Uterine fibroids are non-cancerous tumors which develop from womb muscle layers. These smooth muscle benign growths can range from the size of a bean to being as big as a melon.
They’re also known as myomas and leiomyomas.
By the age of 35, fibroids affect about 30 percent of all women, and by the age of 50 from 20 to 80 percent.
They normally grow from 16 to 50 years old. These are the phases of development during which the rates of estrogen are greater.
This article of the Nccmed Knowledge Center will discuss the forms of fibroid, its impact on the body, what causes it, how it is found and what women can do to treat it.
Important facts about fibroids:
- Fibroids are most common during the reproductive years.
- It is unclear exactly why they form, but they appear to develop when estrogen levels are higher.
- Most people experience no symptoms, but they can include lower backache, constipation, and excessive or painful uterine bleeding leading to anemia.
- Complications are rare, but they can be serious.
Types
There are four types of fibroid:
- Intramural: This is the most common type. An intramural fibroid is embedded in the muscular wall of the womb.
- Subserosal fibroids: These extend beyond the wall of the womb and grow within the surrounding outer uterine tissue layer. They can develop into pedunculated fibroids, where the fibroid has a stalk and can become quite large.
- Submucosal fibroids: This type can push into the cavity of the womb. It is usually found in the muscle beneath the inner lining of the wall.
- Cervical fibroids: Cervical fibroids take root in the neck of the womb, known as the cervix.
The classification of a fibroid depends on its location in the womb.
Symptoms
Around 1 in 3 women with fibroids will experience symptoms.
These may include:
- heavy, painful periods, also known as menorrhagia
- anemia from heavy periods
- lower backache or leg pain
- constipation
- discomfort in the lower abdomen, especially in the case of large fibroids
- frequent urination
- pain during intercourse, known as dyspareunia
Other possible symptoms include:
- labor problems
- pregnancy problems
- fertility problems
- repeated miscarriages
If the fibroids are large, the lower abdomen can also experience weight gain and swelling.
When a fibroid grows it will keep developing until menopause. The fibroid will normally decrease as estrogen levels decline after menopause.
Causes
Exactly what induces the fibroids remains unknown. We may have to do with levels of estrogen.
The estrogen and progesterone levels are higher during reproductive years.
Especially during pregnancy, when the estrogen levels are high, fibroids begin to swell. They’re even more likely to grow when a woman takes oestrogen-containing birth control pills.
Low levels of oestrogen can cause fibroids to shrink, for example during and after menopause.
Genetic factors are thought to affect fibroid growth. Having a close relative with fibroids makes them more likely to develop.
There is also evidence that red meat, alcohol and caffeine may increase the risk of fibroids, which can be decreased by an increased intake of fruit and vegetables.
Being obese or overweight raises fibroid risk.
Childbearing increases the risk of fibroid growth. Each time a woman gives birth the risk reduces.
Diagnosis
Because fibroids often show no symptoms, they are usually diagnosed during routine pelvic exams.
The diagnostic tests below will detect fibroids and rule out certain conditions:
- A doctor can create ultrasound images by scanning over the abdomen or by inserting a small ultrasound probe into the vagina. Both approaches may be needed.
- An MRI can determine the size and quantity of fibroids.
- A hysteroscopy uses a small device with a camera attached to the end to examine the inside of the womb. The device is inserted through the vagina and into the womb through the cervix. If necessary, the doctor can take a biopsy at the same time to identify potentially cancerous cells in the area.
- A laparoscopy may also be performed. In a laparoscopy, the doctor makes a small opening in the skin of the abdomen and inserts a small tube with a lighted camera attached through the layers of abdominal wall. The camera reaches into the abdominopelvic cavity to examine the outside of the womb and its surrounding structures. If necessary, a biopsy can be taken from the outer layer of the womb.
Treatment
Treatment is only recommended for those women with fibroid symptoms. If the fibroids do not affect quality of life, treatment may not be needed.
Fibroids can lead to heavy periods, but one may choose not to have treatment if they do not cause major problems.
Fibroids also shrink during menopause and symptoms often become less noticeable or even fully resolve.
It can take the form of medicine or surgery when care is required. The position of the fibroids, the extent of the symptoms and any potential plans for childbearing may all influence the decision.
Medication
The first line of treatment for fibroids is medication.
