Also called fibroids, they are cell growths or benign tumors that form inside the uterus.
About four in 10 women over 40 will have fibroids.
It is not known why fibroids develop, but sex hormones , estrogen, and progesterone are believed to play a key role.
This is because fibroids rarely grow in girls before puberty and in women after menopause.
Pre-existing fibroids stop growing and may even shrink in women after menopause.
Fibroids often do not cause any problems, but they are sometimes associated with infertility , miscarriages, and premature delivery.
Other problems can include long and painful menstrual periods.
Treatment depends on the size, number, and location of the fibroids, but may include medications, procedures performed under local anesthesia, ultrasound procedures, and surgery.
Fibroids rarely become cancerous. They develop from the muscle tissue of the uterus.
They can range in size from being too small to be seen with the naked eye to the size of a melon.
Uterine fibroids are benign tumors, sometimes they are found alone and other times they grow in groups.
Many of them grow larger, but others shrink or remain the same size as time passes.
When a smooth muscle tumor is cancerous, it is called a leiomyosarcoma and appears only once in every 1,000 smooth muscle tumors of the uterus.
This type of cancer is not believed to arise from benign fibroids.
A person’s chances of developing a cancerous growth are not increased by the presence of uterine fibroids, nor does it increase the chances of contracting other uterine cancers.
Types of fibroids
Fibroids are classified by their location, which includes:
Intramural: Intramural fibroids are the most common type of fibroids. These start from the myometrium in the uterus. The myometrium is the thickest middle layer of the uterus, made up of smooth muscle.
The myometrium is the part that contracts during a menstrual period to remove the endometrial lining. This type of fibroid can distort the shape of the uterus.
Submucosal: Submucosal fibroids grow in the lining of the uterus, called the endometrium, the thin innermost layer that lines the inside of the uterus.
They can be pendular or sessile. Subserous fibroids can stalk as they grow, which means they can develop a stem. These fibroids can reach other organs to obtain an additional blood supply.
Pendunculated submucosal fibroids grow on small stalks that project into the uterus.
In general, these are the ones that can cause the most problems.
Since they are found in the uterine endometrium, they can cause heavy or prolonged bleeding during menstruation.
Submucosal fibroids represent about 5% of all uterine fibroids.
Causes of fibroids
The cause of fibroids is unknown. However, the female hormone estrogen has been linked to the growth of fibroids.
Fibroids generally develop during a woman’s reproductive years, and can shrink after menopause due to reduced levels of estrogen.
Risk factors for fibroids
Fibroids are very common. Surgeons find them in 80 percent of women who have a hysterectomy.
The main risk factors include:
A major risk factor is age. Once women reach their 30s and 40s, their risk increases.
Women in their 30s are the most likely to get fibroids. After menopause, fibroids tend to shrink.
Another risk factor is family history. When a family member has the condition, the likelihood of experiencing them increases.
If that family member is the mother, the chances of developing fibroids are about three times higher than average.
Race also plays a role in determining the likelihood of developing fibroids.
African American women have a higher risk of fibroids than white women.
Asian women are less likely to experience associated symptoms.
Diet plays another important part in the development of fibroids. Some foods seem to encourage them, while other foods do not.
Diets associated with higher risk include a large amount of red meat (beef, pork, ham).
Lower-risk diets include lots of green vegetables.
Eating dairy products (milk, yogurt, cheese, ice cream, among others) at least once a day was shown in a study to influence risk reduction.
Eating enough micronutrients, such as iron, vitamin A, and vitamin D, can also help reduce the patient’s risk.
Other associated risk factors are excessive alcohol consumption, and women who do not have a history of pregnancy.
Consistent use of birth control pills appears to decrease a woman’s risk of developing fibroids.
Most women with fibroids (also known as fibroids) do not experience symptoms. But at least 25% of patients will present some symptoms.
These can include abdominal pressure, which can feel like fullness in the pelvic region, or swelling in the pelvis or stomach.
Large fibroids can widen the lower stomach area, sometimes giving the false appearance of pregnancy.
Uterine fibroids can also affect the menstrual cycle. This can take several forms.
Some women experience mild to severe cramping and pain.
Others will find that their bleeding is heavier, and their heavy periods sometimes include blood clots.
Others find that their periods last longer or become more frequent.
