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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Uterine fibroids facts
• What are uterine fibroids?
• What causes uterine fibroids and how common are they?
• What are the symptoms of uterine fibroids?
• Do untreated uterine fibroids pose a risk?
• What are the usual ways of diagnosing uterine fibroids?
• What is the treatment of uterine fibroids?
• Surgery for fibroids
• Medical treatment for fibroids
• What are the risks of uterine fibroids during pregnancy?
• Patient Comments: Uterine Fibroids - Experience
• Patient Comments: Uterine Fibroids - Surgery
• Patient Comments: Uterine Fibroids - Treatment
• Patient Comments: Uterine Fibroids - Symptoms
• Find a local Obstetrician-Gynecologist in your town
• Uterine Fibroids Index

Uterine fibroids are diagnosed by pelvic exam and even more commonly by ultrasound. Often, a pelvic mass cannot be determined to be a fibroid on pelvic exam alone, and ultrasound is very helpful in differentiating it from other conditions such as ovarian tumors. MRI and CT scans can also play a role in diagnosing fibroids, but ultrasound is the simplest, cheapest, and almost without question the best technique for imaging the pelvis. Occasionally, when trying to determine if a fibroid is present in the uterine cavity (endometrial cavity), a hysterosalpingogram (HSG) is done. In this procedure, an ultrasound exam is done while contrast fluid is injected into the uterus from the cervix. The fluid within is visualized in the endometrial cavity and can outline any masses that are inside, such as submucosal fibroids.

There are several options for the treatment of uterine fibroids that include surgery (hysterectomy, myomectomy, cryosurgery, and uterine artery embolization (UAE). Medical treatments include medications such as mifepristone (RU-486, danazol (Danocrine), raloxifene (Evista), and low dose formulations of oral contraceptives.

There are many ways of managing uterine fibroids. Surgical methods are the mainstay of treatment when treatment is necessary. Possible surgical interventions include hysterectomy, or removal of the uterus (and the fibroids with it). Myomectomy is the selective removal of just the fibroids within the uterus. Myomectomy can be done through a laparoscope or with the standard open incision on the abdominal wall. Some treatments have involved boring holes into the fibroid with laser fibers, freezing probes (cryosurgery), and other destructive techniques that do not actually remove the tissue but try to destroy it in place. Surgery is necessary if there is suspicion of malignancy in any case of leiomyoma or uterine mass.

Another technique for treating fibroids is known as uterine artery embolization (UAE). This technique uses small beads of a compound called polyvinyl alcohol, which are injected through a catheter into the arteries that feed the fibroid. These beads obstruct the blood supply to the fibroid and starve it of blood and oxygen. While this technique has not been in use long enough to evaluate long-term effects of UAE versus surgery, it is known that women undergoing UAE for fibroids have a shorter hospital stay than those having surgery but a greater risk of complications and readmissions to the hospital. Studies are underway to evaluate the long-term outcomes of UAE as opposed to surgical treatment. Uterine artery occlusion (UAO), which involves clamping the involved uterine arteries as opposed to injecting the polyvinyl alcohol beads, is currently under investigation as a potential alternative to UAE.