Monthly menstrual pain or cramps is not characteristic of myomas and should signal a search for coexisting adenomyosis . It is not known whether the initial or ongoing stimulus is genetic, viral, inflammatory repair of normal cell loss or any other cause. Unless there is an extremely high suspicion of malignancy based upon size, contour and MRI characteristics, transcervical core needle biopsy is unnecessary prior to surgery because the incidence of malignancy is so low. Natural history untreated Fibroids are almost unknown before an adolescent starts having menstrual periods. They grow slowly unless they are under the stimulation of extra estrogen and progesterone such as oral contraceptives.
Fibroids shrink as more time after menopause passes.
They may become calcified and it is not unusual to have an incidental finding on xray or ultrasound in the decade of the 70's and 80's show round calcified areas in the region of the uterus. Prior to menopause the goal is to keep the fibroids from growing too large or too fast. If a woman can get to menopause without having symptoms from the fibroids, then it is likely that she will never have problems from the growths that require treatment. If there are symptoms of abnormal uterine bleeding, the therapeutic goal becomes to control the bleeding. If the symptoms are pelvic pressure due to size of the fibroids, surgical removal, myomectomy, hysterectomy, or medical shrinkage of the fibroids is the goal.