It can also cause spotting or bleeding between periods.
Other potential symptoms of uterine fibroids include pain during intercourse and lower back pain.
Because fibroids can press against the bladder. They can also cause frequent urination. Sometimes fibroids can cause complications.
Large fibroids can cause infertility by preventing a fertilized egg from implanting in the uterus or blocking the fallopian tubes.
Fibroids in pregnant women can also cause difficulties during labor and pregnancy loss (miscarriage) in rare cases.
Complications of fibroids
Fibroids can cause a variety of complications, including:
- Anemia: Excessive menstrual blood loss can cause anemia, coupled with the fact that the body cannot carry enough oxygen in the blood. Symptoms of anemia include shortness of breath, fatigue, and paleness.
- Urination problems: Large fibroids can cause the uterus to swell, pressing against the bladder. This can cause a feeling of fullness or discomfort and the need to urinate frequently.
- Infertility: Fibroids can interfere with implantation of the fertilized egg in several ways. For example, the egg may try to implant in a fibroid or fibroids may change the shape of the uterus and make it difficult for the egg to implant.
- Miscarriage and Preterm Birth: Fibroids can reduce blood flow to the placenta or compete for space with the developing baby.
Fibroids can be detected by ultrasound, where sound waves create a two-dimensional image.
The inside of the uterus can be seen with a hysteroscope, which is a thin tube that passes through the cervix (entrance to the uterus).
A small camera can be attached to the tip of the hysteroscope to view the inside of the uterus on a monitor.
Uterine fibroids vary in size and location. It is its size and location that determines the possible symptoms you may have.
Fibroids can be found during a routine gynecological exam.
Many women are unaware that they have fibroids and only find out that they have fibroids when they become pregnant.
If fibroids are large enough, a doctor can feel them during a pelvic exam.
The smallest can be seen through an ultrasound.
Ultrasound is the most common way to diagnose fibroids with advanced imaging, but CT scans and MRIs are also used.
Another method is saline infusion ultrasound, during which salt water is injected into the uterus to help provide clear ultrasound images.
Treatment for fibroids
Treatment depends on the size, number, and location of the fibroids, but may include:
If the fibroids are not causing any symptoms and they are not large, the condition can be monitored over time for any changes.
A combination of hormones or some other medicine can be used to shrink fibroids before surgery.
Because one of the most common symptoms of this condition is painful periods, medications can be sought to control these symptoms.
Over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), and naproxen can help relieve pain.
Additionally, non-steroidal anti-inflammatory drugs like the over-the-counter drug Motrin can also be helpful in managing many of the symptoms caused by fibroids.
Periods can be heavier for women with uterine fibroids.
Both standard birth control pills and their low-dose counterparts can help avoid the symptom of heavy bleeding.
Injectable birth control can also help control bleeding during periods.
Gonadotropin-releasing hormone agonists are used as treatment to control the development of uterine fibroids.
Given, either as an injection, implant, or nasal spray, this hormone causes the amount of estrogen in the body to decrease, which can cause fibroids to stop growing or shrink.
For this reason, gonadotropin-releasing hormone agonists are sometimes used before surgery to help remove tumors.
Gonadotropin-releasing hormone agonist medications provide additional relief for fibroids symptoms and can help reset the blood count after an episode of anemia.
Gonadotropin-releasing hormone agonists are generally safe for women, and most can use the hormone without any negative consequences.
However, some experience side effects similar to menopausal symptoms, such as hot flashes, mood swings, decreased libido, insomnia, headaches, and joint pain.
Because it can cause bone thinning, treatment with gonadotropin-releasing hormone agonists is generally limited to six months, often the six months prior to surgery.
Gonadotropin-releasing hormone is a compound prescribed to shrink fibroids.
This treatment works by reducing the production of hormones in the body, which limits the growth of fibroids.
Danazol is an androgenic steroid that is most commonly used for the medical treatment of endometriosis, but it may also be helpful by inducing amenorrhea (abnormal suppression or absence of menstruation) to control myoma-related anemia caused by heavy menstrual flow. .
Another androgenic steroid, gestrinone, has also been tested to cause volume reduction and amenorrhea in women with fibroids.
Hormones that reduce fibroid symptoms include birth control pills, progestins like Megace, and the experimental drug RU-486, the “morning after” pill.
