What are Uterine Fibroids?

Uterine fibroids (also known as leiomyomas or myomas) are non-cancerous growths that develop from the muscle tissue of the uterus. They are extremely common — up to 70-80% of women will develop fibroids by age 50. Many fibroids cause no symptoms and require no treatment.

Types of Fibroids

Fibroids are classified by their location within the uterus:

Subserosal — grow on the outer surface of the uterus
Intramural — grow within the muscular wall of the uterus
Submucosal — grow just beneath the inner lining (endometrium) and protrude into the uterine cavity
Pedunculated — attached to a stalk, either on the outer surface or within the cavity

Symptoms

Many women with fibroids have no symptoms. When symptoms do occur, they may include:

Heavy or prolonged menstrual bleeding — the most common symptom, particularly with submucosal fibroids
Pelvic pressure or pain — especially with larger fibroids
Urinary frequency or difficulty emptying the bladder — when fibroids press on the bladder
Constipation — when fibroids press on the rectum
Reproductive difficulties — some fibroids can affect fertility or cause pregnancy complications

Diagnosis

Fibroids are often diagnosed through:

Pelvic examination — larger fibroids may be felt during physical exam
Pelvic ultrasound — the primary imaging modality for assessing fibroid size, number, and location
MRI — may be used for detailed surgical planning
Hysteroscopy — to evaluate submucosal fibroids

Treatment Options

Expectant Management

If fibroids are asymptomatic, observation with periodic monitoring is often appropriate. Many fibroids shrink after menopause.

Medical Management

Hormonal therapies to reduce bleeding (progestins, combined oral contraceptives, hormonal IUD)
GnRH agonists or antagonists to temporarily shrink fibroids
Tranexamic acid to reduce menstrual bleeding

Surgical Options

Myomectomy (Uterus-Preserving)

Removal of fibroids while preserving the uterus. This is the preferred approach for women who wish to preserve fertility or avoid hysterectomy.

Laparoscopic myomectomy — for selected fibroids depending on size, number, and location
Hysteroscopic myomectomy — for submucosal fibroids, performed through the cervix with no abdominal incisions
Open myomectomy — for very large or numerous fibroids

Hysterectomy

Definitive treatment involving removal of the uterus. May be performed laparoscopically, vaginally, or through an open incision depending on uterine size and other factors. This is typically considered when childbearing is complete and other treatments have been inadequate.

Note: The decision between myomectomy and hysterectomy depends on symptom severity, fibroid characteristics, age, fertility goals, and patient preference. Dr. Kruger emphasizes shared decision-making and individualized care.