Uterine fibroids — also called leiomyomas or myomas — are non-cancerous growths that develop within or on the wall of the uterus. They are composed of smooth muscle cells and fibrous connective tissue, ranging from a few millimeters to several centimeters in size. A woman may have a single fibroid or multiple at once, and their size can change over time in response to hormones.
Fibroids are the most common benign gynecologic tumors in women of reproductive age. Many women suffer for years with symptoms dismissed as “just heavy periods” — unaware that a fibroid is the cause. At Hackensack CMIGS, Dr. Adam Shoman provides accurate diagnosis, clear explanation of all treatment options, and minimally invasive surgical solutions.
Uterine fibroids are almost always benign. Uterine sarcoma occurs in fewer than 1 in 1,000 uterine masses. However, untreated fibroids can significantly impact quality of life, fertility, and long-term health.
| Women Affected (US) | Symptom-Free Cases | Fibroids & Infertility | Minimally Invasive Success |
|---|---|---|---|
| 26M26 million — up to 80% of women by age 50 | ~50%of cases discovered incidentally | 5–10%of female infertility cases primarily caused by fibroids | 95%+of fibroid cases at CMIGS treated without open surgery |
Fibroids are classified by their location within and around the uterus — the single most important factor in determining which treatment will be most effective. Dr. Shoman maps fibroid location precisely using ultrasound and MRI before recommending any treatment.
| Type | Location | Prevalence | Typical Symptoms | Fertility Impact |
|---|---|---|---|---|
| Intramural | Within the uterine muscular wall (myometrium) | Most common (~70% of cases) | Heavy bleeding, pelvic pressure, cramping, frequent urination, back pain. Large fibroids can distort the uterine cavity. | Can impair implantation and increase miscarriage risk when distorting the cavity. |
| Submucosal | Beneath the endometrium, projecting into the uterine cavity | Least common (5–10%) but most symptomatic | Severe heavy bleeding, prolonged periods, breakthrough bleeding, anemia, cramping. Even small fibroids cause major symptoms. | Most significant fertility impact. Directly interferes with implantation; increases miscarriage risk; can obstruct fallopian tube openings. |
| Subserosal | Outer surface of the uterus, projecting into the pelvis | Common (~20–25%) | Pelvic pressure, bloating, back/leg pain, urinary frequency, constipation. Rarely causes heavy bleeding. | Least direct fertility impact; very large fibroids may alter uterine anatomy enough to affect implantation. |
| Pedunculated | Attached to the uterus by a stalk — can be submucosal or subserosal | Subtype of submucosal or subserosal | Subserosal: pelvic pain, especially if stalk twists (torsion). Submucosal: heavy bleeding, cramping, occasional prolapse through cervix. | Pedunculated submucosal: significant fertility impact. Pedunculated subserosal: minimal direct impact. |
A 2cm submucosal fibroid may warrant more urgent treatment than a 6cm subserosal fibroid, depending on symptoms and fertility goals. Location, not size alone, drives the treatment decision.
Approximately 50% of women with fibroids have no symptoms — fibroids are discovered incidentally during a routine pelvic exam or ultrasound. For the other 50%, symptoms range from inconvenient to debilitating:
Diagnosis begins with a review of your symptoms and how they affect daily life. Dr. Shoman uses the following tools:
Not every fibroid requires surgery. For mild-to-moderate symptoms, small fibroids, or women who prefer to delay surgery, non-surgical options can manage symptoms effectively — though they do not eliminate fibroids permanently.
| Option | Mechanism | Best For | Limitations |
|---|---|---|---|
| NSAIDs | Reduces inflammation and menstrual cramping | Mild pain; light-to-moderate bleeding | Does not shrink fibroids |
| Combined Oral Contraceptives | Regulates cycle and reduces bleeding volume | Bleeding control; cycle regulation | May slow growth; does not eliminate fibroids |
| Progestin Therapy (Mirena IUD / Oral) | Reduces endometrial lining and bleeding | Heavy bleeding; uterine cramping | Limited effect on fibroid size |
| GnRH Agonists (Lupron) | Temporary menopause-like state; shrinks fibroids | Pre-surgical shrinkage; anemia correction | Fibroids regrow within months of stopping; hot flashes, bone loss |
| GnRH Antagonists (Oriahnn / Myfembree) | Reduces estrogen without full menopause induction | Long-term non-surgical symptom management | More tolerable than GnRH agonists; fibroids may regrow after stopping |
| Tranexamic Acid (Lysteda) | Non-hormonal; reduces heavy bleeding volume | Heavy bleeding only | Does not affect fibroid size; taken only during menstruation |
Non-surgical options treat fibroid symptoms, not fibroids themselves. When treatment is stopped, fibroids typically return to their previous size and symptoms recur. For definitive relief — particularly with moderate to severe symptoms or fertility goals — surgical treatment offers a more permanent solution.
