Fibroids

What are fibroids?

Fibroids are non-cancerous growths that develop in or on the uterus, commonly affecting women during their reproductive years.

Also known as uterine leiomyomas or myomas, fibroids vary in size and number and can be asymptomatic or cause significant symptoms. Common signs include heavy menstrual bleeding, pelvic pain, frequent urination, and fertility issues. The exact cause is unknown, but hormones (especially estrogen) are believed to play a key role.

Diagnosis typically involves pelvic exams and imaging like ultrasound or MRI. Treatment options range from medication to surgical procedures such as myomectomy or hysterectomy, depending on symptoms and fertility goals. Fibroids are very common and often manageable with proper care.

Classification of fibroids

There are five different classifications: intramural, subserosal, submucosal, intracavity, and cervical.

Intramural fibroids

These are located in the thick wall of the uterus (myometrium) and are the most common type of fibroids, but also the easiest to remove.

Subserosal fibroids

Located in the outer wall of the uterus, these can often grow to be the largest. They are one of two types of fibroids that can form a “stalk” on which the mass is attached (pedunculated fibroids).

Submucosal fibroids

These are located in the muscle beneath the lining of the uterine wall (endometrium). They also can form pedunculated fibroids.

Intracavity fibroids

These are located in the cavity of the uterus itself.

Cervical fibroids

These form in the cervix (the neck of the uterus).

Causes and risk factors of fibroids

The exact cause of fibroids is not fully understood, but they are believed to be influenced by hormonal factors, especially estrogen. High estrogen levels during reproductive years can promote fibroid growth. Genetics also play a role, as women with a family history of fibroids are at higher risk.

Additionally, age and childbirth history can influence fibroid risk, with women over 30 and those who have not had children being more likely to develop them.

Fibroids and pregnancy

For the most part, fibroids do not usually affect pregnancy. Nevertheless, there are some instances in which they can make conception difficult and even lead to miscarriages. When they physically distort the uterine cavity, several complications can arise, including infertility, recurrent miscarriages, premature labor, or complications of labor. As a result, in the case of large symptomatic fibroids, women may often choose to undergo an imaging review of the uterus via hysteroscopy or hysterosalpingography.

Fibroids may also press against and block the entrance to the fallopian tubes, subsequently preventing the egg from reaching the uterus. When they block the birth canal, they can interfere with labor and delivery, causing the need for a Caesarean section. Finally, they can prolong post-delivery recovery as they can increase heavy bleeding and the time it takes for a woman’s womb to return to its normal shape and size.

It is also important to note that pregnancy can cause fibroids to develop due to the elevated levels of progesterone and estrogen. However, there is little evidence to support this theory. Pregnancy may also cause “red degeneration.” This condition cuts off the fibroids’ blood supply and causes the fibromas to turn red and die, subsequently triggering intense abdominal pain and contractions of the womb that can lead to miscarriages.

Congruent disorders

Benign fibromas (leiomyomas) can transform into leiomyosarcomas, malignant smooth muscle tumors in the uterus, in about 0.1% of cases. A pathological exam is the only way to observe this rare transformation. Patients with fibroids often present with anemia.

Fibroids vs. Adenomyosis

There are many cases in which doctors misdiagnose fibroids as adenomyosis or vice versa. However, fibroids are more of a focal condition in which benign singular fibromas arise in several areas of the uterus. Adenomyosis, on the other hand, is usually more diffuse. Even in cases of focal adenomyosis and adenomyoma adenomyosis, the diseased areas are more spread out and contain small pools of blood as opposed to the single, focal mass that is a fibroma. Adenomyosis is ultimately much more challenging and “messier” to remove with excision surgery.

Symptoms of fibroids

Symptoms of fibroids can vary widely depending on their size, number, and location in the uterus. Some people may have no noticeable signs, while others experience symptoms that significantly affect daily life. One of the most common issues is heavy or prolonged menstrual bleeding, which can lead to anemia and fatigue over time.

