Topic Overview

What are uterine fibroids?

Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside , on the outside , or in the wall of your uterus.

Your doctor may call them fibroid tumors, leiomyomas, or myomas. But fibroids are not cancer. You do not need to do anything about them unless they are causing problems.

Fibroids are very common in women in their 30s and 40s. By the time they are 50, about 80 women out of 100 have fibroids. But fibroids usually do not cause problems. Many women never even know they have them.

What causes uterine fibroids?

Doctors are not sure what causes fibroids. But the female hormones estrogen and progesterone seem to make them grow. Your body makes the highest levels of these hormones during the years when you have periods.

Your body makes less of these hormones after you stop having periods (menopause). Fibroids usually shrink after menopause and stop causing symptoms.

What are the symptoms?

Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life. Fibroids make some women have:

• Long, gushing periods and cramping.
• Fullness or pressure in their belly.
• Low back pain.
• Pain during sex.
• An urge to urinate often.

Heavy bleeding during your periods can lead to anemia. Anemia can make you feel weak and tired.

Sometimes fibroids can make it harder to get pregnant. Or they may cause problems during pregnancy, such as going into early labor or losing the baby (miscarriage).

How are uterine fibroids diagnosed?

To find out if you have fibroids, your doctor will ask you about your symptoms. He or she will do a pelvic exam to check the size of your uterus.

Your doctor may send you to have an ultrasound or another type of test that shows pictures of your uterus. These help your doctor see how large your fibroids are and where they are growing.

Your doctor may also do blood tests to look for anemia or other problems.

How are they treated?

If your fibroids are not bothering you, you do not need to do anything about them. Your doctor will check them during your regular visits to see if they have gotten bigger.

If your main symptoms are pain and heavy bleeding, try an over-the-counter pain medicine like ibuprofen, and ask your doctor about birth control pills. These can help you feel better and make your periods lighter. If you have anemia, take iron pills and eat foods that are high in iron, like meats, beans, and leafy green vegetables.

If your symptoms bother you a lot, you may want to think about surgery. Most of the time fibroids grow slowly, so you can take time to consider your choices.

There are two main types of surgery for fibroids. Which is better for you depends on how big your fibroids are, where they are, and whether you want to have children.

• Surgery to take out the fibroids is called myomectomy. Your doctor may suggest it if you hope to get pregnant or just want to keep your uterus. It may improve your chances of having a baby. But it does not always work, and fibroids may grow back.
• Surgery to take out your uterus is called hysterectomy. This is the most common surgery for fibroids. And it is the only way to make sure that fibroids will not come back. Your symptoms will go away, but you will not be able to get pregnant.

It is normal to have mixed feelings about hysterectomy. Some women are sad to lose part of what makes them a woman. Other women just want their symptoms to go away. If you are thinking about hysterectomy, learn all you can about it. This will help you make the choice that is right for you.

There are a number of other ways to treat fibroids. One newer treatment is called uterine fibroid embolization. It can shrink fibroids. It may be a choice if you do not plan to have children but want to keep your uterus. It is not a surgery, so most women feel better soon. But fibroids may grow back.

If you are near menopause, you might try medicines to treat your symptoms. Heavy periods will stop after menopause.

Frequently Asked Questions

Health Tools 

Health Tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I have surgery to treat uterine fibroids?
	Should I have uterine fibroid embolization for uterine fibroids?
	Should I use GnRH-a therapy to treat uterine fibroids?

Cause

The exact cause of uterine fibroids is not known. Fibroids begin when cells overgrow in the muscular wall of the uterus.

After a fibroid develops, the hormones estrogen and progesterone appear to influence its growth.¹ A woman's body produces the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decline, fibroids usually shrink or disappear.

Symptoms

Uterine fibroid symptoms can develop slowly over several years or rapidly over several months. Most women with uterine fibroids have mild symptoms or none at all and never need treatment.

For some women, uterine fibroid symptoms become a problem. Pain and heavy menstrual bleeding are the most common symptoms. In some cases, difficulty becoming pregnant is the first sign of fibroids.

