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May 7, 2009 – Vol. 3 • No. 9
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Questions & Answers

1. Why do uterine fibroids cause infertility?

A fibroid sometimes blocks the fallopian tubes and prevents sperm from reaching and fertilizing eggs, which may cause fertility problems. In some cases, fibroids may prevent a fertilized egg from implanting in the uterine lining. However, treatment of the fibroids may restore fertility.

2. Why are women with fibroids often anemic?

Women with fibroids tend to have periods that are heavier than usual. The more extensive monthly blood loss results in a low red blood count, or anemia. Some women are advised to take iron supplements to boost their red blood count.

3. Is there medication a woman can take to shrink her fibroids?

Yes there is, but it tends to be used for shorter periods of time. Hormonal therapy (Depo Leuprolide injections) is used to shrink the fibroids. This medicine reduces the production of the hormones estrogen and progesterone. The treatment creates a situation in the body that is very similar to menopause. Side effects can be severe and may include hot flashes, vaginal dryness, and loss of bone density. Hormone treatment may last several months. Fibroids will begin to grow again as soon as treatment stops. Hormone therapy is often used before surgery or when the woman is expected to reach menopause soon.

4. If a woman has no symptoms of fibroids, how does she know she has them?

Fibroids may be identified incidentally if a woman is having an ultrasound, x-ray, or CT scan of her abdomen for some other reason. Additionally, a physician may notice a fibroid or an enlarged uterus during a pelvic exam.

5. If a woman has fibroids that do not cause symptoms, does that mean she will remain symptomless?

Not necessarily. Fibroid growth seems to depend on the hormone estrogen and is not predictable. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. The slow growth over time may result in fibroids that are more noticeable in women in their 40s, as their fibroids may eventually reach a size to cause symptoms. Additionally, fibroids may grow more rapidly during pregnancy because of the surge in hormone levels and increased blood flow.

6. Can fibroids become cancerous?

No, fibroids are non cancerous tumors that are not known to change into cancerous growths.

7. How do fibroids affect pregnancy?

After a pregnancy develops, existing fibroids may grow due to the increased blood flow and estrogen levels. The fibroids usually return to their original size after the baby is delivered. Most women are able to carry their babies to term, but some end up delivering prematurely because there is not enough room in the uterus. Some pregnant women with fibroids may need a Cesarean section because fibroids can occasionally block the birth canal or cause the baby to be positioned wrong.

8. Is a hysterectomy the only treatment option for fibroids?

No. There are multiple treatments and the decision about what option to pursue depends on multiple factors including a woman’s age and whether she plans to have children in the future. Birth control pills can be used to control the heavy periods. Non steroidal anti inflammatory drugs, such as ibuprofen, are helpful with treating painful menstrual cramps.

Procedures and surgical options used to treat fibroids include:

Uterine artery embolization: This procedure stops the blood flow to the fibroid, causing it to die and shrink.

Myomectomy: This surgery removes the fibroids. It is frequently the chosen treatment for women who want to have children because it usually can preserve fertility. Another advantage of a myomectomy is that it controls pain or excessive bleeding that some women with uterine fibroids have.

Some fibroids can be removed through hysteroscopy in which a small camera and instruments are inserted through the cervix into the uterus. This outpatient procedure may be used for women with fibroids growing inside the uterine cavity rather than on its outside wall or in the muscle of the womb.

A disadvantage of myomectomy is that more fibroids can develop after the procedure.

Hysterectomy: This invasive surgery, which involves removal of the uterus, may be an option if medicines do not work and other surgeries and procedures are not an option.

Lisa Michelle Owens
Lisa Michelle Owens, M.D.
Medical Director
Brigham Primary Physicians at
Faulkner Hospital

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