Pelvic pain or pressure is another frequent symptom. As fibroids grow, they can press against surrounding organs, causing discomfort in the lower abdomen or back. This pressure may also lead to frequent urination if the bladder is affected or constipation when the fibroids press on the bowel. Larger fibroids can even cause visible abdominal swelling, sometimes mistaken for weight gain or pregnancy.

Diagnosis of fibroids

Fibroids can be visualized indirectly or directly

Indirect visualization

Like in the case of adenomyosis, an ultrasound (sonogram) is the imaging technique most commonly used to diagnose fibroids. While adenomyosis often appears as diffuse thickening of the uterine wall, fibroids appear as round areas with a discrete border. There are two forms of ultrasound used to diagnose adenomyosis. These are abdominal and vaginal ultrasounds. An abdominal pelvic ultrasound can help find large fibroids. A transvaginal ultrasound is a bit more invasive but can detect small, more nuanced ones.

While ultrasound may be the most common technique, magnetic resonance imaging (MRI) is the most powerful. MRI can distinguish leiomyomas from other intramural lesions. However, in the case of endometriosis, most physicians choose to conduct an ultrasound before an MRI because it can be done in an office setting and is far less expensive.

Direct visualization

Direct visualization techniques are more invasive and expensive than an ultrasound or MRI. They are usually performed along with surgeries or in case of highly concerning symptoms. Nevertheless, they provide clear and direct imaging of the uterus, and in turn, fibroids.

They include hysteroscopy and laparoscopy

During hysteroscopy, the doctor inserts a small telescope into the vagina to examine the inside of the womb. This allows them to easily visualize the fibromas.

Laparoscopy is a slightly more invasive procedure that allows the direct visualization of the outside of the uterus and the surrounding pelvic structures. Here, the doctor inserts a laparoscope, a tube with a small camera at one end, into small incisions that they make in the abdominal and pelvic cavities.

Treatment options

There are non-surgical and surgical methods of treatment.

Non-surgical

While there are no medications that will permanently shrink fibroids, there are drugs that can help control symptoms. These medications lower estrogen and progesterone levels, while simultaneously reducing blood flow to the fibroids. However, every case is different, and what may work for one patient may not work for another.

Doctors often prescribe birth control to reduce heavy bleeding. Short-term gonadotropin-releasing hormone agonists (GnRHa) can help shrink fibroids. They also stop menstrual flow. Long-term use of GnRHa can lead to bone loss density due to the reduced levels of estrogen. As a result, long-term use of GnRHa is supplemented with steroid hormones of estrogen and progesterone, which can safely extend the time of GnRHa use without sacrificing efficacy.

There are also several experimental treatments that are under investigation for the treatment of uterine leiomyomas.

Medicated intrauterine devices (IUD) can decrease a woman’s blood flow and thus reduce the size of her fibroids. However, this is not advised for a uterus greater than 12-weeks in size.

Some studies showed that progesterone antagonists can induce uterine shrinking and stop menstrual cycles in women with fibroids. However, this method is not available in the U.S.

The antifibrotic drug could be used to control prolonged and/or profuse blood flow in women with leiomyomas by shrinking the endometrium.

Often referred to as male hormones, synthetic androgens can also help slow or stop the growth of fibroids and relieve symptoms such as anemia and menstruation.

Finally, the French abortion pill Mifepristone can decrease the size of fibromas and reduce abdominal uterine bleeding.

Surgical

Myomectomy is the surgical removal of myomas by cutting into the uterus, followed by uterine suture repair. There are three types of myomectomies: laparotomic, laparoscopic, and hysteroscopic.

Laparotomic myomectomy is an open abdominal surgery, which gives a surgeon the full visualization necessary to remove fibroids.

Laparoscopic myomectomy is a minimally invasive abdominal surgery that is the preferred method for removing fewer than four small fibroids. This is a much more precise, difficult, and longer surgery, but is also extremely effective.