Uterine fibroid symptoms and problems include:

• Abnormal menstrual bleeding. Up to 30% of women with fibroids have menstrual period changes, such as:^{2 3}
  • Heavier, prolonged periods that can cause anemia.
  • Painful periods.
  • Spotting before or after periods.
  • Bleeding between periods.
• Pelvic pain and pressure, such as:
  • Pain in the abdomen, pelvis, or low back.
  • Pain during sexual intercourse.
  • Bloating and feelings of abdominal pressure.
• Urinary problems, such as:
  • Frequent urination.
  • Leakage of urine (urinary incontinence).
  • Kidney blockage following ureter blockage (rare).
• Other symptoms, such as:
  • Difficulty or pain with bowel movements.
  • Infertility. Sometimes, fibroids make it difficult to become pregnant.
  • Problems with pregnancy, such as placental abruption and premature labor.
  • Miscarriage.

What Happens

Uterine fibroids can grow on the inside wall of the uterus , within the muscle wall of the uterus , or on the outer wall of the uterus . They can alter the shape of the uterus as they grow. Over time, the size, shape, location, and symptoms of fibroids can change. See a picture of the female pelvic organs .

As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s through menopause (around age 50). About 80% of women have uterine fibroids by the time they reach age 50.⁴ Uterine fibroids can stay the same for years with few or no symptoms, or you can have a sudden, rapid growth of fibroids.

Fibroids do not grow before the start of menstrual periods (puberty). They sometimes grow larger during the first trimester of pregnancy, and they usually shrink for the rest of a pregnancy.⁵ After menopause, when a woman's hormone levels drop, fibroids usually shrink and don't come back.

Complications of uterine fibroids are not common. They include:

• Anemia from heavy bleeding.
• Blockage of the urinary tract or bowels, if a fibroid presses on them.
• Infertility, if the fibroids change the shape of the uterus or the location of the fallopian tubes.
• Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
• Infection or a breakdown of uterine fibroid tissue.

Fibroids can cause problems during pregnancy, such as:⁵

• The need for a cesarean section delivery. This is the most common effect of fibroids on pregnancy.¹
• Premature labor and delivery.
• Miscarriage.
• Pain during the second and third trimesters.
• An abnormal fetal position, such as breech position, at birth.
• Placenta problems.

What Increases Your Risk

Factors that increase a woman's risk of developing uterine fibroids include:¹

• Age. Fibroids become more common as women age, especially from the 30s and 40s through menopause. About 80% of women develop uterine fibroids by the time they reach age 50.⁴ After menopause, fibroids usually shrink.
• Family history. Having a family member with fibroids increases your risk.
• Ethnic origin. Black women are more likely to develop fibroids than white women.
• Obesity.⁶

When To Call a Doctor

Call to make an appointment if you have possible symptoms of a problem from a uterine fibroid, including:

• Heavy menstrual bleeding.
• Periods that have changed from relatively pain-free to painful over the past 3 to 6 months.
• Frequent painful urination, blood in your urine, or an inability to control the flow of urine.
• A change in the length of your menstrual cycle over 3 to 6 menstrual cycles.
• New persistent pain or heaviness in the lower abdomen or pelvis.

Watchful Waiting

Unless you have bothersome or severe symptoms, you will probably only need to have a fibroid checked during your yearly gynecological exam.

During a pregnancy, your health professional will check for changes in fibroid size and position.

Who To See

Uterine fibroids can be diagnosed and treated by any of the following health professionals:

• Family medicine physician
• Gynecologist
• Internist
• Nurse practitioner
• Physician assistant

You may need to see a gynecologist for further testing or treatment.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your health professional may suspect that you have a uterine fibroid problem based on:

• The results of a pelvic exam.
• The history of your symptoms and your menstrual periods.

You will probably also have a pelvic ultrasound or hysterosonogram to confirm that you have one or more uterine fibroids. A hysterosonogram is done by filling the uterus with sterile saline during a transvaginal pelvic ultrasound.

If you have had heavy menstrual bleeding, you may have a complete blood count (CBC) to check for anemia.

Laparoscopy may be used to look for and locate fibroids on the outer surface of the uterus before removal (myomectomy).

Additional testing

If you have severe pain, bleeding, or pelvic pressure or have had repeat miscarriages or trouble becoming pregnant, you will probably have other tests to look for other possible causes of your symptoms.

Additional tests for specific symptoms, such as urinary or bowel problems, may be needed to diagnose the problem or develop a treatment plan.

