Uterine Fibroids

What are uterine fibroids?

Fibroids are benign (noncancerous) growths that can occur in different locations in or outside the uterus. They’re also known as leiomyoma, or simply myoma. Fibroids vary in size and location. They can be small or as large as a grapefruit — and at that size, they can change the size and shape of the uterus. They can grow within the wall of the uterus or grow away from it. It’s also possible to have more than one fibroid at once.

Uterine fibroids are most common in women who are menstruating, but women can get them at any age, even in menopause. In fact, up to 80% of women have fibroids.

The risk of having a fibroid by age 50 is 70% in white women and more than 80% in Black women.

What are the different types of fibroids?

A uterine fibroid is classified according to where it grows in the uterus:

• Subserosal: It grows from the outer surface of the uterus (about 55% of fibroids are this type).

• Intramural: It grows within the muscular wall of the uterus (about 40%).

• Submucosal: It protrudes into the inside of the uterus (about 5%).

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When a fibroid grows away from the wall of the uterus and is attached by a stem-like structure, it is pedunculated.

Fewer than 1 in 1,000 fibroids are cancerous.

What are the symptoms of fibroids?

Not all women with fibroids have symptoms. Your healthcare provider might accidentally find fibroids during a routine pelvic examination or an imaging test. In fact, an estimated 50% of fibroids do not cause symptoms.

When women do experience fibroid-related symptoms, they can include:

• Changes in menstrual bleeding: more frequent or longer periods, bleeding in between regular periods, and heavy bleeding that can lead to anemia

• Pain: abdominal cramping, rectal pain, and pain during sex

• Pressure from an enlarged uterus: feeling of fullness in the lower abdomen; swelling of the abdomen; constipation, rectal pressure, and straining with bowel movements; frequent urination, bladder pressure, and difficulty emptying your bladder

Many women have fibroid-related symptoms that are difficult to live with. An online survey of women with fibroids found that these fibroid-related symptoms affected their quality of life:

• Lower back pain

• Fatigue

• Bloating

• Menstrual cramps

• Heavy menstrual bleeding

How common are fibroids?

Most women develop fibroids by the time they are 50 years old. Fibroids are rare before puberty, and tend to develop during the menstrual years. They are more common as women age, especially in women in their 40s and 50s. Fibroids tend to decrease in size after menopause.

Fibroids make up 40% to 60% of all hysterectomies that are carried out.

Who gets fibroids and why?

Certain risk factors can increase a woman’s risk of developing fibroids. They include:

• Diet high in red meat and low in greens

• Ethnicity

• Family history

• High blood pressure

• Increasing age

• Obesity

• Consuming soybean milk

• Vitamin D deficiency

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Black women are more likely than white women to develop fibroids. According to a large study, Black women develop fibroids at an earlier age, have bigger fibroids that grow more quickly, and have more symptoms. They are two to three times more likely to undergo a hysterectomy (removal of the uterus by surgery) for fibroids, and seven times more likely to have a myomectomy (removal of one or more fibroids by surgery).

The reason why Black women have an increased risk of fibroids remains unclear. The Study of Environment, Lifestyle, and Fibroids (SELF) trial is looking into whether vitamin D deficiency, reproductive tract infections, and African ancestry are risk factors for fibroids.

What causes uterine fibroids?

It’s still not clear what causes fibroids. Experts believe that the following factors — or a combination of them — could play a role in increasing your risk of developing fibroids.

• Genetics: Fibroids tend to “run in the family,” and certain genetic mutations have been identified. Researchers continue to study this issue.

• Hormones: Your female hormones estrogen and progesterone affect the growth of fibroids. Most fibroids grow during pregnancy and shrink after menopause, when hormone levels change.

• Lifestyle: Physical activity level, stress, eating habits, smoking cigarettes, alcohol, and caffeine consumption have been shown to play a role in the development and growth of fibroids (see below).

Can fibroids affect my ability to get pregnant?

Fibroids rarely cause reproductive issues, and have not been linked to increased risk of miscarriage. Between 5% and 10% of infertile women have fibroids.

That said, fibroids that are found within the uterine cavity (subserosal), are very large (greater than 6 cm), or grow within the muscle layer of the uterus (intramural) can affect a woman’s fertility. These fibroids can:

• Change the shape of the uterus, interfering with the movement of sperm and the number of sperm that can enter the uterus

• Block one or both of the fallopian tubes

• Change the lining of the uterus, preventing the embryo from implanting

• Affect blood flow to the uterine cavity

Are fibroids cancerous?

Fibroids are almost always benign (not cancerous). Fewer than 1 in 1,000 cases are cancerous. Cancerous fibroids are called leiomyosarcoma.

Having fibroids does not mean you are at increased risk of developing a cancerous fibroid. Fibroids do not increase your risk of other cancers affecting the uterus.

