Uterine Fibroids

What are uterine fibroids ?

Uterine fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes, these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign (noncancerous). The cause of fibroids is unknown.

About 1 in 3 women women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s, but most women do not have any symptoms.

Types of uterine fibroids

Different fibroids develop in different locations in and on the uterus.

Intramural Fibroids. Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.
Subserosal Fibroids. develop outside the wall of the womb into the pelvis and can become very large .
Pedunculated Fibroids. When subserosal tumors develop a stem (a slender base that supports the tumor), they become pedunculated fibroids.
Submucosal Fibroids. develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb . Submucosal tumors are not as common as other types, but when they do develop, they may cause heavy menstrual bleeding and trouble conceiving.

What causes uterine fibroids ?

It is unclear why uterine fibroids develop, but several factors may influence their formation.

Hormones. Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.
Family History. Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.
Pregnancy. Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you are pregnant.

Who gets uterine fibroids ?

Uterine fibroids are common, with around 1 in 3 women developing them at some point in their life. They most often occur in women aged 30-50.

Uterine fibroids are thought to develop more frequently in women of African- Caribbean origin. It’s also thought they occur more often in overweight or obese women because being overweight increases the level of oestrogen in the body.

Women who’ve had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

Who is at risk for uterine fibroids ?

Women are at greater risk for developing uterine fibroids if they have one or more of the following risk factors:

Pregnancy
Family history of fibroids
Being over the age of 30
Being of African-American descent
Having a high body weight
Onset of menstruation at an early age
Use of birth control
Vitamin D deficiency
Having a diet higher in red meat and lower in green vegetables, fruit and dairy
Drinking alcohol, including beer

Uterine fibroids symptoms ?

Uterine fibroids symptoms will depend on the location and size of the tumor(s) and how many tumors you have. If your tumor is very small, or if you are going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause.

Symptoms of uterine fibroids may include:

Heavy bleeding between or during your periods that includes blood clots
Increased menstrual cramping
Pain in the pelvis and/or lower back
Frequent urination
Difficulty emptying the bladder
Menstruation that lasts longer than usual
Pain during intercourse
Pressure or fullness in your lower abdomen
Swelling or enlargement of the abdomen
Constipation

How are uterine fibroids diagnosed ?

You will need to see a gynecologist to get a pelvic exam. This exam is used to check the condition, shape and size of your uterus. You may also need other tests, which include:

Ultrasound. An ultrasound uses high frequency sound waves to produce images of your uterus on a screen. This will allow your doctor to see its internal structures and any fibroids present. A transvaginal ultrasound, in which the ultrasound wand (transducer) is inserted into the vagina, may provide clearer pictures since it is closer to the uterus during this procedure.
Pelvic MRI. This in-depth imaging testing produces pictures of your uterus, ovaries, and other pelvic organs.
Hysteroscopy. For this, your doctor inserts a small telescope called a hysteroscope through your cervix into your uterus. Saline is injected into the uterus, expanding the uterine cavity and allowing the doctor to examine the walls of your uterus and the openings of fallopian tubes.

Uterine fibroids treatment ?

Your doctor will develop a treatment plan based on your age, the size of your fibroid(s), and your overall health. You may receive a combination of treatments.

Watchful waiting

Many women with uterine fibroids experience no or only mild signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option.

Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly or not at all and tend to shrink after menopause, when levels of reproductive hormones drop.

Medications

Medications to regulate your hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.

Other options that can help control bleeding and pain, but will not shrink or eliminate fibroids, include:

an intrauterine device (IUD) that releases the hormone progestin
over-the-counter anti-inflammatory pain relievers, such as ibuprofen
birth control pills

Surgery

Surgery to remove very large or multiple growths (myomectomy) may be performed. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted.

Your physician may perform a hysterectomy (removal of your uterus) if your condition worsens, or if no other treatments work. However, this means that you will not be able to bear children in the future.

Minimally invasive procedures

A newer and completely noninvasive surgical procedure is forced ultrasound surgery (FUS). You will lie down inside a special MRI machine that allows doctors to visualize the inside of your uterus. High-energy, high-frequency sound waves will be directed at the fibroids to destroy (ablate) them.

Similarly, myolysis shrinks fibroids using an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, hot water, or microwaves.

Can fibroids turn into cancer ?

Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman’s chances of getting other forms of cancer in the uterus.

What if I become pregnant and have fibroids ?

Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn’t mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:

Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
Baby is breech. The baby is not positioned well for vaginal delivery.
Labor fails to progress.
Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
Preterm delivery.

Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy.

What can be expected in the long term?

Your prognosis will depend on the size and location of your fibroids. Fibroids may not need treatment if they are small or do not produce symptoms. If you are pregnant and have fibroids, or become pregnant and have fibroids, your physician will carefully monitor your condition. In most cases, fibroids do not cause problems during pregnancy. Speak with your doctor if you expect to become pregnant and have fibroids.