Treatment Overview

Most uterine fibroids are harmless, do not cause symptoms, and shrink with menopause. But some fibroids are painful, press on other internal organs, bleed and cause anemia, or cause pregnancy problems. If you have a fibroid problem, there are several treatments to consider. Fibroids can be surgically removed, the blood supply to fibroids can be cut off, the entire uterus can be removed, or medicine can temporarily shrink fibroids. Your choice will depend on whether you have severe symptoms and whether you want to preserve your fertility.

Watchful waiting for minimal fibroid symptoms or when nearing menopause

If you have uterine fibroids but you have few or no symptoms, you do not need treatment. Instead, your health professional will recommend watchful waiting. This means that you will have regular pelvic exams to check on fibroid growth and symptoms. Talk with your health professional about how often you will need a checkup.

If you are nearing menopause, watchful waiting may be an option for you, depending on how tolerable your symptoms are. After menopause, your estrogen and progesterone levels will drop, which causes most fibroids to shrink and symptoms to subside.

For heavy menstrual bleeding or pain

If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a simple menstrual cycle problem or other problems. (For more information, see the topic Dysfunctional Uterine Bleeding.) Since the only proven medicine for shrinking fibroids has troublesome side effects and should only be used short-term, consider first trying one or both of the following for menstrual pain or heavy bleeding. Combining the two is most likely to relieve pain and lighten bleeding:⁷

• Nonsteroidal anti-inflammatory drug (NSAID) therapy improves menstrual cramping and reduces bleeding for many women.⁷ But there is no evidence that NSAIDs relieve pain or bleeding specifically caused by fibroids.⁶
• Birth control hormones (pill, patch, or ring) lighten menstrual bleeding and pain while preventing pregnancy.⁸

A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may improve fibroids, or may make them grow.^{9 5} This might be different for each woman.

Iron supplement therapy and an iron-rich diet improve anemia caused by blood loss.

NSAID use during conception or early pregnancy may cause miscarriage.¹⁰ If you are trying to get pregnant, talk to your health professional about whether you can use NSAID therapy.

For infertility and pregnancy problems

If you have fibroids, there is no way of knowing for certain whether they are affecting your fertility. Fibroids are the cause of infertility only 2% to 3% of the time. Many women with fibroids have no trouble getting pregnant. Other women with fibroids have fertility problems because of some other reason.⁵

Experts have yet to learn exactly how much of a part fibroids play in pregnancy problems and miscarriage.⁵ If it distorts the wall of the uterus, a fibroid can prevent a fertilized egg from implanting in the uterus. This may make an in vitro fertilization less likely to be successful, if the fertilized egg doesn't implant after it is transferred to the uterus.¹¹

Surgical fibroid removal, called myomectomy, is the only fibroid treatment that may improve your chances of having a baby.⁵ Because fibroids can grow again, it is best to try to become pregnant as soon as possible after a myomectomy.

Some studies suggest that myomectomy may also lower the risk of miscarriages among women with fibroids. But there are not yet good enough studies to know for sure.⁵

For severe fibroid symptoms

If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, you can consider shrinking the fibroid, removing the fibroid (myomectomy) , or removing the entire uterus (hysterectomy). After all treatments except hysterectomy, fibroids may grow back. Only myomectomy is recommended for women who have future childbearing plans.

To shrink a fibroid for a short time, hormone therapy with a gonadotropin-releasing hormone analogue (GnRH-a) puts the body in a state like menopause. This shrinks both the uterus and the fibroids. Fibroids grow back after GnRH-a therapy. GnRH-a therapy can help to:

• Shrink a fibroid before it is surgically removed. This lowers your risk of heavy blood loss and scar tissue from the surgery.
• Provide short-term relief as a "bridge therapy" if you are nearing menopause. (Fibroids naturally shrink after menopause.)

GnRH-a therapy should be used for only a few months because it can weaken the bones. It also may cause unpleasant menopausal symptoms.

To surgically remove fibroids, myomectomy can often be done through one or more small incisions using laparoscopy or through the vagina (hysteroscopy). Sometimes, a larger abdominal incision is needed. Myomectomy preserves the uterus, and makes pregnancy possible for some women.^{5 11}

To shrink or destroy fibroids without surgery, uterine fibroid embolization (UFE) (also called uterine artery embolization) stops the blood supply to the fibroid. The fibroid then shrinks and may break down. UFE preserves the uterus, but pregnancy is not common after treatment. UFE is not usually recommended for women who plan to become pregnant.¹²

To surgically remove the entire uterus, hysterectomy is available to women with long-lasting or severe symptoms who have no future pregnancy plans. Hysterectomy has both positive and negative long-term effects. For more information, see the topic Hysterectomy.

