Uterine Fibroid

In 2021, During the 87th regular legislative session, legislators passed House Bill 1967. This bill added Health and Safety Code Chapter 100A, Uterine Fibroid Education and Research, which directs the Texas Department of State Health Services (DSHS) to maintain an informational database related to uterine fibroid diagnoses and treatment.

About Uterine Fibroids

Fibroids are tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is leiomyoma. Fibroids are almost always benign (not cancerous). They are the most common non-cancerous tumors in women of childbearing age. Up to 80% of women develop uterine fibroids before menopause.

Fibroids can grow as a single tumor or many tumors in the uterus. Fibroids can be very small (the size of a seed) or large (the size of a grapefruit). There are different fibroid shapes and types and they can grow in different places in or on the uterus. Fibroids can grow, shrink, or remain a constant size over time. Fibroids do not increase the risk for cancer in the uterus.

Fibroid symptoms may include:

  • Heavy or prolonged menstrual bleeding (enough to cause anemia);
  • Painful periods;
  • Feeling of fullness in the pelvic area (lower stomach area);
  • Frequent urination; and
  • Lower back pain. 

Rarely, fibroids can impact a woman’s ability to get pregnant. Most fibroids do not cause symptoms, but there are treatments available for women with fibroids who do experience symptoms. Talk to your health care provider if you have concerns about uterine fibroid symptoms. Your doctor can recommend next steps for diagnosis and treatment. 

Uterine Fibroid Risks

No one knows for sure what causes uterine fibroids. Researchers think one or more factors could play a role and that an interplay of multiple factors is likely. Scientists continue to look for exactly what factors may contribute to fibroids risk so they can find better ways to prevent them in the future. 

Fibroids are most common in women in their 30s, 40s, and through menopause. They are more common in Black women than in White, Hispanic, or Asian women. Black women are also more likely than women of other races and ethnicities to experience severe uterine fibroid symptoms.

Some factors that may be associated with a higher risk of being diagnosed with uterine fibroids include:

  • Age - older women are at higher risk than younger women;
  • Family history of uterine fibroids;
  • African American ethnicity;
  • Early age at menarche (before age 10);
  • Diets heavy in red meat; and
  • Obesity.

Some factors that may lower the risk of developing uterine fibroids, include:

  • Pregnancy - the risk of fibroids appears lower in women who have been pregnant;
  • Long-term use of oral or injectable hormonal contraceptives; and
  • Diet - eating plenty of green vegetables seems to protect women from developing fibroids.

Uterine Fibroid Treatment

Most of the time, if fibroids are not causing symptoms, they do not need treatment. Your health care provider can help you decide about the best treatment and may consider the following things before helping you choose:

  • Your age;
  • Your general health;
  • If you are having symptoms;
  • How much the symptoms are bothering you;
  • The type, size, and location(s) of the fibroids;
  • If you want to become pregnant now or in the future; and
  • If you are close to menopause.

If you and your health care provider decide on treatment, there are several options. Your health care provider will talk to you about treatment risks and benefits and which treatments may be best if you are planning to have more children. More treatment options may be available as researchers learn more about fibroids.

Medication-related treatments to reduce symptoms or stop fibroid growth

Common medical treatments for fibroids include:

  • Pain medications for mild or occasional pain; 
  • Iron supplements to treat anemia (low blood iron) if you have heavy menstrual bleeding;
  • Hormonal birth control medications can sometimes help control bleeding, but do not treat the fibroids. The medications can be pills, a shot, or some kinds of intrauterine devices (IUDs);
  • Gonadotropin-releasing hormone agonists (GnRHa) to reduce the fibroids' size. Women taking this medication may experience symptoms like menopause, so it is typically used for only a short time (e.g., to reduce the size of fibroids before surgery); and
  • Anti-hormonal agents or hormone modulators, such as ulipristal acetate, mifepristone, and letrozole, to stop or slow the uterine fibroids' growth, reduce bleeding, and improve symptoms.

Radiological and other minimally invasive fibroid treatment methods to help women address fibroid impacts

Some of the following treatments involve a short hospital stay while others are done in an outpatient setting. Talking with your doctor on what may be the best treatment option for you is an important part of patient and doctor communication regarding potential treatment options.

  • Endometrial Ablation - a procedure using electrical currents, microwave energy, or freezing to destroy the uterus lining. While pregnancy is unlikely after this procedure, it can still happen. Talk to your health care provider about possible pregnancy risks.
  • Uterine artery embolization (UAE) or uterine fibroid embolization (UFE) - a procedure that causes the fibroid to shrink over time and may reduce symptoms. In this procedure, your doctor puts a thin tube into the blood vessels around the fibroid. Then, the doctor injects tiny plastic or gel particles through the tube and into the blood vessels. This blocks the blood supply to the fibroid.
  • Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound - a newer procedure that directs ultrasound waves at the fibroids through the skin. The high-intensity sound waves destroy the fibroids. Researchers are still studying the procedure to determine whether it provides long-term fibroids relief.

Surgery

Surgical treatments for uterine fibroids are:

  • Myomectomy - a surgical procedure that removes the fibroids and preserves the healthy areas of the uterus. This procedure can protect the ability to get pregnant and carry a pregnancy. Depending on the fibroids' locations and sizes, doctors complete this procedure using one of three different methods. Myomectomy results in effective fibroid symptom relief for most women.
  • Hysterectomy - a surgical procedure that permanently removes all or part of the uterus. Hysterectomy completely cures uterine fibroids. It is not possible to get pregnant after a hysterectomy. There are several different methods for performing a hysterectomy.

Uterine Fibroid Data

If you are interested in researching available data regarding uterine fibroids in Texas, send your request to the DSHS Center for Health Statistics to access a compiled research report and/or an associated research dataset. Email the request(s) to thcichelp@dshs.texas.gov.

Uterine Fibroid Educational Resources

 

Additional Uterine Fibroid Resources

More Information on Uterine Fibroids | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development (nih.gov)

Emotional Support for Living with Fibroids | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development (nih.gov)

Uterine Fibroid Research Information from the National Institute of Child Health and Human Development

Management of Uterine Fibroids: Comparative Effectiveness Review No. 195 (2017.) | Effective Health Care (EHC) Program (ahrq.gov)

   

Sources:

National Institute of Child Health and Human Development. Uterine Fibroids. [Online]. Uterine Fibroids | NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development (nih.gov). Accessed June 7, 2022.

Office on Women’s Health. Uterine Fibroids. [Online]. Uterine fibroids | Office on Women's Health (womenshealth.gov).  Accessed June 7, 2022.

National Library of Medicine, Medline Plus. Uterine Fibroids. [Online]. Uterine fibroids: MedlinePlus Medical Encyclopedia. Accessed June 7, 2022.

Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Research Protocol: Management of Uterine Fibroids. Content last reviewed September 2019. [Online].   
Management of Uterine Fibroids | Effective Health Care (EHC) Program (ahrq.gov)

Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD. Systematic Review: Management of Uterine Fibroids. Content last reviewed September 2019. [Online].   
Management of Uterine Fibroids | Effective Health Care (EHC) Program (ahrq.gov). Accessed June 7, 2022.

Last updated June 30, 2022