Hysteroscopic myomectomy is a minimally invasive vaginal surgery used only for small, pedunculated submucosal fibroids. This procedure does not require an incision into the abdomen.

Hysterectomy is the surgical removal of the uterus. It should only be used as a last resort. Only if the fibroids are large, diffuse, and cannot be treated any other way is a hysterectomy considered. This form of surgery is rarely needed for fibroids, and yet it accounts for ⅓ of hysterectomies in the US.

Natural treatment for fibroids

Natural treatment for fibroids focuses on supporting hormonal balance, reducing inflammation, and improving overall reproductive health through lifestyle and dietary changes. While these approaches do not remove fibroids completely, they may help manage symptoms and slow their growth in some cases. Eating a diet rich in fruits, vegetables, whole grains, and lean proteins can provide essential nutrients and support the body’s natural hormone regulation. Limiting processed foods, excess sugar, and unhealthy fats may also help reduce inflammation, which can contribute to fibroid growth.

Some people explore herbal remedies and supplements believed to support reproductive health, but these should only be used under professional guidance to ensure safety and effectiveness. Combining a healthy lifestyle with medical monitoring offers the best chance to keep symptoms under control and maintain quality of life while living with fibroids.

Our approach

With decades of operating experience, Dr. Seckin is highly skilled in treating cases of fibroids via laparoscopic myomectomy and uterine repair. We believe that excision surgery is the best method for removing myomas because it is the only way to remove a fibroma at its root. In cases of laser ablation, there are often small bits of myoma left underneath the tissue.

It is important to find a surgeon who will perform a myomectomy, thus ensuring the complete removal of each underlying fibroma. Through laparoscopic myomectomy, we are able to ensure thorough removal of the patient’s fibroids, with minimal invasion. We pride ourselves on handling each myomectomy with extreme precision and attention to detail.

Patient story

Marilyn M. was diagnosed with fibroids in her early 30s after experiencing severe pelvic pain. A few years later, Marilyn was told that she also had endometriosis. After several gynecology appointments and multiple operations, Marilyn’s half-decade battle led her to see Dr. Seckin, one of the best fibroid surgeons. Read more on how Marilyn’s treatment and comprehensive laparoscopic surgery combined with hormonal supplementation medication have changed her life.

You can read more patient stories in our testimonial section.

Frequently Asked Questions

Do fibroids go away on their own?

Fibroids typically do not go away on their own, but their size may change over time. After menopause, fibroids often shrink due to decreased estrogen levels. However, during the reproductive years, fibroids may continue to grow or cause symptoms. In some cases, small fibroids may remain stable without causing significant issues.

If fibroids cause discomfort or interfere with fertility, treatment options like medication or surgery may be necessary. Regular monitoring with a healthcare provider helps manage symptoms and assess any changes in fibroid size.

How do I know if I have fibroids?

If you have fibroids, you may experience symptoms like heavy menstrual bleeding, pelvic pain, or frequent urination. However, some women with fibroids don’t have noticeable symptoms. A pelvic exam may reveal an enlarged uterus or a mass, prompting further investigation.

Imaging tests like ultrasound or MRI can provide a clear diagnosis and determine the size and location of the fibroids. If you experience symptoms that disrupt your daily life, it’s important to consult a healthcare provider for evaluation and treatment options.

Are fibroids cancerous?

No, fibroids are generally non-cancerous. They are benign growths made of muscle and fibrous tissue in the uterus. While rare, in some cases, fibroids can develop into a type of cancer called leiomyosarcoma, but this occurs in less than 1 in 1,000 cases. Most fibroids remain harmless and do not increase the risk of cancer.

What size fibroid is considered large?

A fibroid is generally considered large if it is greater than 5 cm in diameter. Fibroids of this size can cause significant symptoms, such as pelvic pain, heavy bleeding, and pressure on surrounding organs.

In some cases, fibroids larger than 10 cm may cause noticeable abdominal bulging. Larger fibroids are more likely to require medical intervention, including medication or surgery. The impact of the fibroid depends on its size, location, and whether it’s causing symptoms.