Should I use GnRH-a therapy to treat uterine fibroids?

Should I have surgery to treat uterine fibroids?

Should I have uterine fibroid embolization for uterine fibroids?

What To Think About

Fibroids can grow back after a myomectomy or after uterine fibroid embolization (UFE).

Compared to myomectomy, UFE is quicker and has a shorter recovery time.

The risk of complications (like severe pain or infection) is about the same after surgery or UFE.¹³

• With surgery (hysterectomy or myomectomy), most complications happen in the first days, in the hospital.
• With UFE, most complications happen in the following weeks or months, at home.

UFE is not always a definitive, final treatment option. In one study, nearly 1 in 5 women who had UFE later had a repeat UFE or a hysterectomy within 3½ years.¹³

There are several new ways of removing fibroids or killing fibroid tissue using extreme cold (cryomyolysis), laser (myolysis), or high-frequency focused ultrasound (ExAblate). But they are still new enough that risks and long-term benefits are not yet fully known.¹⁴ If your doctor offers one of these procedures, ask how many of the procedures he or she has done, how successful they have been, and what kinds of problems can result. These treatments are not recommended for women who are trying to become pregnant.⁵

Prevention

There is no known treatment that prevents uterine fibroids. But getting regular exercise may help. According to one study, the more exercise women have, the less likely they are to get uterine fibroids.¹⁵

Preventing fibroids from coming back after treatment

It is common for fibroids to grow back after treatment. The only treatment that absolutely prevents regrowth of fibroids is removal of the entire uterus, called hysterectomy. After hysterectomy, you cannot get pregnant. While many women report an improved quality of life after hysterectomy, there are also possible long-term side effects to consider. For more information, see the topic Hysterectomy.

Home Treatment

Home treatment can ease menstrual period pain and anemia that may be linked to uterine fibroids.

Tips for relieving menstrual pain

Painful menstrual periods (dysmenorrhea) are one of the most common symptoms of fibroids.

Why fibroids cause pain is not known. Try one or more of the following tips to help relieve your menstrual pain:

• Apply heat to the lower abdomen by using a heating pad or hot water bottle or taking a warm bath. Heat improves blood flow and may improve pelvic pain.
• Lie down and elevate your legs by putting a pillow under your knees. This may help relieve pain.
• Lie on your side and bring your knees up to your chest. This will help relieve back pressure.
• Use sanitary napkins instead of tampons.
• Get exercise, which improves blood flow and may decrease pain.

Tips for preventing anemia

Anemia occurs when your body cannot produce blood as fast as it is being lost. As a result, you have fewer red blood cells in the blood. A test called a complete blood count (CBC) can tell you whether you have anemia. Take the following steps to prevent anemia:

• Increase the amount of iron in your diet. Your body needs iron to make new blood cells, and your diet is the best source. Get 18 mg to 20 mg of iron per day. Red meats, shellfish, eggs, beans, leafy green vegetables, and iron-enriched breads and cereals are the best sources of iron.
• Eat a well-balanced diet. If you are not able to meet your need for iron through diet alone, consider taking a nonprescription iron supplement (such as ferrous sulfate) or a multivitamin. You may become constipated when you are taking an iron supplement. To avoid constipation, eat more fiber, eat plenty of fruits and vegetables, and drink at least 2 to 4 extra glasses of water per day.
• Be sure your diet includes 250 mg of vitamin C per day. Vitamin C helps your body absorb iron more effectively.
• For more information about getting enough iron, see the U.S. National Institutes of Health Web page at www.ods.od.nih.gov//factsheets/iron.asp#h4.

For more information on how to prevent constipation, see healthy bowel habits to prevent constipation.

Medications

Medicine can be used to help relieve uterine fibroid problems. The goals of medicine treatment are to:

• Relieve severe pain or other symptoms caused by fibroids.
• Correct anemia caused by heavy bleeding.
• Shrink fibroids before fibroid removal (myomectomy) or uterus removal (hysterectomy).
• Avoid hysterectomy.

When treatment is stopped, symptoms usually return.

