Fibroids FAQ

By: Robert Hunt, MD
Dr. Hunt is a Clinical Professor at Harvard Medical School, who practices at New England Baptist Hospital in Boston. Dr Hunt is Editor-in-Chief of The Journal of the American Association of Gynecologic Laparoscopists and past president of the same organization.

Q: What are fibroids?
A: These tumors (also called myomas) commonly arise from the uterus and are usually benign. Their cellularity makeup is similar to the normal uterus. At least one-half of women have them by age 40 years.

Q:How did I get fibroids?
A: This is a good question and remains controversial. The most likely explanation is that a single cell in the uterus goes awry and begins reproducing itself, resulting in a tumor.

Q:Do all fibroids have to be removed?
A: No. The majority of women with fibroids do not require treatment. These women simply need to be followed by their healthcare providers to make certain a change in the fibroids, such as rapid growth, is detected.

Q:What is the best way to follow fibroids?
A: Many diagnostic techniques can be used. The most practical is a combination of pelvic examinations and ultrasounds obtained at appropriate intervals.

Q:When do fibroids have to be removed?
A: This varies from patient to patient. In general, surgery is indicated if fibroids appear to have caused infertility, miscarriages, or heavy menstrual periods. Other reasons for removal would be rapid growth or growth to a size that fibroids are causing pelvic pressure.

Q: When do fibroids cause infertility problems?
A: Most fibroids do not result in infertility concerns. In cases where large or multiple fibroids cause obstruction of one or both fallopian tubes, fibroid removal is indicated. Fibroids may also grow into the uterine cavity and result in implantation problems leading to infertility or miscarriage. In these cases, fibroid removal with the use of hysteroscopy (placing a scope in the uterus) is useful.

Q:If surgery is recommended, do I require hysterectomy?
A: Usually not. Most women that require surgery can have fibroids removed with preservation of the uterus, tubes, and ovaries. If fertility is the major issue the uterus is not removed.

Q: Is a large incision required?
A: My colleagues and I have been refining techniques to allow removal by less invasive means. Examples are: no incision as in vaginal removal (hysteroscopic resection); very small incisions as with laparoscopic removal; and, if laparotomy is required, myomectomy through the smallest and most cosmetic abdominal incision feasible.

Q:Is hysterectomy sometimes the indicated procedure?
A: Yes. For example, the women with a very large uterus that contains dozens of small fibroids scattered throughout the uterine wall may be served best by hysterectomy. This is done in women who are not considering further child bearing.

Q: Can fibroids come back?
A: Sometimes fibroids develop again, but the majority of women do not require another myomectomy. The key is to plan the correct operation, exercise excellent surgical judgement, and take precautions to lessen postoperative scar tissue formation at the myomectomy site.