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My doctor says I have fibroids. Should I worry?

A tumor of the uterus, fibroids are usually more bothersome than dangerous. Dr. Judith Reichman has details, including treatments.

Q: My periods have gotten heavy recently, and the doctor told me I have fibroids. What are these? Will I get cancer or need surgery to get rid of them?

A: Fibroids are common — so common that if I were to examine 100 women age 35 or older by pelvic exam or ultrasound, I would diagnose fibroid tumors in 40 of them.

Fibroids, or myomas, are benign tumors of uterine smooth muscle fibers. They can grow within the wall of the uterus (intramural fibroids), project outward onto the uterine surface like “Mickey Mouse ears” (subserosal fibroids) or grow downward into the uterine cavity (submucosal fibroids).

Intramural and subserosal fibroids cause the uterus to become enlarged and irregular. Submucosal fibroids may cause heavy periods and prolonged bleeding.

The chance of firboids becoming malignant is nearly zero. There is a form of uterine cancer that can develop in conjunction with fibroids or cause rapid uterine enlargement that may be mistaken for fibroids, but this rare malignancy is thought to develop separately — not as a result of fibroids.

Fibroid growth seems to be stimulated by hormone production. As you enter your late 30s, several conditions that enhance fibroid growth may arise. Uterine smooth muscle tissue may become more sensitive to estrogen, while monthly hormonal cycles may add an additional stimulus by becoming unbalanced. (As your ovaries age, they may produce too little progesterone and emit surges of estrogen that aid fibroid growth.)

Some women also have a genetic tendency to this condition. If your close female relatives had fibroids, or if you are African-American, you may be more likely to develop fibroids (and at a younger age).

In general, fibroids do not mandate medical or surgical intervention. However, you might need therapy if:

  • you have very heavy or prolonged periods, causing anemia
  • you develop significant pelvic pain or pressure
  • the fibroid grows very rapidly or becomes extremely large (the equivalent of a four-month pregnancy or more).

Here are the main treatment options, which are usually directed toward the symptoms.

  • Heavy bleeding can often be controlled with birth-control pills. A ‘pill period’ tends to be lighter than one decreed by your own hormonal cycling. When you’re on the pill, the endometrium — the blood-rich mucus that lines the uterus each month — is not stimulated to the same extent, so the period is less severe. The balanced dose of estrogen and progestin in the pill may also help prevent further fibroid growth. The intrauterine system Mirena, an IUD that slowly secretes progestin, is another way to decrease endometrial buildup and reduce blood flow.
  • Monthly injections of leuprolide, a synthetic hormone usually known by its commercial name, Luprone, can be given to shut down the ovarian production of hormones, causing a temporary menopausal state. This will stop monthly bleeding and after 3 to 6 months may cause fibroids to shrink to half their size. But Lupron can also cause significant menopausal symptoms and, if given for more than six months, result in loss of bone mass. This therapy is most likely to be used temporarily to shrink fibroids and to stop bleeding so a woman can build up her blood count, making future surgery safer and easier.
  • A fairly new, non-surgical technique called embolization may help control bleeding or pain from certain types of fibroids. A catheter is threaded through the blood vessel in the upper thigh and guided into vessels that supply the fibroids. Small synthetic pellets are then injected, blocking these feeding vessels. The fibroids, denied their sustenance, undergo necrosis, or tissue death. They often shrink by 60 percent. (This process of tissue death, however, can be accompanied by severe pain, which may last for a few days or several weeks. Embolization should not be done if you want to get pregnant, since the blood supply to the uterus is diminished and may not be enough to support a growing fetus.)
  • Minimally invasive surgery is often effective for submucosal fibroids and the heavy bleeding they cause. These procedures are usually done on an outpatient basis in a procedure called hysteroscopic resection, in which the fibroids are resected, or removed, through a scope placed through the cervix and into the uterine cavity. Other techniques destroy these fibroids and ablate, or scar, the endometrial lining by freezing, laser, or heating techniques.
  • A more invasive surgery that removes the fibroid tumors is called a myomectomy. In some cases this can be done through a laparascope, using several small incisions in the belly button and lower abdomen. Open myomectomy, through a larger surgical incision, may be necessary for very large or multiple fibroids. This allows the surgeon to close the defects left after removing the fibroids and to “reconstruct” the uterus.
  • Fibroids are a still major cause of hysterectomy, but only women with very large or recurrent fibroids who don’t want the option of future childbearing should opt for a hysterectomy.

New procedures to treat fibroids are under investigation. One exciting method uses MRI to guide high-intensity ultrasound waves into the fibroids. The ultrasound causes tissue death, and the fibroids “collapse.”

Dr. Reichman’s Bottom Line: Fibroids are extremely common, and most do not need medical or surgical intervention. But if fibroids become problematic, you and your doctor should review all your treatment options.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.