Getting a diagnosis

How are fibroids diagnosed?

If you have any of the symptoms mentioned above and someone in your immediate family has fibroids, you may be wondering if you do, too. If you have symptoms, be sure to speak with your healthcare provider about them. The first step in getting a correct diagnosis is telling your provider about your symptoms, any of your medical problems, and medical problems that run in your family.

Next, your healthcare provider will perform a pelvic examination in which they check your reproductive organs, including your cervix, uterus, and ovaries. The provider will use two hands to feel the uterus, and they will note its size. If they find that you have an enlarged uterus or a painless lump, you might have a fibroid that needs to be further checked out. Your provider may comment on how large or small your fibroid is by comparing it with the size of what your uterus would be if you were pregnant.

If your provider suspects that you have fibroids, they may also order imaging tests. These tests may take images or “pictures” of what the inside and outside of your uterus look like. These tests include:

• Ultrasound

• Magnetic resonance imaging (MRI)

• X-rays

• Computed tomography (CT or “cat” scan)

• Hysterosalpingogram (HSG)

• Sonohysterogram

You may also need to undergo a surgical procedure so your provider can see the fibroids better, depending on where they are and their size.

• Laparoscopy: A small camera is inserted through puncture holes in the skin, allowing the provider to see your organs on a monitor and take pictures.

• Hysteroscopy: A small camera is inserted into the vagina and through the cervix. This allows the provider to see into the uterus.

Before ordering tests or performing a procedure, your healthcare provider will talk with you about the options. It’s normal to feel overwhelmed with all the information, so be sure to ask questions if you have them.

What treatment options exist for fibroids?

If symptoms from fibroids are affecting your quality of life, know that treatment options are available. If you decide that you need treatment, talk to your healthcare provider about options to help manage your symptoms. Sometimes, watching and waiting is fine. But they may suggest treatment if you have these signs and symptoms:

• Heavy menstrual bleeding causing anemia, which may make you feel tired, lightheaded, and dizzy on the heaviest days of your period

• Bleeding in between periods

• Pain that affects your day-to-day activities

• Pain with intercourse

• Rapid increase in fibroid growth seen on imaging tests

• Infertility

Treatment options in the form of medication or surgery are available. They may help control heavy bleeding, improve menstrual and pelvic pain, and even shrink your fibroids.

Can fibroids be treated without surgery?

If you have mild symptoms, medication may be the best way to treat uterine fibroids. It’s also a good option for those who want the possibility of getting pregnant in the future. Here are some examples of medications that can help reduce fibroid-related symptoms:

• Over-the-counter medication, such as ibuprofen or acetaminophen, may improve menstrual pain.

• Birth control pills, patches, and rings may decrease heavy menstrual bleeding.

• Progestin-like injections (Depo-Provera) may decrease heavy menstrual bleeding or cause no menstrual bleeding.

• Intrauterine devices (IUDs) may improve menstrual pain, decrease heavy bleeding, or even eliminate bleeding.

• Gonadotropin-releasing hormone (GnRH) agonists (Lupron) may improve menstrual pain and decrease bleeding.

• GnRH antagonists (Elagolix) may improve pain related to sex and menstrual cycles, as well as decrease menstrual bleeding.

• Combination GnRH antagonist + estradiol + norethindrone acetate (Oriahnn) may improve period- and intercourse-related pain and decrease bleeding.

Surgical treatment for fibroids

If your fibroids are causing moderate to severe symptoms, surgery may be the best option. That said, the most definitive option (hysterectomy) will prevent you from getting pregnant in the future.

• Myomectomy: surgical removal of fibroids while leaving the uterus in place

• Hysterectomy: surgical removal of the entire uterus

Nonsurgical procedures that treat fibroids

If you have symptoms that are not controlled by hormonal medications and do not want a hysterectomy or a myomectomy, these procedures might be for you:

• Hysteroscopy: A thin, tube-like instrument is used to remove fibroids growing inside the cavity of the uterus. The fibroid is destroyed by electricity or laser energy.

• Uterine artery embolization (UAE): Tiny particles are injected into the vessels that supply blood to the uterus. These particles cut off the blood flow to the fibroid, causing it to shrink.

• Radiofrequency ablation: Heat is used to shrink the fibroid without harming the normal lining of the uterus.

• MRI-guided ultrasound surgery: Ultrasound waves are used to destroy the fibroids.

It’s best to speak with your healthcare provider about all the options so you can make a plan together.

Prevention 

Lifestyle changes may help lower your risk of fibroids. Some studies suggest that certain food choices and activities may decrease your risk of developing fibroids. While the studies are not conclusive, there is no harm in eating well, getting regular activity, and maintaining a healthy weight.