A medication known as Gonadotropin-releasing hormone agonist (GnRHa) causes less estrogen and progesterone to be released in the body. This reduces on fibroids. GnRHa ends the menstrual cycle at the completion of therapy, without affecting fertility.
GnRH agonists that cause menopause-like symptoms, including hot flashes, a tendency to sweat more, vaginal dryness, and higher risk of osteoporosis in some instances.
These can be administered to compress fibroids before surgery. GnRH agonists are only intended for short-term use.
GnRH antagonists are another alternative, which prevents the pituitary gland from producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). When a person is taking antagonists of GnRH, the ovaries stop producing progesterone and estrogen.
There are other drugs available but they may be less effective in the treatment of larger fibroids.
These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These include mefenamic and ibuprofen. Anti-inflammatory medications reduce the production of hormone-like lipid compounds called prostaglandins. Prostaglandins are associated with crampy periods, and they are thought to be associated with heavy menstrual periods. For those with fibroids, an NSAID may be effective at reducing fibroid pain, does not reduce bleeding from fibroids, and does not affect fertility.
- Birth control pills: Oral contraceptives help regulate the ovulation cycle, and they may help reduce the amount of pain or bleeding during periods.
- Levonorgestrel intrauterine system (LNG-IUS): This plastic device is placed inside the womb. It then releases a hormone called levonorgestrel over an extended timeframe. The hormone stops the inside lining of the womb from growing too fast, which reduces menstrual bleeding. Adverse effects include irregular bleeding for up to 6 months or longer, headaches, breast tenderness, and acne. In some cases, it can stop periods.
Surgery
Severe fibroids may not react to more conservative treatment options, and may require surgery.
The treating physician might consider the following procedures:
- Hysterectomy: A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding. A total hysterectomy can prevent the return of fibroids. If a surgeon also removes the ovaries and fallopian tubes, side effects can include reduced libido and early menopause.
- Myomectomy: This is the removal of fibroids from the muscular wall of the womb. It can help women who still want to have children. Women with large fibroids, or fibroids located in particular parts of the womb, may not benefit from this surgery.
- Endometrial ablation: Removing the lining inside of the womb may help if fibroids are near the inner surface of the womb. Endometrial ablation may be an effective alternative to a hysterectomy for some women with fibroids.
- Uterine artery embolization (UAE), more specifically uterine fibroid embolization (UFE): Cutting off the blood supply to the area shrinks the fibroid. Guided by fluoroscopic X-ray imaging, a chemical is injected through a catheter into the arteries supplying blood to any fibroids. This procedure reduces or removes symptoms in up to 90 percent of people with fibroids but is not suitable for women who are pregnant and typically not for those who still wish to have children.
- MRI-guided percutaneous laser ablation: An MRI scan is used to locate the fibroids. Fine needles are then inserted through the skin and body tissues of the patient and pushed until they reach the targeted fibroids. A laser fiber device is inserted through the needles. A laser light is sent through the device to shrink the fibroids.
- MRI-guided focused ultrasound surgery: An MRI scan locates the fibroids, and high energy ultrasound waves are delivered to shrink them.
Natural treatments
Fibroids don’t have proven natural treatment. Holding weight down through exercise and a balanced diet can also help reduce levels of estrogen.
Complications
Usually, fibroids do not result in complications, but they can be severe and even life-threatening if they do happen.
Complications may include:
- Menorrhagia, also called heavy periods: This can sometimes prevent a woman from functioning normally during menstruation, leading to depression, anemia, and fatigue.
- Abdominal pain: If fibroids are large, swelling and discomfort may occur in the lower abdomen. They may also cause constipation with painful bowel movements.
- Pregnancy problems: Preterm birth, labor problems, and miscarriages may occur as estrogen levels rise significantly during pregnancy.
- Infertility: In some cases, fibroids can make it harder for the fertilized egg to attach itself to the lining of the womb. A submucosal fibroid growing on the inside of the uterine cavity may change the shape of the womb, making conception more difficult.
- Leiomyosarcoma: This is a rare form of cancer that is thought by some to be able to develop inside of a fibroid in very rare cases.
Other serious complications include acute thromboembolism, thrombosis of the deep vein (DVT), acute renal failure and internal bleeding.
A woman with fibroids who unexpectedly experiences extreme abdominal pain will immediately contact her doctor.
