Anne Donovan was 32 and trying to get pregnant when she first heard the phrase "fibroid tumor."

During a pelvic exam, her doctor discovered she had some uterine "fullness" and ordered an ultrasound. Donovan was shocked and worried.

What was this "thing" and why did she get it? She took good care of herself and had regular checkups, says Donovan, creative director for a Web-design business.

In retrospect, Donovan realized she'd had fibroid symptoms for some time, but like many women hadn't heeded the vague feelings of abdominal pressure, or occasional pain during sex.

Donovan embarked on her own research, which included visits with several different types of health professionals, from medical to alternative. In the course of exploring her options, she learned a lot about fibroids — technically known as leiomyomas — and about the wide variety of treatments for them.

Donovan discovered there was much she didn't know. For example, uterine fibroids are incredibly common. These tangles of muscle fibers and collagen, a type of connective tissue, are rarely malignant and may occur in as many as three in four women, according to Mayo Clinic figures.

Researchers suspect a genetic link because fibroids seem to run in families; black women are as much as three times more likely to get fibroids.

Donovan began talking to relatives and was startled to find that her 29-year-old sister, her mother and her great-grandmother also had been diagnosed with fibroids.

Most women with fibroids don't have symptoms, experts say. In those who do, the symptoms — heavy periods, abdominal pressure, frequent urination, backaches, constipation, pain with sex, trouble conceiving — don't always lead to a quick diagnosis.

Fibroids can cause such heavy bleeding that women become anemic; they are behind a third of all hysterectomies (surgical removal of the uterus) in the U.S.

But researchers have been working hard to find less invasive procedures, and hysterectomy no longer is the only treatment.

If you've been diagnosed with fibroids, you'll want to actively research your options because they can involve different types of specialists who may not be familiar with all the procedures. Some procedures are done by interventional radiologists, while others are done by obstetrician-gynecologists.

If you have fibroids but no symptoms, "watch and wait" is likely your Plan A, particularly if you're close to menopause, when most fibroids typically shrink.

But if you're a long way from a hot flash, and fibroid symptoms interfere with your life, you may want to shift to Plan B.

First, you need information. Where are the fibroids? How big? Are they growing?

Ultrasound will give you a lot of information. You may also need a hysteroscopy, a look inside your uterus, and other tests, if other medical issues are suspected.

Next, you need to explore your own attitudes and plans.

Are you terrified of surgery? Do you hate the idea that a body part could go suddenly missing? Do you have six to eight weeks for recovery? Are you skeptical of procedures with no long-term track record? Do you prefer trying less-drastic treatments first? Are you planning a pregnancy?

Once you've answered those questions, explore the options:

Drug treatment

Many doctors believe hormone therapy can help relieve the symptoms of fibroids. But while blocking or changing reproductive hormones may shrink them slightly, it won't make the growths disappear, according to a National Institutes of Health study published in October.

Embolization

Secretary of State Condoleezza Rice made this procedure famous in December when she took a day off from work to be treated with this "minor surgery" for fibroids.

Known as Uterine Artery Embolization (UAE) or Uterine Fibroid Embolization (UFE), the treatment involves injecting small particles into an artery, blocking the blood supply to the fibroid, which then withers and shrinks.

It's been used for fibroids in this country for about a decade, but the procedure itself has been used in other ways for 25 years, said Dr. Sanjiv Parikh of Radia Medical Imaging, medical director of interventional radiology at Swedish Medical Center/Providence.

The procedure has a good track record, says Dr. R. Torrance Andrews, chief of vascular and interventional radiology at the UW Medical Center. Complications occur in about 7 percent of cases, but the rate for serious complications is about 1 percent.

A British study of 400 women showed that after a year and a half, more than 80 percent had less bleeding and pain, and 97 percent said they'd recommend embolization. The procedure failed in 23 women, some of whom had regrowth of fibroids.

The operation itself, done by an interventional radiologist, takes about an hour, with typically an overnight stay and some pain and cramping for about a week. Most women can resume light to normal activity in 10 days.

Advantages of the procedure, said Parikh, include fast recovery and avoiding some surgical risks such as damage to adjacent body parts, bleeding or scar tissue.

