Understanding the most common benign gynecologic tumors affecting up to 80% of women by menopause
Understanding the most common benign gynecologic tumors affecting up to 80% of women by menopause
Call 911 or go to the nearest emergency room immediately. Do not delay care.
Uterine fibroids (also called leiomyomas or myomas) are benign (non-cancerous) smooth muscle tumors that grow from the muscle wall of the uterus. They are the most common pelvic tumors in women, with diagnoses in 50-70% of women by menopause, and rates exceeding 80% in Black women.
Fibroids can range from tiny seedlings smaller than a grain of rice to large masses that can enlarge and distort the uterus. Most women have multiple fibroids. While 70-80% of women will develop fibroids, only 25-30% experience significant symptoms.
When symptomatic (about 30% of cases), fibroids can cause:
Fibroids are the leading indication for hysterectomy in the United States, accounting for 39% of all hysterectomies. Black women face a disproportionate burden, developing fibroids at younger ages, with larger and more numerous tumors, and more severe symptoms.
Note: 70% of women with fibroids are asymptomatic. Fibroids are often discovered incidentally during pelvic exams or imaging for other reasons.
Fibroids are classified by their location in or on the uterus, which affects symptoms and treatment options. The International Federation of Gynecology and Obstetrics (FIGO) classification system categorizes fibroids into types 0-8.
Project into the uterine cavity. Most likely to cause heavy bleeding even when small. May interfere with fertility and implantation.
Located within the uterine wall. Can cause uterine enlargement, pressure symptoms, and heavy bleeding. Most common type.
Project outward from the outer surface of the uterus. May cause pressure symptoms but less likely to cause heavy bleeding. Can become very large.
Cervical fibroids, broad ligament fibroids, or other unusual locations.
Pelvic examination + transvaginal ultrasound (TVUS): Ultrasound is the preferred initial imaging modality. Can detect fibroids, determine number, size, and location.
MRI: Most accurate imaging (99% sensitivity). Used for:
Saline infusion sonography (SIS): Fluid instilled into uterus during ultrasound to better visualize submucosal fibroids that project into the cavity.
Treatment depends on symptoms, fibroid size and location, desire for future pregnancy, and proximity to menopause. Many options exist between watchful waiting and hysterectomy. This is educational information only - treatment decisions should be made with your healthcare provider.
Recommended for asymptomatic fibroids. Most fibroids shrink after menopause. Regular monitoring with periodic exams or imaging.
Note: Long-term efficacy data for some minimally invasive procedures is still emerging.
Leiomyosarcoma (malignant fibroid) occurs in less than 1% of cases (approximately 1 in 400 women with fibroids). Key points:
This educational content cannot and does not:
Treatment decisions require individualized assessment of your symptoms, fertility desires, age, and fibroid characteristics by your healthcare provider.
Often coexists with fibroids. Learn about this related condition.
Scripts for discussing treatment options and getting second opinions
Understanding pelvic imaging options
Fibroid symptoms often peak in this decade. Learn about life stage-specific considerations.