Medication Choices

The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods—they do not shrink fibroids:

• Nonsteroidal anti-inflammatory drug (NSAID) therapy relieves menstrual cramping and greatly reduces heavy menstrual bleeding for many women.⁷ But there are no studies that show that NSAIDs decrease fibroid pain or bleeding.⁶
• Birth control hormones (pill, patch, or ring) reduce heavy menstrual periods and pain while preventing pregnancy. But they usually do not affect the size of uterine fibroids.⁸
• A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may improve fibroids, or may make them grow.^{9 5} This might be different for each woman.
• Iron supplements, available without a prescription, are an important part of correcting anemia caused by fibroid blood loss.

The following medicine is used to shrink fibroids before surgery and to temporarily relieve symptoms:

• Gonadotropin-releasing hormone analogue (GnRH-a) therapy puts the body in a state like menopause, which shrinks the uterus and fibroids. GnRH-a therapy should be used for only a few months, because it can weaken the bones. It may also cause unpleasant menopausal symptoms. Fibroids grow back after GnRH-a therapy is stopped.¹⁶

Should I use GnRH-a therapy to treat uterine fibroids?

What To Think About

If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a menstrual cycle problem that can be improved with birth control hormones and/or NSAID therapy. (For more information, see the topic Dysfunctional Uterine Bleeding.) Using the two together is most likely to relieve pain and lighten bleeding.⁷

GnRH-a therapy is sometimes used to stop bleeding and improve anemia. But taking iron supplements can also improve anemia and does not cause the troublesome side effects and bone weakening that can happen with GnRH-a therapy.

NSAID therapy use during conception or early pregnancy may increase the risk of miscarriage.¹⁰ If you are trying to get pregnant, talk to your health professional about whether you can use NSAID therapy.

Surgery

To treat uterine fibroids, surgery can be used to remove fibroids only (myomectomy) or to remove the entire uterus (hysterectomy).

Surgery is a reasonable treatment option when:¹⁴

• Heavy uterine bleeding and/or anemia has continued after several months of therapy with birth control hormones and a nonsteroidal anti-inflammatory drug (NSAID).
• Fibroids grow after menopause.
• The uterus is misshapen by fibroids and you have had repeat miscarriages or trouble getting pregnant.
• Fibroid pain or pressure affects your quality of life.
• You have urinary or bowel problems (from a fibroid pressing on your bladder, ureter, or bowel).
• There is a possibility that cancer is present.
• Fibroids are a possible cause of your trouble getting pregnant.

Surgery Choices

Surgical treatment options include:

• Myomectomy, or fibroid removal. This is the only fibroid treatment that may improve your chances of having a baby.⁵ It is known to help with a certain kind of fibroid called a submucosal fibroid. But it does not help with any other kind of fibroid.¹
• Hysterectomy, or uterus removal. This is only recommended for women who have no future pregnancy plans. Hysterectomy is the only fibroid treatment that prevents regrowth of fibroids. It improves quality of life for many women, but it can also have negative long-term effects, such as pelvic organ prolapse. For more information, see the topic Hysterectomy.

Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina, or through a larger abdominal cut (incision). The method depends on your condition, including where, how big, and what type of fibroid is growing in the uterus and whether you hope to become pregnant.

Should I have surgery to treat uterine fibroids?

Uterine fibroid embolization (UFE) (also called uterine artery embolization) is a nonsurgical option that shrinks or destroys a fibroid by cutting off its blood supply. For more information, see the Other Treatment section of this topic.

What To Think About

If you are hoping for a future pregnancy, myomectomy is your one surgical option. An abdominal myomectomy may be safer than a laparoscopic one—there is limited research about pregnancy safety after laparoscopic myomectomy.⁵

Heavy, prolonged, and painful periods caused by uterine fibroids will stop naturally after you reach menopause. If you are nearing menopause and your symptoms are tolerable, consider controlling symptoms with home treatment and medicine until menopause. Uterine fibroid embolization (UFE) may also be a reasonable option for you, although it has some risks.

Other Treatment

Uterine fibroid embolization (UFE) (also called uterine artery embolization) is a recent addition to the list of uterine fibroid treatment options. It shrinks or destroys uterine fibroids by blocking the artery that supplies blood to them. During a UFE procedure, a radiologist places a thin, flexible tube called a catheter into the upper thigh and guides it into the uterine artery that supplies blood to the fibroids. A solution is then injected into the uterine artery through the catheter.

