• Emergency symptom: sharp, sudden pain in the lower abdomen (when a fibroid with a stalk becomes twisted)
  
  
• heavier bleeding during menstrual periods
• abdominal discomfort, fullness, or pain
• lower back pain
• frequent urination; constipation
  
  

Women should have annual pelvic exams once they reach age 18 or become sexually active, to aid in early detection and treatment of any abnormalities.  A pelvic examination, during which a doctor presses upon the uterus and ovaries to feel for any abnormalities, may reveal the presence of uterine fibroids. A pelvic ultrasound scan can confirm the diagnosis.

Women diagnosed with asymptomatic fibroids should have pelvic examinations once a year so that fibroid growth may be monitored.

Asymptomatic fibroids rarely require treatment. Iron supplements may be advised if a patient has heavy bleeding during menstrual periods. Surgical removal of the fibroids that leaves the uterus intact (myomectomy) is an option for some patients. Myomectomies usually have higher blood losses than hysterectomies, however, they preserve the chance for future pregnancies. Emergency surgery is necessary to remove a twisted fibroid. A hysterectomy, the surgical removal of the uterus (and perhaps of other reproductive organs), may be recommended for severe or recurrent cases.

Call a gynecologist if you develop symptoms of uterine fibroids. Get immediate medical attention for sharp, sudden pain in the lower abdomen.

Diagnosing Uterine Fibroids

To diagnose uterine fibroids, your doctor will first conduct a complete pelvic exam to feel for the presence of them. To confirm the presence of uterine fibroids, your doctor may order one or more of the following tests:

• Abdominal ultrasound: a painless exam in which sound waves are used to project an image of the uterus onto a video screen. A detailed view of the image allows the clinician to see the size, shape and texture of uterus to evaluate any possible growths.
  
  
• Transvaginal ultrasound: This exam, which most women find painless, involves the insertion of an ultrasound probe into the vagina; it offers an even clearer picture of the inside of the uterus than the abdominal ultrasound.
  
  
• Magnetic resonance imaging (MRI): Imaging technology that provides highly refined, optimal-quality images of body parts.
  
  
• Computed tomography (CT Scan): Two-part imaging technology that works as follows. First, special x-ray equipment obtains images from different angles around the body. Then, that information is processed via a computer to show a cross-section of body tissues and organs.
  
  
• Diagnostic hysteroscopy: A noninvasive surgical procedure that takes place in a doctor’s office, it allows the doctor to examine the uterus lining and, if necessary, take tissue samples. During the procedure, the doctor inserts a small, lighted telescope through the vagina and cervix and into the uterus.
  
  

For fibroids that are painless, your doctor may recommend watchful vigilance rather than treatment. This may include regular follow-up visits and occasional ultrasound exams to monitor the size of the fibroids. Other treatments include the following:

Drug treatment:

• Oral contraceptives may help control heavy menstrual bleeding associated with fibroids; they don’t, however, control growth of fibroids.
  
  
• Hormonal treatment may be used to control healthy menstrual bleeding. But like oral contraceptives, it does not control growth of fibroids.
  
  
• Drugs known as gonadotropin-releasing hormone (Gn-RH) agonists work to shrink fibroids by reducing the amount of estrogen in the body. The downsides of this drug therapy are that it cannot be used long-term, and it causes menopausal symptoms.
  
  

Surgical options:

• Traditional surgical procedures include myomectomy, which removes the fibroids but leaves the uterus intact, an important factor for women who are considering having children in the future. The downside of a myomectomy is that fibroids return in 10 percent of cases.
  
  
• Hysterectomy, or removal of the uterus, has long been the standard treatment for removing fibroids. Compared to a myomectomy, hysterectomy has a low rate of complications, and it offers a permanent solution.
  
  
• Johns Hopkins is now offering an alternative treatment for the removal of fibroids that eliminates the need for surgery. Called fibroid embolization or uterine artery embolization (UAE), the procedure involves cutting off blood flow to the fibroids, which causes them to shrink. An interventional radiologist -- a physician with special training to diagnose and treat illness using miniature tools and imaging guidance -- performs the procedure. Patients undergoing the procedure are sedated, but conscious, as the physician makes a small nick in the skin in the groin, then inserts a tiny tube called a catheter into an artery. A moving X-ray, called a fluoroscopy, allows the physician to watch as the catheter is guided through the artery to the uterus. Once the catheter is in place, the physician injects plastic or gelatin sponge particles the size of grains of sand into the artery that supplies blood to the fibroid. This cuts off the blood flow, causing the fibroid to shrink. Patients typically stay in the hospital for one night after the procedure, and require one week to recover. Research to date shows fibroid embolization effective in reducing symptoms of fibroids in at least 85 percent of patients.
  

Research at Johns Hopkins Medicine

At Johns Hopkins, we are constantly seeking new and better ways to diagnose, treat and, ultimately, prevent conditions that affect our patients’ quality of life. In addition to being recognized globally for these efforts, we often partner with other researchers from around the world.

For instance, Johns Hopkins is currently participating in an eight-site, international clinical trial to determine the efficacy of an innovative treatment for uterine fibroids. The study, which will evaluate the treatment of uterine fibroids using magnetic resonance imaging (MRI)-guided high intensity ultrasound, may demonstrate the safety and effectiveness of an entirely new approach to treating uterine fibroid tumors.

Researchers believe the technique will work as follows: using MRI to identify the precise location of fibroids, ultrasound wave energy is then delivered through the abdominal wall. This technique works by heating the targeted tissue enough to damage or destroy fibroids, within seconds. Then, over the next few weeks, the body is expected to naturally expel the dead tissue from the body. This procedure, if proven safe and effective, would be a welcome alternative to the hysterectomy, which removes the uterus and requires several weeks recovery time.

To learn more about this fascinating technique, click here.