1 in 2 believe or aren't sure if fibroids go away with menopause

FIBROIDS do not diminish during or after menopause. Delaying surgery with this hope can be harmful.

Uterine fibroids (also called myomas or leiomyomas) are noncancerous tumors that originate in the smooth muscle cells inside the wall of the uterus. Fibroids can occur anywhere in the uterus and grow either as a single tumor or in clusters. In both situations, the fibroids can vary in size from as small as an apple seed to a very large growth. As such, they can change the shape or size of the uterus and sometimes the cervix.

About 30 percent of women will get fibroids by age 35, and between 70 percent and 80 percent will do so by age 50. African American women develop fibroids two to three times more often than white and Hispanic women. Also, African American women develop problems with fibroids at an earlier age, with the fibroids growing faster, becoming larger, and causing more bleeding and anemia than in women of other races.

Fibroids can cause:

• Heavy bleeding during a woman's period and cause anemia
• Reproductive problems, including infertility and miscarriage
• Abdominal pain or pressure
• Constipation
• Incontinence
• Frequent urination
• Pain during intercourse
• Lower back pain

Yes.  In fact, there are four types of fibroids, which are named for their location because the position has a direct impact on a woman’s symptoms and fertility.  They include:

• Intramural fibroids, the most common form, are found in 70 percent of women of childbearing age.  They begin as small nodules in the muscular wall of the uterus and with time, may expand inwards, decreasing the size of the uterine cavity.  When this happens, intramural fibroids can increase bleeding during menstruation and may press on the bladder, which can cause pelvic pain, back pain, frequent urination, constipation, bloating, and indigestion. 
• Submucosal fibroids are located just beneath the outer layer of the uterus and can cause severe bleeding, even if they are small, and interfere with a woman’s ability to conceive. 
• Subserosal fibroids appear on the outer surface of the uterus and continue to grow outwards. This means they can take up space and push against other structures like the spine and pelvis, causing pelvic pressure and pain, and back pain. 
• Pedunculated fibroids grow outside the wall of the uterus but are attached to the uterus by a narrow stalk.  Because the stalk can twist, pedunculated fibroids can be very painful.

Depending on the location and size of a woman’s fibroids, these growths can interfere with conception, prevent implantation of a fertilized egg, or obstruct the fallopian tubes, preventing the embryo from passing into the uterine cavity and implanting on the endometrial lining. Fibroids can also cause problems during pregnancy, including affecting the blood flow and preventing the fetus from growing properly and causing pre-term labor and birth. 

To prevent these problems, women with fibroids who want to become pregnant should consider a type of GYN surgery called a myomectomy to remove them. In many cases, infertility specialists will refer patients for this surgery before attempting in vitro fertilization (IVF).

Among the treatment options for uterine fibroids are hormone therapy, radiological treatment and a type of surgery called myomectomy (fibroid removal) that can be performed either as open abdominal surgery or through minimally invasive laparoscopic surgery.  Patients who are no longer interested in childbearing can also opt to have a hysterectomy.

Myomectomy is the surgical removal of fibroids from the uterus. This surgical procedure allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. Depending on the location of the fibroids, the myomectomy can be done through the pelvic area or through the vagina and cervix. 

After fibroids are removed through a myomectomy, women can expect to see a reduction in their symptoms and their chances of becoming pregnant may increase.

Board certified GYN surgeons at The Center for Innovative GYN Care have developed a pioneering surgical approach called LAAM-BUAO, which takes the best elements of both laparoscopic and open approaches for fibroid removal (myomectomy).  LAAM (Laparoscopic Assisted Abdominal Myomectomy) uses two small incisions, one at the belly button and one at the bikini line. It is specifically designed for women seeking fertility. Women who are past childbearing may not be candidates for LAAM.  LAAM is not limited by fibroid size, number, or location. BUAO (Bilateral Uterine Artery Occlusion) is the blockage of the uterine artery during the procedure to control bleeding. Due to the advantage of the surgeon being able to feel all of the fibroids, LAAM is the most thorough minimally invasive technique used for a myomectomy. Most LAAM procedures are done in an outpatient setting, and patients are able to return to their lives sooner than with open procedures.

In general, the LAAM-BUAO procedure takes approximately 1 hour (by comparison, standard open procedures are up to four hours), can be performed as an outpatient procedure and significantly reduces recovery time and surgical complications.

Other common procedures to remove fibroids include an open myomectomy, which requires either making a horizontal incision above the public pubic bone or a vertical incision from just below the navel to the pubic bone, and a laparoscopic or robotic myomectomy, which are minimally invasive procedures that can remove fibroids on stalks or from the outside the uterus. While commonly offered by OB-GYNs, these procedures have major disadvantages. 

Open myomectomies require much larger incisions, resulting in more pain and longer recovery times of 6 to 8 weeks. There is a much higher rate of complications as well. Choosing a standard laparoscopic or robotic procedure also can present challenges when the fibroids are very large or there are large numbers of fibroids in the uterus.

Recovery times vary from ten days to 6-8 weeks depending on the type of surgery. This chart details recovery time for a variety of surgical techniques.

Depending on a woman’s symptoms and medical condition, fibroids can be treated with medications that regulate the menstrual cycle. While treating the symptoms of heavy bleeding and pelvic pressure, these medications do not eliminate fibroids.  Types of medical therapy include hormones that block the effects of estrogen or progesterone, or reduce or eliminate the production of these hormones from the ovaries.

Before undergoing surgery, you will likely have many questions for your physician or surgeon. View our recommended questions to ask - and background information to help you weight the answers - below or download a printable version. 

Women need to be their own best advocate, which is why getting a second opinion is always good practice. Since there are different surgical options for treating fibroids, getting a second opinion is a way you can ask questions about how the surgery will be performed, the recovery time, and possible complications. 

Hear about Helene’s experience with fibroids and her treatment