UFE is a nonsurgical alternative to hysterectomy or myomectomy. It relieves fibroid symptoms for most women, but in rare cases, it can lead to complications such as serious infection or early menopause.

UFE may be a reasonable treatment option when:

• You have no future childbearing plans. Pregnancy is possible after UFE, but the risks to pregnancy after UFE are not fully known.¹¹
• Heavy uterine bleeding and/or anemia has continued after several months of therapy with birth control hormones and a nonsteroidal anti-inflammatory drug (NSAID).
• You have fibroid pain or pelvic pressure that affects your quality of life.
• You have urinary or bowel problems from a fibroid that is pressing on your bladder, ureter, or bowel.
• You do not wish to have a hysterectomy or myomectomy.
• You have a disease or disorder that makes surgery with general anesthesia dangerous.

Should I have uterine fibroid embolization for uterine fibroids?

What to Think About

In one study, about 1 in 5 women who had uterine fibroid embolization (UFE) needed another UFE or a hysterectomy within 3½ years.¹³

Pregnancy is possible after UFE. Whenever you need to prevent pregnancy after UFE, be sure to use a dependable form of birth control.

Heavy, prolonged, and painful periods caused by uterine fibroids will stop naturally when you reach menopause. If you are nearing menopause and your symptoms are tolerable with home treatment or medicines, then the risks of UFE may not outweigh the benefits.

There are several new ways of removing fibroids or killing fibroid tissue, including using extreme cold (cryomyolysis), laser (myolysis), or high-frequency focused ultrasound (ExAblate). But they are still new enough that risks and long-term benefits are not yet fully known.¹⁴ If your doctor offers one of these procedures, ask how many of the procedures he or she has done, how successful they have been, and what kinds of problems can result. These treatments are not recommended for women who are trying to become pregnant.⁵

Other Places To Get Help

Organizations

Related Information

• Cervical Polyps

References

Citations

1. Parker WH (2007). Etiology, symptomatology, and diagnosis of uterine myomas. Fertility and Sterility, 87(4): 725–736.

2. Drinville JS, Memarzadeh S (2007). Benign disorders of the uterine corpus. In AH DeCherney et al., eds., Current Obstetric and Gynecologic Diagnosis and Treatment, 10th ed., pp. 639–653. New York: McGraw-Hill.

3. American College of Obstetricians and Gynecologists (2000). Surgical alternatives to hysterectomy in the management of leiomyomas. ACOG Technical Bulletin No. 16. Obstetrics and Gynecology, 95(5): 1–9.

4. Day Baird D, et al. (2003). Highly cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1): 100–107.

5. Practice Committee of the American Society for Reproductive Medicine (2006). Myomas and reproductive function. Fertility and Sterility, 86(4): S194–S199.

6. Lethaby A, Vollenhoven B (2006). Fibroids (uterine myomatosis, leiomyomas). Online version of Clinical Evidence (15).

7. Mishell DR Jr, et al. (2001). Abnormal uterine bleeding. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 1079–1097. St. Louis: Mosby.

8. Haney AF (2003). Leiomyomata. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 869–887. Philadelphia: Lippincott Williams and Wilkins.

9. American College of Obstetricians and Gynecologists (2006). Use of hormonal contraception in women with coexisting medical conditions. ACOG Practice Bulletin No. 73. Obstetrics and Gynecology, 107(6): 1453–1472.

10. Li D, et al. (2003). Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population-based cohort study. BMJ, 327(7411): 368–372.

11. Hart R (2003). Unexplained infertility, endometriosis, and fibroids. BMJ, 327(7417): 721–724.

12. American College of Obstetricians and Gynecologists (2004, reaffirmed 2006). Uterine artery embolization. ACOG Committee Opinion No. 293. Obstetrics and Gynecology, 103(2): 403–404.

13. Edwards RD, et al. (2007). Uterine-artery embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine, 356(4): 360–370.

14. Wallach E, Vlahos NF (2004). Uterine myomas: An overview of development, clinical features, and management. Obstetrics and Gynecology, 104(2): 393–406.

15. Baird DD, et al. (2007) Association of physical activity with development of uterine leiomyoma. American Journal of Epidemiology, 165(2): 157–163.

16. Speroff L, Fritz MA (2005). The uterus. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 113–144. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

• Hindley J, et al. (2004). MRI guidance of focused ultrasound therapy of uterine fibroids: Early results. AJR, 183(6): 1713–1719.

Credits