Uterine fibroids are benign growths that develop in the uterus, commonly appearing in women during their reproductive years.
Despite the fact that 70-80% of women will develop fibroids by the age of 50, awareness and knowledge about them remain limited. This is primarily because most fibroids are asymptomatic and often go undetected.
In certain cases, fibroids can lead to significant medical issues, potentially affecting pregnancy and reproductive health. The treatment of a fibroid depends on many factors, such as the severity of the symptoms, a woman’s age and whether she is currently pregnant or planning to start a family in the near future. It is important for all women who experience symptoms of fibroids to speak to their doctor.
How We Provide Effective Solutions and Ongoing Support
Fibroids are sometimes called uterine myomas, fibromyomas, or leiomyomas. They vary in size and shape and can be as small as a pea or as big as a melon. When fibroids become large, they can develop into a bulky mass that can distort the entire shape of the uterus and start to affect its function.
Because fibroids can grow in different parts of the uterus, they are often described according to their location. For example, intramural fibroids (which are the most common) grow within the wall of the uterus and are usually asymptomatic [4], while submucosal fibroids are the least common but are also the most likely to cause symptoms [5].
Fibroids generally are not cancerous, they rarely interfere with pregnancy and usually grow slowly — or not at all [13], however they are an extremely common medical condition that at times requires treatment.
Fibroids are usually diagnosed by a doctor during a pelvic exam. The diagnosis is then usually confirmed with imaging scans like an Ultrasound or MRI. Other diagnostic tests that may be used include hysteroscopy, a procedure that allows the doctor to visualize the inside of the uterus and rule out any distortion or abnormality of the uterine lining, and hysterosalpingography, a type of X-ray exam of the uterus and fallopian tubes.
Once diagnosed, treatment of a fibroid usually depends on many factors, such as the severity of the symptoms, a woman’s age, and whether she is currently pregnant or planning to start a family soon. Doctors can use a wide range of treatments depending on each woman’s medical circumstances and personal preference.
Fibroid-Related Issues and Treatments
Causes and Risk Factors
The exact causes of fibroids are not entirely known]. What we do know is that fibroids can be are sensitive to estrogen and progesterone (female hormones that are made in the ovaries). This is partly why We know this because fibroids tend to changeincrease in size when levels of these hormones are changinghigh – for example, increasing during pregnancy and fibroids will shrinking when levels are low – like just after menopause [14].
Although the causes of fibroids are not completely understood, the following factors may increase a woman’s chances of developing them [7]:
- Family history – Women with a family history of fibroids are more likely to develop fibroids themselves. This means that if you have a mother or sister with fibroids, you have an increased risk of having them.
- Race – fibroids are more common in African-American women than women of other races or ethnicities. The reasons for this are unknown and not yet fully understood.
- Early menstrual history – Women whose period started at an early age (<10 years old) have a higher risk of developing fibroids.
Symptoms
Up to half of women with fibroids have no symptoms. The fibroids that go on to cause symptoms usually do so because they are larger in size, located in a specific part of the uterus or are multiple in number. Some of the following are common symptoms of uterine fibroids [8]:
- Heavy or prolonged menstrual cycles
- Pelvic pressure or pain
- Painful periods
- Frequent urination or difficulty emptying the bladder
- Constipation
- Bleeding between periods
Complications
Although fibroids are not dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss [12].
Fibroids and pregnancy
Most pregnant women with fibroids do not have any complications related to the fibroids themselves [9], but there is a slightly increased risk of developing obstetric complications such as miscarriage, premature labor, placental abruption, or postpartum hemorrhage [10].
Women that have been diagnosed with fibroids either before pregnancy (or during pregnancy) may undergo some additional monitoring by their doctor to help reduce the risk of problems or complications arising.
Treatment
Some of the more common treatment options for fibroids include the following:
- Observation: Also called ‘watchful waiting.’ This option is usually only appropriate for women with fibroids that are not causing any symptoms. Women whose symptoms are not too bad may choose this option, especially since menopause causes fibroids to shrink and its symptoms to ease or go away completely. Your doctor may recommend that you go for repeat scans to monitor the growth of the fibroid, and if symptoms become worse over time, women can always change their mind and consider more definitive treatments.
