African-American women are more likely to develop uterine fibroids and have larger fibroids.

Story by: Amy Higgs on April 10, 2019

As recently as 30 years ago, if a doctor found a mass on the smooth tissue of a woman’s uterus, it was assumed to be dangerous and surgically removed, regardless of whether it caused any symptoms.

Today, we know that these masses, called uterine fibroids, often don’t require treatment at all, according to Jonathan Reinstine, M.D., OB/GYN with Associates in Obstetrics & Gynecology, a part of Norton Women’s Care. “If a woman has a fibroid that is not causing symptoms, or if it isn’t growing rapidly, we can often leave it alone. Uterine fibroids are rarely cancerous.”

Uterine fibroids will develop in up to 50 percent of women in the United States. They are more common in black women, often occurring at younger ages than in white women. If you are African American, you also are more likely to have more fibroids or larger fibroids.

Fibroids can occur on the outer wall of the uterus (subserosal), on the inner wall (submucosal) or within the uterine wall itself (intramural).

Uterine fibroid symptoms

There are two main types of symptoms: pain symptoms and bleeding symptoms, according to Dr. Reinstine. Fibroids can cause a woman to feel pressure or pain in her pelvis and on the pelvic floor. Heavy or prolonged periods can also be a sign of submucosal fibroids on the inner wall of the uterine cavity.

“There may be other symptoms if a fibroid compresses a neighboring organ,” Dr. Reinstine said. “For example, a woman might have urinary-related symptoms if a fibroid is right behind her bladder or bowel symptoms, such as a sensation of constipation, if the fibroid is on the back wall of the uterus and pressing on the colon.”

Submucosal fibroids also can cause infertility. If they distort the shape of the uterus, it could make it difficult to get pregnant or have a successful pregnancy, according to Dr. Reinstine.

Uterine fibroid treatment

Often, doctors can detect possible fibroids during a routine pelvic exam. An ultrasound can then confirm the diagnosis. Surgery is still the main treatment to remove fibroids — they cannot be cured with medication.

The two most common surgeries are myomectomy, which removes only the fibroids, and hysterectomy, which often is recommended for women past their childbearing years because it can be a less involved procedure with an easier recovery.

“When we perform surgery, we want to do the least invasive, least risky, least complicated procedure, but that still meets our patients’ needs,” Dr. Reinstine said.

The type of surgery that can be used depends on the location of the fibroids. For fibroids inside the wall or on the outer wall of the uterus, a myomectomy can be performed laparoscopically, robotically or through an open incision in the abdomen. Fibroids on the inside of the uterine wall often can be removed hysteroscopically, through the cervix.

Uterine fibroid embolization, a nonsurgical procedure performed by a radiologist, also has been shown to successfully treat some fibroids. Using an X-ray called fluoroscopy, the arteries leading to the fibroids are blocked, which cuts off their blood supply. This shrinks large fibroids, relieving pressure and pain.

All of these treatments are available through the Norton Women’s Care Pelvic Health Program, a multidisciplinary program specializing in caring for pelvic disorders, including uterine fibroids, through advanced, minimally invasive treatments.

“We’re a center of excellence for laparoscopic and hysteroscopic surgery,” Dr. Reinstine said. “We customize treatment based on a number of factors, including location of fibroids, their size, symptoms, a patient’s age and their preferences. Treatment is truly individualized. That’s the beauty of a state-of-the-art center like ours.”