My doctor says I have fibroids. What happens next?

I just learned that I have fibroids. What are they, and why are they a problem?

A. By the time they turn 50, as many as 80% of women will develop fibroids, noncancerous tumors that grow in the uterus.

Not all women have symptoms. But fibroids can cause heavy menstrual bleeding, pelvic pain and pressure, constipation and a need to urinate more frequently, said Dr. Vanessa Jacoby, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. In some instances, they can cause miscarriages or prevent women from getting pregnant.

The symptoms can affect women’s quality of life, including their sex lives, relationships, mental health and even finances, if severe enough to cause them to miss work.

Some women live with symptoms for years without seeking care. But there are several options for treating and managing fibroids, Jacoby said. She added that what’s most effective depends on a few factors, including what your symptoms are and whether you want to get pregnant in the future.

Q. What causes fibroids?

A. Fibroids can form inside the uterus, within its walls or on its outer surface. They can also be attached to the uterus by a stalk, said Dr. Taraneh Shirazian, a gynecologist and the director of NYU Langone Health’s Center for Fibroid Care.

Jacoby said that what causes fibroids to form and grow is unknown, but it’s probably a “mix” of biological, genetic, environmental and hormonal factors. The tumors are generally slow-growing and can range from as small as a pea to larger than a watermelon, she added.

They are affected by the hormones estrogen and progesterone, and research suggests that they grow when hormone levels are higher, as in pregnancy, and shrink when the levels decline, as during menopause.

You may be more likely to get fibroids if other women in your family have them, Shirazian said. Black women are about three times as likely to have fibroids as the general population. They’re often diagnosed at younger ages and have more significant symptoms, Jacoby said. Hispanic and Asian women are also at elevated risk for a fibroid diagnosis, research shows.

Q. How are fibroids diagnosed?

A. Fibroids are typically diagnosed through imaging tests like ultrasound, magnetic resonance imaging (MRI) or CT scans, said Dr. Arleen H. Song, a minimally invasive gynecologic surgeon at Duke Health in Durham, North Carolina.

Doctors may recommend one of these scans if you have symptoms like pain or intense bleeding or if, during a pelvic exam, they feel a mass on your uterus.

Sometimes women without symptoms discover they have fibroids after getting an MRI or another scan for a different reason, like suspected appendicitis, Song said.

Q. How are fibroids treated?

A. When fibroids are small and asymptomatic, doctors typically monitor them over time and may recommend a yearly ultrasound, Shirazian said.

When the growths cause heavy bleeding, however, doctors often start with medications, like hormonal birth control pills, patches, rings or hormonal IUDs, which, besides providing contraception, can decrease bleeding, Jacoby said. Another treatment is a nonhormonal medication called tranexamic acid, taken only on days with heavy bleeding, she said.

Shirazian said treatment with gonadotropin-releasing hormone antagonists can minimize bleeding and reduce the volume of fibroids.

And medications that treat bleeding, Song said, also treat anemia related to excessive blood loss, which is common in women who have fibroids.

For patients who experience pelvic pain and pressure, doctors typically recommend procedures to shrink the growths. One of these is uterine artery embolization, in which tiny particles are injected into the arteries to the fibroid, blocking its blood supply and causing it to shrink. Another is radiofrequency ablation, which uses high heat to destroy fibroid tissue and reduce the growth’s size.

However, these procedures often aren’t recommended for women who want to get pregnant, Song said, as more research is needed to show that they are safe for future pregnancies.

Fibroids can also be removed through a surgery known as a myomectomy, Song said.

In about 10% to 30% of women who have had a myomectomy or other procedure to shrink their fibroids, the growths return, and another treatment will be needed at some point, Jacoby said. And the more fibroids you have, the greater the risk.

A hysterectomy, which removes the uterus, is the only sure way to prevent fibroids from returning. Shirazian said women may choose to have the surgery if they don’t plan to get pregnant or have tried other treatments and their fibroids returned. In some cases, women just “don’t want to have to deal with this anymore,” she added, referring to fibroid symptoms and recurrences.

But too often, Jacoby said, women are told that a hysterectomy is their only option for treating fibroids, whether or not they hope to carry a pregnancy in the future, and they are not offered less invasive treatments. She suggested getting a second opinion. “In most cases, there’s a variety of options,” she said, and “women should know their options and be able to make a really informed decision.”

This article originally appeared in The New York Times.