Leiomyomas, often called fibroids or myomas, are the most common benign uterine tumors. Fibroids often do not cause any symptoms. The condition develops in nearly 40% of all women in the U.S. and over 50% of women of African descent.
Fibroids that occupy the uterine cavity (submucosal) will often cause excessive bleeding and can lead to both infertility and recurrent miscarriages. Fibroids that distort the uterine cavity but are within the wall (intramural) and not within the uterine cavity may cause increased bleeding, and reproductive problems. Fibroids that are pushed to the outside of the uterus and do not distort the cavity usually have no effect on fertility or miscarriage, but if excessively large, can present problems during pregnancy.
Diagnosing fibroids
The diagnosis of fibroids is generally made on a pelvic exam and confirmed with an ultrasound. Symptoms associated with fibroids include heavy bleeding with the menses, painful periods or pressure symptoms, and urinary symptoms. Fibroids that impact the uterine cavity can cause recurrent miscarriages and may contribute to infertility.
The impact of the fibroid on the uterine cavity is the most important predictor of its clinical significance. As a result, further imaging of the uterine cavity is an important next step in assessing fibroids once they have been diagnosed.
Our team leverages a sonohysterogram imaging test, also known as a saline infusion sonogram (SIS). This test combines transvaginal sonography with saline instilled into the uterine cavity to provide a precise definition of the uterine cavity as well as imaging of the fibroids and their location in reference to the uterine cavity. Additionally, by obtaining a three-dimensional measurement of the cavity distortion, enlargement of the uterine cavity due to fibroids can be assessed.
Fibroids are often described by their location in the uterus:
- Myometrial — in the muscle wall of the uterus
- Submucosal — just under the surface of the uterine lining
- Subserosal — just under the outside covering of the uterus
- Pendunculated — occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus
Symptoms
More common symptoms of uterine fibroids are:
- Bleeding between periods
- Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
- Menstrual periods that may last longer than normal
- Needing to urinate more often
- Pelvic cramping or pain with periods
- Sensation of fullness or pressure in lower abdomen
- Pain during intercourse
Note: There are often no symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and do not cause symptoms in women who have gone through menopause.
Treatment options
There are many modalities to treat uterine fibroids, but it should be noted that after sonohysterography, most fibroids do not require any treatment. Surgical treatment of fibroids includes hysteroscopy myomectomy for fibroids in the cavity, laparoscopic or robotic myomectomy for fibroids in the wall of the uterus, and some large or partially cavitary fibroids may benefit from open myomectomy. Additionally, in women who no longer want to conceive, treating fibroids and bleeding with combined hysteroscopic myomectomy and endometrial ablation for cavitary myomas, or MRI-guided sonoablation for large intramural myomas may be an appropriate option.