When fibroids cause significant symptoms, affect fertility, or have not responded to medical management, surgery provides the most effective and durable solution. Dr. Shoman performs all fibroid surgeries using minimally invasive techniques — smaller incisions, less pain, and faster recovery than open surgery in virtually every case.
| Procedure | Description | Best For | Recovery | Key Benefit |
|---|---|---|---|---|
| Laparoscopic Myomectomy | Fibroid removal through 3–4 small abdominal incisions | Intramural & subserosal fibroids; women preserving fertility | Same day; work in 1–2 weeks | Preserves uterus; fast recovery |
| Robotic Myomectomy (Da Vinci) | Fibroid removal with robotic precision and 3D vision | Multiple/large fibroids; complex locations; reoperative cases | Same day or 1 night; work in 1–2 weeks | Superior precision for complex cases |
| Hysteroscopic Myomectomy | Removal through the cervix — no abdominal incisions | Submucosal fibroids; heavy bleeding; infertility | Home same day; normal activity in 1–2 days | No external scars; fastest recovery |
| Laparoscopic Hysterectomy | Minimally invasive uterus removal | Completed childbearing; multiple large fibroids; failed myomectomy | 1–3 weeks | Definitive — fibroids cannot recur |
| Robotic Hysterectomy (Da Vinci) | Robotic-assisted uterus removal | Dense adhesions; prior pelvic surgery; large/multiple fibroids | 1–3 weeks | Most precise minimally invasive hysterectomy |
Myomectomy does not guarantee fibroids will not recur. New fibroids develop in approximately 15–30% of cases over 10 years. However, the procedure significantly improves fertility outcomes and quality of life, and many women remain symptom-free for years.
The right choice depends on your symptoms, fibroid type and size, fertility goals, age, and personal preferences.
| Factor | Non-Surgical Management | Surgical Treatment |
|---|---|---|
| Goal | Manage / reduce symptoms | Remove fibroids or uterus entirely |
| Effect on fibroids | Suppresses or shrinks temporarily | Permanently removes fibroids or uterus |
| Recurrence risk | Fibroids may regrow when treatment stops | Low (myomectomy) to none (hysterectomy) |
| Fertility | Most options preserve fertility | Myomectomy preserves uterus; hysterectomy ends fertility |
| Recovery | No surgical downtime | Minimally invasive: 1–4 weeks |
| Durability | Symptoms may return | Long-term or permanent relief |
| Best for | Mild–moderate symptoms; pre-surgery bridge | Moderate–severe symptoms; definitive treatment |
Uterine fibroids are one of the most common — and correctable — structural causes of infertility and recurrent pregnancy loss. The mechanisms include:
Evidence is strongest for submucosal fibroids: hysteroscopic myomectomy has been shown to improve clinical pregnancy rates and reduce miscarriage rates. For intramural fibroids distorting the uterine cavity, laparoscopic or robotic myomectomy can also meaningfully improve fertility outcomes. The decision to pursue fibroid surgery before fertility treatment should be discussed with both Dr. Shoman and your reproductive endocrinologist.
| Hoboken Office | Hasbrouck Heights Office |
|---|---|
| Address: 104 Hudson St, Suite 2C, Hoboken, NJ 07030 Hours: Mon–Fri: 8:00 AM – 5:00 PM | Sat: 9:00 AM – 3:00 PM Serving: Jersey City, Weehawken, Union City, Kearny, Manhattan | Address: 777 Terrace Ave, Suite 302, Hasbrouck Heights, NJ 07604 Hours: Mon–Sat: 8:00 AM – 5:00 PM Serving: Hackensack, Lodi, Wallington, Little Ferry, Ridgefield |
Are uterine fibroids cancerous?
No — the vast majority are benign. Uterine sarcoma is extremely rare, occurring in fewer than 1 in 1,000 women with uterine masses.
Will my fibroids grow back after surgery?
Hysterectomy is the only permanent solution. After myomectomy, there is a 15–30% chance of new fibroids developing over 10 years, though many women remain symptom-free far longer.
Can fibroids shrink on their own?
After menopause, declining estrogen often causes fibroids to shrink. GnRH agonist medications can temporarily shrink fibroids by 30–50%, though they typically regrow once stopped.
What is the difference between myomectomy and hysterectomy?
Myomectomy removes only the fibroids, preserving the uterus and fertility. Hysterectomy removes the entire uterus, permanently eliminating fibroids but ending the ability to carry a pregnancy.
Can I get pregnant after fibroid surgery?
Yes — myomectomy is designed to treat fibroids while preserving fertility. Dr. Shoman typically recommends waiting 3–6 months after laparoscopic myomectomy before attempting conception.
How do I know which fibroid treatment is right for me?
The right treatment depends on fibroid type, size, location, symptoms, and your fertility goals. Dr. Shoman reviews your imaging and presents a personalised recommendation at your consultation.
Is fibroid surgery covered by insurance?
Medically necessary fibroid surgery is typically covered by most major insurance plans, though coverage varies. Our staff will verify your benefits and communicate any out-of-pocket costs in advance.
How do I schedule a fibroid consultation?
Visit hackensackcmigs.com or call our Hoboken or Hasbrouck Heights office to request an appointment, available Monday through Saturday. Bring any recent ultrasound or MRI imaging to your consultation.
Dr. Adam Shoman | Hackensack CMIGS | Hoboken & Hasbrouck Heights, NJ
hackensackcmigs.com | Mon–Sat