Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.

Fibroids may have the following symptoms:

• Changes in menstruation
  • Longer, more frequent, or heavy menstrual periods
  • Menstrual pain (cramps)
  • Vaginal bleeding at times other than menstruation
  • Anemia (from blood loss)

• Pain
  • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
  • During sex
• Pressure
  • Difficulty urinating or frequent urination
  • Constipation, rectal pain, or difficult bowel movements
  • Abdominal cramps

• Enlarged uterus and abdomen
  • Miscarriages
  • Infertility
• Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

Tests

• Ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.
• Imaging tests, such as magnetic resonance imaging and computed tomography scans, may be used but are rarely needed. Some of these tests may be used to track the growth of fibroids over time.

Surgical options to treat fibroids:

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.

Hysterectomy is the removal of the uterus.  Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the reproductive years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. 

Types of cysts include the following:

• Functional cyst—This is the most common type of ovarian cyst. It usually causes no symptoms. Functional cysts often go away without treatment within 6 to 8 weeks.
• Teratoma—This is a cyst or benign tumor that contains different kinds of tissues that make up the body, such as skin and hair. Teratomas may be present from birth and can grow during the reproductive years. In very rare cases, some teratomas can become cancer.
• Cystadenoma—This is a benign tumor that forms on the outer surface of the ovary. These tumors can grow very large even though they usually are benign.
• Endometrioma—This cyst forms as a result of endometriosis.

In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen, bloating, and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting may cause pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.

Ovarian cysts are generally diagnosed through a variety of tests. Pregnancy test to rule out a possible ectopic pregnancy, ultrasound or other imaging tests, and blood tests that measure the level of a substance called CA125.  An increased level of CA 125, along with certain findings from ultrasound and physical exams, may raise concerns for ovarian cancer.

There are several treatment options for cysts. Watchful waiting is a way of monitoring a cyst with repeat ultrasound exams to see if the cyst has changed in size or appearance. Many cysts go away on their own after one or two menstrual cycles.

Surgery may be recommended if your cyst is very large or causing symptoms or if cancer is suspected.  A cystectomy is the removal of a cyst from the ovary. In some cases, an ovary may need to be removed. This is called an oophorectomy.

Minimally invasive surgery is done using small incisions and a special instrument called a laparoscope or Robot.  Another type of surgery is called “open” surgery. In open surgery, an incision is made horizontally or vertically in the lower abdomen.  If cancer is suspected, it is important to remove the cyst intact. Sometimes open surgery is the only way to do this.

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found in other places in your body. These patches of tissue are called “implants,” “nodules,” or “lesions.” They are most often found:

• On or under the ovaries
• On the fallopian tubes, which carry egg cells from the ovaries to the uterus
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In rare cases, the tissue may grow on your lungs or in other parts of your body.

Endometriosis tissue responds to changes in a hormone called estrogen. The tissue may grow and bleed as the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue to form. 

Almost 4 in 10 women with infertility have endometriosis. 

The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sexual intercourse. If endometriosis affects the bowel, there can be pain during bowel movements. If it affects the bladder, there can be pain during urination. Heavy menstrual bleeding is another symptom of endometriosis.

Many women with endometriosis have no symptoms. Women without symptoms often learn they have endometriosis when they cannot get pregnant or when they are having surgery for something else.

Surgery is the only way to know for sure that you have endometriosis. First, however, your health care provider will ask about your symptoms and medical history. You will have a pelvic exam and may have some imaging test.   

The most common surgery to diagnose endometriosis is a laparoscopy.  This is a type of surgery that uses a laparoscope, a thin tube with a camera and light. The surgeon inserts the laparoscope through a small cut in the skin. Your provider can make a diagnosis based on how the patches of endometriosis look. He or she may also do a biopsy  to get a tissue sample.

Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

Medications that are used to treat endometriosis include pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal medications, including birth control pills, progestin-only medications, and in 2018, the U.S. Food and Drug Administration (FDA) approved a medication to treat pain associated with endometriosis. The medication is called a gonadotropin-releasing hormone (GnRH) antagonist. 

After surgery, most women have relief from pain. But there is a chance the pain will come back. Up to 8 in 10 women have pain again within 2 years of surgery. This may be due to endometriosis that was not visible or could not be removed at the time of surgery.   Taking birth control pills or other medications after having surgery may help extend the pain-free period.

Removal of the uterus without the cervix through an abdominal incision.

A surgical procedure to remove uterine fibroids. These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years, but they can occur at any age.

Supracervical Hysterectomy

Removal of the uterus without the cervix through small (about 1 cm) laparoscopic incisions. This procedure may be performed laparoscopically or robotically.

Myomectomy
A surgical procedure to remove uterine fibroids. These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years, but they can occur at any age. This procedure may be performed laparoscopically or robotically.

Salpingoophorectomy is the removal of the fallopian tube (salpingectomy) and ovary (oophorectomy). This procedure may be performed laparoscopically or robotically.

Lysis of it adhesions is a procedure that destroys scar tissue that’s causing abdominal and chronic pelvic pain. The scar tissue typically forms after surgery as part of the healing process, but can also develop after an infection or a condition that causes inflammation, such as endometriosis. This procedure may be performed laparoscopically or robotically.

Total Vaginal Hysterectomy

Removal of the entire uterus including the cervix with or without the tubes and ovaries vaginally. The removal of the uterus may be necessary when performing some, but not all surgeries for pelvic organ prolapse.