I got an unexpected ultrasound report in my inbox this week concerning a young woman under my care who had recently gone for a routine GYN appointment. She was complaining of some painful and heavier-than-usual menstrual bleeding, so the nurse practitioner there ordered an ultrasound for her, which—I was sorry to read—showed a very large fibroid.

I care for a number of other women who also have fibroids or who have had hysterectomies to end their troubles from fibroids.

About 50 percent of women have these smooth-muscle "tumors" within their uteri. I use the word "tumor" here simply to imply a mass—fibroids are most definitely not a cancerous growth. But unfortunately, they can increase in size over time and cause trouble. Common symptoms include painful menses, excessive menstrual bleeding, infertility, or recurrent miscarriages.

Their growth is likely stirred by female hormones, including estrogen but also some others. Women who have multiple pregnancies or who spend years on the Pill are less likely to develop these growths. But other than these 2 approaches, we know of no other ways to prevent fibroids from developing.

If they are small and causing only limited symptoms, treatment for them can be as simple as taking the Pill or getting depo-provera injections. In the event that they are large, however, I suggest care by a gynecologist with specialty experience in managing fibroids.

Choice of treatment for fibroids starts with deciding if you are still looking to have children, or if you're ready to bring your fertility to a close.

Methods to preserve fertility include:

• a myomectomy, a surgery that attempts to remove the fibroid while still preserving the uterus
• uterine artery embolization, in which a specially trained radiologist attempts to cut off the blood supply to the fibroid, thus reducing its size
• endometrial ablation or myolysis, a surgical procedure in which a fibroid is burned away with heat energy, either in the form of lasers or electrical currents, thus decreasing its tendency to bleed. (Note: This option is not preferred in a woman still considering future child-bearing.)
• the most effective option is to have a hysterectomy—which of course is the easiest decision for a woman after her child-bearing years are done, but the most difficult for a woman who has yet to conceive or who has not decided whether she has completed her family.

None of these options are easy, nor are they entirely trouble-free and clear-cut. If you believe you have symptoms of a fibroid, your first step should be to have an ultrasound (likely by way of the vagina) to help make the diagnosis. Once a fibroid has been detected, make sure to talk with an experienced surgeon who offers you all the treatment options while giving you an idea of how effective each method is in relieving your particular symptoms and meeting your needs.