- Medications: These may range from hormonal birth control pills or intrauterine devices (IUDs) to manage bleeding to other medications, including Gonadotropin-releasing hormone agonists (GnRH agonists) used for shrinking fibroids in preparation for surgery. Most of the medications used target the body’s hormones (Estrogen and Progesterone), which themselves can affect increase the size of a fibroid. Other non hormonal medications are often used to treat symptoms such as pain or heavy bleeding.
- Non-invasive or minimally invasive treatments: The goal of these treatments is to maintain or preserve the uterus. Examples of minimally-invasive treatments include a procedure called Uterine artery embolization, also called uterine fibroid embolization, where the arteries that provide blood supply to the fibroids are blocked which causes them to shrink.
A myomectomy is another option where the doctor attempts to remove the fibroids while leaving the uterus in place. These are just two procedures of a large number of different options that currently exist.
- Traditional surgery: This includes procedures like a hysterectomy (removal of the uterus) or an abdominal myomectomy which may be used to treat patients with very large fibroids or those that are multiple in number. These surgeries are usually reserved for very specific cases or as a last resort.
Newer treatment techniques (15) include the following. For both, the potential effects on fertility are not currently understood.
- Magnetic resonance-guided focused ultrasound focuses sound waves on fibroids located at the front of the uterus.
Radiofrequency ablation of fibroids is performed under laparoscopic and ultrasound guidance where heat is applied into the fibroids to make them smaller and softer.
All treatment options have their own risks and benefits and should always be discussed with your doctor in detail.
Fibroids and Advantia Health
Fibroid symptoms can be easily confused with other conditions, and it can be difficult to know when to consult a doctor. Women who have some or all of the symptoms noted above, particularly if the symptoms have been ongoing for a long period of time, should speak to their gynecologist as soon as possible. The earlier the diagnosis of a fibroid is made, the sooner symptoms can be addressed and treatment started.
Advantia Health providers can help diagnose and determine a treatment plan for uterine fibroids that is customized to the severity of your condition and family planning objectives.
The providers at Advantia Health are here to answer your frequently asked questions about women’s health, including concerns about fibroids and fibroid treatment. Contact Advantia to book an appointment if you are experiencing the symptoms listed above.
References
1) National Institute of health. Uterine fibroids. US Department of Health & Human Services. Last updated March 2013
https://www.nichd.nih.gov/health/topics/uterine
2,7,8,9,10) Up-to-date. Epidemiology, clinical manifestations, diagnosis, and natural history of uterine leiomyomas (fibroids). Elizabeth A Stewart, MD. Last updated Apr 29, 2015.
https://www.uptodate.com/contents/epidemiology-clinical-manifestations-diagnosis-and-natural-history-of-uterine-leiomyomas-fibroids?source=search_result&search=fibroid&selectedTitle=2~150#H5291363
3,4,5) Sue, W., & Sarah, S.-B. (2009). Radiological appearances of uterine fibroids. The Indian Journal of Radiology & Imaging, 19(3), 222–231. http://doi.org/10.4103/0971-3026.54887
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766886/
6) Up-to-date. Histology and pathogenesis of uterine leiomyomas (fibroids). Elizabeth A Stewart, MD. Last updated June 05 2014.
https://www.uptodate.com/contents/histology-and-pathogenesis-of-uterine-leiomyomas-fibroids
11,12, 13) Mayo clinic. Uterine fibroids. Mayo Foundation for Medical Education and Research. July 2016.
http://www.mayoclinic.org/diseases-conditions/uterine-fibroids/home/ovc-20212509
14) Lee, H. J., Norwitz, E. R., & Shaw, J. (2010). Contemporary Management of Fibroids in Pregnancy. Reviews in Obstetrics and Gynecology, 3(1), 20–27.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876319/
15) Johns Hopkins Medicine
https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-fibroids
VII. PCOS (Dr. Jackson)