Can I live normally with fibroids?

Yes, many women can live normally with fibroids, especially if symptoms are mild or managed with appropriate treatment. Some fibroids cause no noticeable issues and require only regular monitoring by a healthcare provider. When symptoms like heavy bleeding or pelvic pain occur, treatment options (ranging from medication to minimally invasive surgery) can help improve quality of life.

Lifestyle changes, such as maintaining a healthy weight and balanced diet, may also reduce symptom severity. Regular checkups are important to track fibroid growth or complications. With proper management, most women can lead active, healthy lives despite having fibroids. Always consult a doctor for a personalized care plan.

How to stop fibroids from growing?

Stopping fibroids from growing involves managing the factors that contribute to their development, especially hormonal balance. Since fibroids are influenced by estrogen and progesterone, treatments that regulate these hormones can help slow or prevent growth. This may include certain medications prescribed to lower hormone levels or control the menstrual cycle, reducing the stimulation that causes fibroids to enlarge.

Lifestyle habits can also play a role in prevention. Maintaining a healthy weight is important because excess body fat can increase estrogen production, which may encourage fibroid growth. A balanced diet rich in vegetables, fruits, whole grains, and lean proteins can support hormonal health, while limiting processed foods, high sugar intake, and unhealthy fats may help reduce inflammation. Regular physical activity not only supports weight control but also promotes better circulation and overall reproductive health.

What not to do when you have fibroids?

When you have fibroids, it is important to avoid habits and choices that may worsen symptoms or encourage their growth. Diets high in processed foods, refined sugars, and unhealthy fats can contribute to inflammation and disrupt hormonal balance, which may cause fibroids to enlarge. Limiting these foods and focusing on nutrient-rich, whole ingredients can help support better overall health.

Incorporating moderate physical activity into daily routines can improve circulation, reduce inflammation, and help maintain hormonal balance. Skipping medical check-ups is also risky, as fibroids can change in size or cause new symptoms without warning. Regular monitoring allows for early intervention if needed.

What makes fibroids grow?

Fibroids grow in response to hormonal factors, especially estrogen and progesterone, which stimulate the development of uterine muscle tissue. These hormones increase during reproductive years, explaining why fibroids often develop and enlarge during this time. Pregnancy can also accelerate fibroid growth due to heightened hormone levels. Genetics, obesity, and dietary habits (like high red meat consumption) may contribute to fibroid development. Certain growth factors, such as insulin-like growth factor, also play a role in cellular proliferation.

Fibroids typically shrink after menopause when hormone levels decline. Understanding these triggers helps guide treatment strategies and lifestyle adjustments to manage or slow fibroid growth effectively.

What are the symptoms of fibroids in a woman?

The symptoms of fibroids in a woman include heavy periods, pelvic pain, frequent urination, and potential fertility issues.

Other common signs are menstrual cramps, lower back pain, pain during intercourse, and a feeling of fullness or pressure in the abdomen. Some women may experience constipation or bloating if fibroids press on surrounding organs. The severity of symptoms often depends on the size, number, and location of the fibroids.

While some women remain asymptomatic, others may face significant discomfort affecting their daily life. If symptoms persist or worsen, consulting a healthcare provider is essential for diagnosis and personalized treatment options.

How do fibroids affect your life?

Fibroids can affect your life by causing heavy bleeding, pelvic pain, fatigue, and fertility issues, impacting daily comfort and well-being. Women with fibroids may struggle with prolonged or painful periods, leading to anemia and reduced energy levels. Pelvic pressure or discomfort can interfere with physical activity, sleep, or sexual health. In some cases, fibroids may complicate pregnancy or make conception more difficult.

Emotionally, managing chronic symptoms can affect mental health and quality of life. However, many treatment options (from medication to surgery) can relieve symptoms. Early diagnosis and personalized care help minimize fibroids’ impact, allowing most women to maintain an active and fulfilling lifestyle.