How do lifestyle and diet affect fibroids?

Here’s what we know so far about some of these factors:

Exercise

Regular physical activity protects against fibroids, based on a few studies. Women who exercised the most (>7 hours per week) were significantly less likely to have fibroids than those who exercised the least (<2 hours per week).

Stress

Stressful experiences are linked to an increased risk of fibroids. One study showed that childhood exposure to physical, sexual, and emotional abuse increased fibroid risk, although having an emotionally supportive relationship during childhood might lessen that risk.

Diet

Several studies suggest that eating fruits and green vegetables can protect you from fibroids, including:

• Citrus fruit

• Cruciferous vegetables (broccoli, cabbage, and Chinese cabbage)

• Tomatoes

• Apples

In an Italian case–control study, eating a lot of beef and other red meats or ham was associated with an increased risk of fibroids. Eating fish was linked with a decreased risk.

Vitamin D deficiency

Several studies suggest that vitamin D deficiency is a risk factor for uterine fibroids. Also, vitamin D3 has been shown to slow the growth of fibroids in animal studies.

Smoking and alcohol consumption

Studies are mixed when it comes to smoking and increased risk of fibroids. The link between alcohol consumption and a higher risk of fibroids seems to be stronger.

Caffeine consumption

Caffeine consumption has not been proven to be a risk factor for fibroids.

Getting help

If you have reached a point where you need medical help for the symptoms of your fibroids, or you think you may have fibroids but you need a diagnosis, see a women’s health provider. Your provider will ask you about your symptoms, medical history, and any medications you have tried. They may perform a pelvic exam during a face-to-face visit and possibly order an imaging test to locate your fibroid(s) and measure the size. The information from your visit and the tests can help determine the best next steps.

If you already have medication treatment for uterine fibroids and need a refill, consider scheduling a consultation with an online doctor through a telehealth service like GoodRx Care.

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Costs and savings tips

What percentage of the cost of fibroid treatment is usually covered by insurance?

Most insurance plans cover diagnosis and treatment for fibroids, especially if you’re having fibroid-related symptoms. But the level of coverage will differ depending on what kind of insurance you have and how you use it. Some health insurers may require you to try medication before they will cover a surgical procedure, such as a hysterectomy or myomectomy.

When possible, keep your share of out-of-pocket costs lower by going with in-network providers instead of out-of-network providers.

If you’re insured, among the costs you could face are:

• Copays for visits with your healthcare provider

• Copays or coinsurance for prescription drugs

• Copays or coinsurance for laboratory work (blood draws)

• Copays or coinsurance for imaging

• Hospital coinsurance if you need surgery

Be sure to check your plan for the specifics because coverage is different with each plan.
In general, conditions such as uterine fibroids that don’t require urgent action may allow you time to compare prices and potentially save money. This is especially helpful if you don’t have insurance or if you have a high-deductible health plan. It can also pay to shop around if you’re prescribed an expensive medication or one that isn’t on your insurer’s list of covered drugs.

What is the monthly cost of typical medication for fibroids?

For people without health insurance, treatment with drugs typically ranges from $20 a month to $240 per year. For example, birth control pills cost about $20 to $50 a month — for a total of $240 to $600 per year. An IUD typically costs $175 to $600. People with insurance may find they can get birth control at no out-of-pocket cost because it is considered preventive care under the Affordable Care Act. A few exceptions apply.

If medication costs are a concern, consider:

• Checking GoodRx for discounts up to 80% off the retail price

• Looking into patient assistance programs (if you’re uninsured or on Medicare)

• Checking manufacturer copay cards  (if you have health insurance)

Co-contributor

Kristen Gerencher, MSOT, contributed to this article’s “Costs and savings tips” section. She’s the personal finance editor on the Research Team at GoodRx. She has reported on healthcare and insurance trends for 20 years and is a licensed occupational therapist.

Discussion guide

Here are some questions to guide your discussion with your healthcare provider about fibroids:

• How many types of fibroid(s) do I have?

• What size is my fibroid(s)?

• Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?

• Can I expect the fibroid(s) to grow larger?

• How rapidly have they grown (if they were known about already)?

• How will I know if the fibroid(s) is growing larger?

• What problems can the fibroid(s) cause?

• What tests or imaging studies are best for keeping track of the growth of my fibroids?

• What are my treatment options if my fibroid(s) becomes a problem?

• What are your views on treating fibroids with a surgery or procedure versus medications?

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Written by:

Camille Moreno, DO, NCMP

Camille Moreno, DO, NCMP, is a women’s health specialist currently practicing at Duke University Medical Center in obstetrics and gynecology. She earned her bachelor of science degree in biology from Virginia Tech and her Doctor of Osteopathic Medicine from Virginia College of Osteopathic Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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