Uterine fibroids are common, affecting as many as 75% of women in the United States. In most cases, these small, noncancerous tumors are harmless and do not require medical treatment.

In some circumstances, however, uterine fibroids can grow large and lead to a range of symptoms. Even small fibroids can be problematic, depending on their location. At Yale Medicine, we specialize in treating uterine fibroids that lead to medical complications or fertility problems.

"When a woman comes to us for fibroids, our first priority is listening to understand her needs and goals,” says Sangini Sheth, MD, MPH, chief of Yale Medicine Obstetric and Gynecologic Specialties. “Are they bleeding? At risk for cancer? Are they in pain or are the fibroids affecting internal organs if they are very large? In this way, we have a chance to personalize their care. We offer a whole array of treatments from medical and interventional radiology to minor and major surgical procedures.”

Uterine fibroids are benign (non-cancerous) growths inside the uterus. When uterine fibroids become too large, too numerous, or press against another organ, a woman might experience severe pelvic pain or abdominal swelling, discomfort during sex, heavy menstrual bleeding, problems when urinating or defecating, anemia due to blood loss, infertility, miscarriages, and other pregnancy complications.

The greatest risk factor for uterine fibroids is being a woman of reproductive age. Other factors that may increase the risk are:

• Family history: A woman whose mother or sister had uterine fibroids is at greater risk of developing them herself.
• Race: African American women are more likely to develop uterine fibroids at younger ages. They are also likely to develop complex fibroids.
• Unhealthy lifestyle: Women who eat more red meat, drink more alcohol, and consume fewer fruits and vegetables are more likely to develop uterine fibroids. Vitamin D deficiency is also associated with increased risk of fibroids.

A woman with small fibroids may not have any symptoms unless the fibroids are impinging on the uterine cavity, in which case they can cause abnormal uterine bleeding, infertility, or miscarriage. Women with larger fibroids may have additional symptoms, including:

• Heavy, painful menstrual bleeding
• Enlargement of the lower abdomen
• Frequent urination
• Constipation
• Pain during sex
• Lower back pain

Uterine fibroids are typically detected during a standard pelvic exam. If a doctor finds any abnormal growths, follow-up tests may include:

• Ultrasound: This test uses sound waves to create images of the uterus and can help identify fibroids.
• Blood test: If a woman’s periods have been especially heavy, a doctor may check her blood to see if she has anemia (a condition that can result from blood loss). A blood test can also rule out other conditions with similar symptoms, such as thyroid problems.

Only 10% to 20% of uterine fibroid cases require treatment. There are many options available for these women. At Yale Medicine, we focus on each patient’s preferred outcome, whether it be retaining fertility or alleviating specific symptoms. For most women, surgery isn’t necessary. Some options include:

• Medication: For women with severe symptoms, medication may be an option. Pain relievers may help reduce the pain of menstrual cramps; birth control pills and other hormonal methods can control heavy periods. In addition, women might be prescribed an intrauterine device that releases progestogen (a hormone) to reduce heavy bleeding. A class of drugs called gonadotropin-releasing hormone (GnRH) agonists can reduce the size of fibroids and halt menstrual bleeding. Because of side effects, GnRH agonists are typically used for up to six months, and fibroids will usually return to their previous size after the drug is stopped.
• Uterine fibroid embolization (UFE): This procedure is used to alleviate severe symptoms and complications such as anemia, cramps, or incontinence. Small particles are injected into the blood vessels that supply the fibroid, starving it of its blood supply and causing the fibroid to shrink.
• Endometrial ablation: In this procedure, which is also intended to alleviate symptoms, a thin layer of the uterus is destroyed, which can reduce menstrual bleeding. It can be done quickly in the doctor’s office.
• Magnetic resonance-guided focused ultrasound: This technique uses magnetic resonance imaging (MRI) to direct focused ultrasound waves to the fibroid, which can shrink it and reduce symptoms.
• Surgery: For some women, surgery may be recommended. Uterine fibroids can negatively impact fertility, and surgically removing them with a procedure called a myomectomy may be an option for a woman who wishes to become pregnant. There are several different ways to perform a myomectomy. A surgeon may access the uterus by inserting a surgical instrument through the navel (laparoscopic), through the vagina (hysteroscopic), or through an incision in the abdomen (laparotomy). Certain fibroids can also be removed using robotic surgery while preserving fertility. In rare cases, a doctor may recommend a hysterectomy, which is the removal of the uterus.

Although fibroids are benign, their impact on daily life should not be downplayed. At Yale Medicine, we recognize that uterine fibroids can seriously impact physical and emotional well-being, and we work closely with patients to evaluate all possible treatment options.

"If the main concern is pain, we gear treatment to that. If it's fertility, we might explore surgery," says Linda Fan, MD, a Yale Medicine gynecologic surgery specialist. "We take a holistic approach to guide treatment and look at the big picture of what is best for the patient."

The benefits of coming to an academic medical center such as Yale are many, she adds. "We have high-volume surgeons and physicians who see uterine fibroids frequently, and many of them have specialized training," she says. "Forty years ago, hysterectomies were the only option for fibroids, but now we have more alternatives, from new medical management strategies to minimally invasive surgery."