Uterine fibroids
Uterine fibroids, also known as leiomyomas or myomas, are noncancerous growths of the uterus that often appear during childbearing years. They are composed of muscle and fibrous tissue and can vary in size, from tiny undetectable nodules to large masses that can distort and enlarge the uterus. Although they are generally benign (noncancerous), fibroids can cause discomfort and may lead to complications like heavy bleeding, pain, and fertility issues in some women.
Key Features of Uterine Fibroids
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Location: Fibroids can develop in different parts of the uterus, which can influence the symptoms:
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Submucosal Fibroids: Located just beneath the inner lining of the uterus (endometrium) and can protrude into the uterine cavity, often causing heavy bleeding and fertility problems.
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Intramural Fibroids: Found within the muscular wall of the uterus, they can enlarge the uterus and cause pressure or pain.
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Subserosal Fibroids: Grow on the outer surface of the uterus and can press on surrounding organs, like the bladder or bowel, causing discomfort.
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Pedunculated Fibroids: Attached to the uterus by a stalk, they can twist and cause severe pain if the blood supply to the fibroid is cut off.
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Size and Number: Fibroids can be solitary or multiple, ranging from as small as a seed to as large as a grapefruit or even larger. Their size can affect the severity of symptoms.
​Common Symptoms
Many women with fibroids have no symptoms at all, but when symptoms are present, they may include:
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Heavy Menstrual Bleeding (Menorrhagia): Prolonged periods or excessive bleeding that may lead to anemia.
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Pelvic Pain or Pressure: Larger fibroids can cause a feeling of fullness or pressure in the lower abdomen.
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Frequent Urination: Fibroids pressing on the bladder can cause frequent urination or difficulty emptying the bladder.
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Constipation: Fibroids pressing on the rectum may lead to bowel issues.
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Lower Back Pain: Especially if the fibroids are large.
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Painful Intercourse: Depending on the location of the fibroids.
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Enlarged Abdomen: In severe cases, fibroids may cause the abdomen to appear distended.
Causes and Risk Factors
The exact cause of uterine fibroids is unclear, but several factors are thought to contribute:
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Hormones: Estrogen and progesterone, the hormones that regulate the menstrual cycle, appear to promote the growth of fibroids. They often shrink after menopause due to a decrease in hormone levels.
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Genetic Changes: Some fibroids contain genetic mutations that are different from the normal uterine muscle cells.
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Family History: If a woman’s mother or sister had fibroids, her risk of developing them is higher.
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Ethnicity: African-American women are more likely to develop fibroids at a younger age and may experience more severe symptoms.
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Obesity: Women who are overweight or obese are at higher risk of developing fibroids.
Diagnosis
Uterine fibroids are often discovered during routine pelvic exams or when investigating symptoms. Common diagnostic methods include:
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Ultrasound: Transabdominal or transvaginal ultrasound can help confirm the presence and size of fibroids.
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MRI: Provides more detailed images to map the size, number, and location of fibroids, especially in complicated cases.
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Hysterosonography: A special ultrasound where saline is injected into the uterine cavity to provide clearer images, especially for submucosal fibroids.
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Hysteroscopy: A thin, lighted scope is inserted through the cervix to examine the inside of the uterus and check for fibroids that are protruding into the uterine cavity.
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Laparoscopy: A surgical procedure where a camera is inserted into the abdomen to look for fibroids on the outer surface of the uterus.
Treatment Options
Treatment for uterine fibroids depends on factors such as the severity of symptoms, size and location of fibroids, and whether the woman wishes to preserve fertility.
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1. Medications:
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Hormonal Therapy: Birth control pills or other hormonal therapies can help control heavy bleeding and pain but do not shrink fibroids.
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Gn-RH Agonists: These drugs induce a temporary menopause-like state, reducing estrogen levels and shrinking fibroids.
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Tranexamic Acid: Non-hormonal medication used to reduce heavy menstrual bleeding.
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Anti-inflammatory Drugs (NSAIDs): Like ibuprofen to manage pain.
2. Non-Surgical Procedures:
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Uterine Fibroid Embolization (UFE): A minimally invasive procedure that blocks the blood supply to fibroids, causing them to shrink.
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MRI-Guided Focused Ultrasound Surgery (FUS): Uses high-intensity ultrasound waves to destroy fibroid tissue without making an incision.
3. Surgical Options:
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Myomectomy: The surgical removal of fibroids while preserving the uterus, recommended for women who wish to maintain fertility.
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Hysterectomy: The removal of the uterus, which is the only definitive cure for fibroids. This procedure is usually considered when other treatments fail or when a woman no longer wishes to have children.
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Endometrial Ablation: Destroys the lining of the uterus to reduce heavy bleeding but does not remove fibroids themselves.
Fertility and Pregnancy Complications
Fibroids, especially those inside the uterine cavity (submucosal), can interfere with conception and pregnancy by blocking the fallopian tubes, altering the shape of the uterine cavity, or causing complications such as miscarriage or preterm birth.
Long-Term Outlook:
Uterine fibroids may shrink naturally after menopause due to lower hormone levels, but premenopausal women who experience symptoms may require treatment. Managing fibroids often involves regular monitoring and treatment to improve quality of life and prevent complications.
Women should discuss the best course of action with their healthcare provider based on their symptoms, reproductive goals, and overall health.