FIBROIDS

What are fibroids?

Fibroids are non-cancerous growths in the uterus. They can have different sizes, shapes and locations on the uterus. They can be in the inside of the uterus (submucosal), within the walls (intramural), outer surface (subserosal) or attached by a stem (peduculated).

How do I know if I have fibroids?

If you have fibroids, you might have:

Heavy, more frequent or longer menstrual periods
Painful periods
Difficulty or frequent urination
Constipation or difficult bowel movements
Enlarging abdomen
Miscarriage or pregnancy loss
Difficulty getting pregnant

Most women with fibroids do not have any symptoms.

How are fibroids diagnosed?

Ultrasound is the most common test to find fibroids. Sound waves are used to create a picture of the uterus. Sometimes, a sonohysterogram is needed find the location of the fibroids. This is a test where fluid is put into the uterus through the cervix. Ultrasound is then used to create a picture of the inside of the uterus. Other tests, such as MRI and CT scans, may be used but are rarely needed.

I have fibroids. Do they need to be treated?

If your fibroids are small and not causing symptoms, you do not need treatment.

Fibroids should be treated if they are causing:

Heavy menstrual bleeding or discomfort
Growing quickly
Miscarriage or difficulty getting pregnant

What medications can I use to treat my fibroids?

There are many drugs that can treat fibroids. You should talk about the side effects of these medications with your doctor.

Here are some options:

Birth control pills: these hormone-based drugs control heavy bleeding and painful periods.
Progestin-releasing intrauterine device: the device can stay in the uterus for up to 5 years. It releases a hormone called progesterone to decrease bleeding.
Selective progesterone receptor modulator (SPRM): this hormone-based drug decreases heavy bleeding and shrinks fibroids.
Gonadotropin-releasing hormone (GnRH) agonist: this drug decreases your hormone levels to stop bleeding and shrink fibroids.
Tranexemic acid: this non-hormone drug decreases heavy bleeding.

What types of surgery can be used to treat fibroids?

Your options for surgery depend on the size and location of the fibroids. It also depends on if you want to have children in the future. You should talk about the risks and benefits of surgery with your doctor.

These are your options:

Myomectomy: this is the surgical removal of fibroids leaving the uterus in place. This surgery lets a woman keep her uterus so that she can have babies in the future. If a woman becomes pregnant, she might need a cesarean section for the birth of the baby after this surgery. There are 3 ways to do this surgery: laparotomy (open surgery with 1 large incision on the abdomen), laparoscopic (keyhole surgery with 4 small incisions on the abdomen), and hysteroscopic (no incisions. The fibroid is removed using a device inserted through the vagina.)
Hysterectomy: this is the removal of the uterus, including the fibroids inside the uterus. This surgery is for women who no longer want babies. Your ovaries may or may not be removed. There are 3 ways to do this surgery: laparotomy, laparoscopic, and vaginal (no incisions on the abdomen. The uterus is removed through the vagina.)

Are there any other options for treating my fibroids?

Some women cannot take the medications or have surgery. There are other options for treating fibroids. You should talk to your doctor to see if these are good treatment options for you.

Uterine Artery Embolization (UAE): a radiologist performs this procedure. Tiny particles are injected into the blood vessels to the uterus. This blocks the blood flow to the uterus and causes the fibroids to stop growing. Because this blocks the blood flow to the uterus, it can cause problems in future pregnancies. Women who want children should consider other treatments.

High Intensity Focused Ultrasound (HIFU): a radiologist performs this procedure. Sound waves are focused into the fibroid to heat and destroy the fibroid. Because this is a newer technology, we do not know the effects on future pregnancy. We recommend that women who want children should consider other treatments. In Canada, this is still considered experimental and patients can only access this through clinical trials.