Fibroids can take root in a variety of places along the uterine walls and cavities.
However, a fibroid’s blood supply can be cut off in a uterine artery to block blood flow through the capillaries that feed the fibroid.
Embolization is a non-surgical procedure that deprives fibroids of blood and causes them to shrink.
This is done under local anesthesia, a thin tube is passed through an artery in the arm or leg into the main artery that is supplying blood to the fibroid. The process is monitored by X-rays.
Fine sand-like gel or plastic particles are then injected into the artery to block the blood supply to the fibroid.
The fibroid dies slowly, and symptoms usually go away within a few months.
To perform an embolization, the doctor will make a small incision in the groin area to place the catheter in a large blood vessel.
The tube is flexible, allowing it to meander inside the blood vessel until it reaches close to the fibroid, at which point a solution of the tiny particles is injected, blocking the blood supply to the fibroid.
This procedure generally does not harm the uterus itself, which continues to be supplied with blood by other vessels.
Embolization reduces fibroids to half their size or more.
This therapy is not for everyone. The best candidates are those who experience heavy bleeding whose fibroids cause pain or pressure in the bladder or rectum.
The long-term effects on pregnancy are not fully known, although some report an increased risk of miscarriage.
For this reason, embolization is only recommended for those patients who do not want to become pregnant in the future.
The procedure is generally safe, but it can lead to complications in some cases.
If the blocking solution travels into the ovarian artery, it can cause problems with the functions of the ovaries.
It has been argued, that embolization can lead to early ovarian failure, because a small number of women have reported that their menstrual cycle stopped completely after the procedure.
Also, pain is commonly reported in connection with this method.
Some research tells us that while treatment is generally successful, up to a third of patients will find that their fibroids will reappear within five years.
The MRI team locates and monitors fibroids.
Fibroids are removed through the cervix.
Ultrasound and hysteroscope (a thin tube with a light on the end, inserted into the vagina to examine the cervix and the inside of the uterus), are used to cauterize and destroy fibroid tissue.
The procedure is done without anesthesia, but medications are given to help with relaxation.
The lining of the uterus (the endometrium) is destroyed with endometrial ablation.
The procedure can be performed by freezing, laser, electrical current, instrumentation, or boiling water.
A heated balloon is often used. Other times, a device that uses microwave energy is used to destroy the coating.
Nickel-titanium needles are used in this treatment. This system burns the nucleus of a fibroid and causes it to die.
Four needles are inserted into the anterior abdomen and guided to the fibroid by MRI.
This treatment does not eliminate fibroids, but reduces them, thus eliminating severe symptoms.
Endometrial ablation makes pregnancy unlikely, but not impossible.
When a pregnancy occurs, the pregnancy carries a higher risk of miscarriage and other complications.
Most women recover quickly from this outpatient procedure.
About half of patients will no longer bleed during their periods. About 30% will experience much lighter bleeding.
Although complications can occur, they are unusual with most endometrial ablation methods.
For women who want to get pregnant, myomectomy is the most promising surgical option.
Myomectomy removes fibroids while leaving healthy womb tissue intact.
This surgery can be performed in a number of ways and can be classified as major surgery based on the extent of the procedure and the location of the fibroids.
For this reason, complications vary depending on the details of a given procedure.
One downside of myomectomy care is that although existing fibroids will be destroyed, new fibroids can appear and develop later.
The only safe and permanent treatment for fibroids is hysterectomy.
Hysterectomy involves removing part or all of the uterus and sometimes the ovaries and fallopian tubes as well.
The patient will be infertile after hysterectomy surgery.
It is a major surgery, although the health risks are among the most serious surgeries.
However, serious complications can occur, such as blood clots, injury to the urinary tract and intestines, severe infection, and, rarely, death.
Recovery time for hysterectomy is usually several weeks.
The options for treating fibroids are seemingly endless, but the common goal of all treatment is to reduce estrogen levels in a woman’s body, because tumors depend on estrogen for growth.
The most extreme treatment option for fibroids is a hysterectomy.
A procedure that is similar to a hysterectomy but avoids removal of the uterus is a myomectomy.
Unfortunately, because the cause of the tumors is not fully understood, there is no way to prevent the development of uterine fibroids.
If a woman falls into one of the categories that puts her at higher risk, she should be screened for fibroids at every visit to her doctor.