Do I Have Uterine Fibroids? A Q&A with Dr. Wittenberg

dreamstime_s_52261963Dr. Heidi Wittenberg, Director and physician at the Urogynecology Center of San Francisco recently answered some of the most common questions asked by patients about uterine fibroids. Check out the Q&A with Dr. Wittenberg below to read her answers and contact UGSF today if you’d like to learn more about fibroids and fibroid treatment with Dr. Wittenberg.

What are uterine fibroids?

Fibroids are benign growths in the wall of the uterus that can vary in size from small pea to the size of a basketball. They can grow at varying rates and can arise from the inner layer of the wall and protrude into the uterine cavity, or be in the middle of the wall, or grow along the outside edge of the uterus.

What causes uterine fibroids?

Some cells in the uterine wall abnormally develop and start to grow at varying rates.

What are the symptoms of uterine fibroids?

Heavy periods, painful periods, pelvic fullness, sometimes lower back pain, or if located in the uterine cavity they can cause difficulty getting pregnant. Also, if large enough, the fibroid can press on the bladder and cause urinary urgency and frequency, or if pressing on the rectum cause constipation.

Are uterine fibroids cancerous?

Fibroids themselves are not cancerous. They are benign. Occasionally a growth that looks like a fibroid, is actually not a fibroid, but a rare cancer. The most talked about is one called leiomyosarcoma, usually detected as a single growth with the appearance of a fibroid. These start to grow around the age of menopause. True incidence is unknown and ranges from 1/300- 1/1500 of women with symptomatic fibroids. More research is needed on screening and detecting these particular cancers.

Are uterine fibroids painful?

Sometimes fibroids can cause painful periods or if they have grown fast enough to outgrow their blood supply they can become painful.

How are uterine fibroids treated? 

How to treat uterine fibroids depends on symptoms, age, fertility concerns, location of fibroids, size of fibroids, number of fibroids and other medical issues a woman may concurrently be treated. Usually if asymptomatic, observation is reasonable and preferred. Depending on the symptoms and severity treatments go from medications first to minimally invasive options. Medication treatments commonly start with low dose birth control periods to control heavy periods and cramping. A progesterone IUD insertion to help with cramping and bleeding as well. If procedures are then needed we like to start with the most minimally invasive option then progress up the ladder if needed.

Options include: endometrial ablation, radio frequency of fibroids, removal of fibroids hysteroscopically, removal of fibroids laparoscopically, offering ablation/embolization of fibroids vessels, sometimes open surgery, or removing a uterus that has already had multiple fibroid removals and the woman is done with childbearing. Under research right now are ultrasound treatments.

When should I see a fibroid specialist?

If you start having symptoms or symptoms that medication has not helped you need to see a specialist. Symptoms include: heavy periods, heavy cramping, pressure symptoms on your bowel or bladder like urinary frequency, urgency, constipation, or you can’t get pregnant.