Fibroids are very common. At least 25 percent of women have signs of fibroids that can be detected by a pelvic examination or ultrasound; not all of these women have symptoms of their fibroids.

FIBROID CAUSES — Although the exact cause of fibroids is unknown, fibroid growth seems to be related to the hormones estrogen and progesterone. When these hormone levels decline at menopause, many fibroid-related symptoms begin to resolve. However, it is not clear that hormones actually cause the fibroids. And in fact, women who have had high levels of both of these hormones during pregnancy or from taking birth control pills have a lower incidence of fibroids later in life.

FIBROID SYMPTOMS — The majority of fibroids are small and do not cause any symptoms at all. However, many women with fibroids have significant bleeding and/or pelvic pain that interfere with some aspect of their lives.

The severity of symptoms is related to the number, size, and location of the fibroids. Fibroid symptoms fall into three main groups: increased uterine bleeding, pelvic pressure and pain, and problems related to pregnancy and fertility. Fibroid symptoms tend to decrease at the time of menopause.

Pelvic pressure and pain: Fibroids can range in size from microscopic to the size of a grapefruit or even larger. Larger fibroids may cause a sense of pelvic pressure or fullness in the abdomen, similar to that caused by pregnancy.

FIBROID DIAGNOSIS — Fibroids are often diagnosed during a routine pelvic exam. A pelvic ultrasound may be recommended to confirm the diagnosis.

Hysterosalpingogram: A hysterosalpingogram (also called HSG or tubogram) may be recommended for a woman who is trying to become pregnant. During this test, an x-ray of the uterus and tubes is taken after dye is inserted through the cervix. The dye outlines the shape of the inside of the uterus and fallopian tubes. This test can diagnose the presence, size, and location of fibroids in the uterine cavity, and can show if the fallopian tubes are patent (open).

FIBROID TREATMENT — Women who have no symptoms from their fibroids do not usually require treatment. Women with significant symptoms may try medical or surgical treatment.

Medical fibroid treatment: Medical treatment includes the use of medications to treat the symptoms of fibroid-related bleeding and pain.

Surgical fibroid treatment: Surgical fibroid treatment may be recommended for longer-term relief of fibroid symptoms such as bleeding and pain. In other cases, surgical fibroid procedures are done in an attempt to treat infertility. A number of surgical fibroid treatments are available.

Choosing a fibroid treatment: A number of factors should be considered before deciding upon the best surgical treatment for fibroids. One of the most critical factors is whether or not childbearing has been completed.

• Although hysterectomy provides excellent relief of symptoms, a woman who wishes to become pregnant in the future should consider myomectomy.

• A woman who is done with childbearing but who is not interested in hysterectomy may consider uterine artery embolization, myolysis, endometrial ablation, or a combination of the above.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.