Improvement of symptoms, however, may take weeks or months, said Parikh.

About a third of patients will experience fever accompanied by nausea for two or three days. Other complications, though rare, include persistent infection (in extreme cases leading to hysterectomy and in a few cases, to death), particles migrating to other organs, vaginal discharge, ovarian failure and early menopause.

Doctors usually advise against embolization if you plan to become pregnant because there may be increased risk of complications. But Andrews, who thinks risks have been overstated, says many patients deliver successfully after embolization.

Of the particles used, polyvinyl alcohol (PVA) has the longest track record.

Acrylic microspheres have been used with fibroids for about three years. Because they are easier to handle, Andrews says, the procedure may take less time, and they're his first choice unless a patient objects to their relatively short track record.

The third agent is a gel foam, commonly used to temporarily stop bleeding from traumatic injuries. It's absorbed by the body over about two weeks. Because it's been widely used in other procedures, Andrews considers it safe. Like particles, the foam cuts off the blood supply.

Patients who do best with embolization, said Parikh, are those without large fibroids outside the uterus, who don't plan to get pregnant, and are near menopause.

Endometrial ablation

If you're not planning to get pregnant, your fibroids aren't distorting your uterus, and bleeding is your main symptom, ablation can be for you, says Dr. James "Heath" Miller, an obstetrician-gynecologist at Swedish.

This procedure destroys the uterine lining. Various methods include use of low-level microwaves, hot water in a balloon, electrodes or lasers.

After ablation, about 90 percent of women have lighter periods; about half stop menstruating. More than 20 percent need a repeat procedure or hysterectomy.

Ablation usually is done as an outpatient procedure or with a one-night stay. There can be some cramping and pain afterward.

Complications are rare but can be serious, including: puncture of the uterus, burns, injury to the opening of the uterus and blood clots.

Myomectomy

A myomectomy removes the fibroids, while leaving the uterus intact. This might be done through an abdominal incision or laproscopically, with "Band-Aid" incisions: one through the bellybutton, and three other tiny cuts. Miller, at Swedish, specializes in laproscopic myomectomies, typically an overnight procedure, with significant recovery usually from three to five days.

Myomectomy is the only fibroid-removal plan recommended by most doctors for a woman who wants to become pregnant.

Whether a woman is a good candidate depends on the number, size and location of her fibroids. The skill of the surgeon, Miller said, is an important factor in whether they can be removed laproscopically.

Studies show about 4 percent of myomectomy patients need transfusions, but Miller said that with laproscopy, it's a "pretty bloodless procedure." There is also about a 10 percent chance that a patient who starts out with a laproscopy will end up with an abdominal incision, Miller said.

In some cases, fibroids return after surgery.

Hysterectomy

For some women, losing the uterus is the best choice. That may be because of the number and location of fibroids or because of the woman's attitudes about other alternatives.

Miller, who also does hysterectomies laproscopically, says it's an easier surgery, "more predictable" than myomectomy. But whether a hysterectomy can be done laproscopically, he says, depends on the size of the uterus.

There's lots of literature on risks and complications of hysterectomy, which involves a six- to eight-week recovery.

Ultrasound and MRI

This treatment, just approved and not yet available beyond a few U.S. clinics, combines an MRI machine to locate fibroids and an ultrasound beam to destroy them. The device, ExAblate, won approval in October from the federal Food and Drug Administration; its manufacturer says the treatment successfully reduced fibroid-caused problems in 71 percent of 109 women. However, about 20 percent of them needed surgical treatment within a year.

The FDA said the treatment shouldn't be used by women planning pregnancy.

Ready for another try

Donovan, who was diagnosed in 2002, scheduled and canceled a myomectomy, concerned about its risks for vaginal delivery.

She tried diet and lifestyle changes; after four months of acupuncture, her fibroid had shrunk a bit.

In June of last year, she discovered she was pregnant, but she miscarried. The fibroid wasn't the cause, doctors told her, but the pregnancy spurred its growth.

Finally, in November, she opted for an abdominal myomectomy. Doctors told her the position of the fibroid would make it impossible to sustain a pregnancy.

After six weeks, she went on vacation. Now she's ready to try again to conceive, she said.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com