to the fibroids
• Deprived of their blood supply, the fibroids shrink and symptoms improve significantly

Benefits of UFE:

• Preserves the uterus — no hysterectomy required
• Treats all fibroids simultaneously, regardless of size or location
• Performed as an outpatient procedure
• Recovery time of 1-2 weeks (compared to 6-8 weeks for hysterectomy)
• Over 90% of patients experience significant symptom improvement [2]
• No general anesthesia required

Radiofrequency Ablation (RFA)

Radiofrequency Ablation is another minimally invasive option that uses heat energy to destroy fibroid tissue. During the procedure, a thin probe is inserted into the fibroid using imaging guidance, and radiofrequency energy heats and destroys the targeted tissue. The treated fibroid gradually shrinks over the following months.

Why Choose Preferred Vascular Group?

Our interventional specialists have extensive experience in minimally invasive fibroid treatment. At Preferred Vascular Group, you benefit from:

• Expert interventional radiologists trained in UFE and other advanced techniques
• Uterus-preserving treatments — we offer alternatives to hysterectomy
• Outpatient procedures with significantly shorter recovery times than surgery
• Comprehensive care from diagnosis through treatment and follow-up
• Eight convenient locations across Georgia and Ohio

If uterine fibroids are affecting your quality of life, you don’t have to live with the symptoms. Our specialists can help you explore your treatment options and find the right solution for your needs.

References

1. Stewart EA, et al. “Epidemiology and management of uterine fibroids.” Obstetrics & Gynecology, 2017. PubMed
2. Uterine Fibroid Embolization. StatPearls, StatPearls Publishing, 2024. NCBI Bookshelf
3. Gupta JK, et al. “Uterine artery embolisation in women with symptomatic uterine fibroids.” Cochrane Database of Systematic Reviews, 2014. PubMed