Get answers to the most frequently asked questions about uterine fibroids from Michelle Louie, M.D., a minimally invasive gynecologic surgeon at Mayo Clinic.

Hi, I'm Dr. Michelle Louie, a minimally invasive gynecologic surgeon at Mayo Clinic. And I'm here to answer some of the important questions you might have about uterine fibroids.

How do I pick the right treatment option?

There's no such thing as the right decision as there are many potential options that may be available to you. A fibroid specialist will be able to tell you what options are possible based on the size, number and location of the fibroids and your treatment goals. You may want to consider the severity of your symptoms, your feelings about surgery, your plans for pregnancy and how close you are to menopause.

Should I have my fibroids removed before or after pregnancy?

Fibroids in the uterine cavity can cause miscarriage or make it more difficult to get pregnant. So those are usually removed before pregnancy is attempted. If you're having bothersome symptoms now, getting them removed before pregnancy is possible. But depending on the size and location of the fibroids, your doctor may advise that you have a C-section in a future pregnancy because the scar on the uterus can open during labor. And that would be very dangerous for both you and the baby. If you're not having severe symptoms now, you could wait until after pregnancy to have the fibroids removed. But fibroids can grow during pregnancy and about 20 to 30% of cases, and that causes pain. Large fibroids, usually those bigger than 3 to 5 centimeters and cause issues with the placenta, growth of the baby, excessive bleeding during childbirth, preterm labor, and sometimes cause problems with delivery of the baby.

Can uterine fibroids come back after being removed?

Any treatment that preserves the uterus means that fibroids can occur in the future. So a hysterectomy, in which the uterus and cervix are removed, is the only treatment that can actually guarantee fibroids won't return. Fibroids can reoccur in about 60% of people who have them. But just because they come back doesn't mean they need to be treated.

Are there any natural medicines to shrink my fibroids?

There are some small studies looking into possible dietary and environmental factors that may promote fibroid growth. Foods like red meat, dairy, soy products, and exposure to BPA have been shown to have a possible link to fibroid development. But this data is weak and furthermore, avoiding these exposures has not been shown to treat, shrink or prevent fibroids. It does appear that fibroid growth is related to increasing weight. So exercise and eating a nutritious diet to maintain a healthy weight can help. The best evidence we have for vitamin supplements is for vitamin D. Vitamin D deficiency, which is very common in people with dark skin, has been associated with fibroid growth in some studies. But we don't yet have enough information to recommend a certain dose of vitamin D supplements. Limited data does not support the use of herbal supplements like black cohosh or vaginal steaming. Additionally, because these supplements are not FDA regulated, they may be dangerous to your health. Acupuncture has shown promise for improving fibroid outcomes in small studies. And while there's not enough data to promote its use as primary treatment, it's very low-risk and would be acceptable as an adjunctive treatment.

Do fibroids disappear after menopause?

Since fibroids are hormonally responsive growths, most people do experience a decrease in fibroid size and fibroid-related issues as they get closer to menopause and beyond. In fact, the whole uterus decreases in size after menopause. However, studies do show that fibroids can continue to keep growing after menopause because there are other tissues in our body that produce estrogen besides the ovaries. This ongoing growth does not mean the fibroids are cancerous or that they even need to be treated. But if you are having bothersome symptoms, treatment is absolutely an option. How much the fibroids grow and how fast varies from person to person. But it's more likely with increasing weight or obesity and more likely with smaller rather than larger fibroids.

Are fibroids cancerous?

Fibroids have a very typical appearance on an ultrasound, and because they're so common, they're almost always accurately diagnosed. In some situations, your doctor may recommend a biopsy of the uterine lining or of the mass if there's a concern for cancer. If there's a concern for cancer, you may be referred to a specialist to discuss whether a hysterectomy is the best option rather than trying uterine sparing treatments. If you have a myomectomy, your surgeon may recommend using a special containment bag to remove the fibroids from your body since this can limit the spread of any cancerous or even noncancerous cells.

How can I be the best partner to my medical team?

Be upfront about your treatment goals and concerns. Don't be afraid to ask for a second opinion or referral to a fibroid specialist. If you feel like your doctor is advising a more invasive therapy, then seeing a fibroid specialist can help you ensure that you're being given all the options. Never hesitate to ask your medical team any questions or concerns you have. Being informed makes all the difference. Thanks for your time and we wish you well.

Sept. 23, 2022