Diagnosis, Symptoms, and Treatment of Fibroids and Polyps
Fibroids—also known as leiomyomas, or myomas—are the most common pelvic tumor in women. They are benign, muscular growths in the later of the uterus called the myometrium. While it is difficult to determine the exact frequency of fibroids in the population, it is estimated that 1 in 5 women of childbearing age have uterine fibroids. Fibroids are more common (approximately 2-3 times) in black women and the prevalence of fibroids increases with age. However, in most cases, fibroids decrease in size after menopause.
Fibroids can be detected during a pelvic exam, although often they are very small and go unnoticed. To confirm the diagnosis, your doctor may ask you to have a trans-vaginal/pelvic or abdominal ultrasound or an MRI.
Symptoms of Fibroids
The majority of women with small fibroids are asymptomatic. However, there are many women who have significant symptoms including:
- Heavy or prolonged menstrual bleeding
- Pelvic pressure or pain
- Multiple miscarriages
There are several ways to treat fibroids, however, it is important to keep in mind that most treatments affect fertility. These include:
- Hormone therapy with estrogen-progestin contraceptives, progesterone containing intrauterine device, progestin implants/injections/pills, gonadotropin-releasing hormone agonists (GnRH agonists) to lower estrogen levels and decrease stimulation of fibroids
- Uterine artery embolization to cut off blood flow to the fibroids
- Myometomy – the surgical removal of fibroids from the uterus
- Hysterectomy—the surgical removal of the entire uterus
Fibroids can grow back even after treatment, so some may need to be treated more than once. If you have fibroids, you should discuss which treatment option is best for you with your doctor.
Polyps are small overgrowths of the endometrium, or the lining of the uterus. They are most often benign but, in some cases, can become malignant/cancerous. Endometrial polyps are most common among reproductive aged women.
Symptoms of Polyps
Endometrial polyps are often asymptomatic. Common symptoms associated with polyps are:
- Abnormally heavy periods
- Irregular periods (prolonged or very heavy bleeding)
- Infertility or recurrent pregnancy loss
There are several ways to confirm a diagnosis of endometrial polyps as often they can go undetected during a pelvic exam:
Sonohysterogram is a type of ultrasound that uses sterile water to expand the uterus and view the uterine cavity
Hysterosalpingogram uses a dye and x-ray imaging to view the contour of the uterus
Hysteroscopy uses a thin telescope-like viewing device to look inside the uterus and confirm the presence of polyps.
Polyps do not always require treatment however, if treatment is necessary, they can often be removed during a hysteroscopy.
Dr. Taraneh Gharib Nazem is Senior Fellow in Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York. She is a board-certified Obstetrician Gynecologist. Dr. Nazem completed her residency in Obstetrics and Gynecology at the New York University School of Medicine, where she was elected administrative chief resident and graduated with the Robert F. Porges Honor Resident Award, for outstanding performance.