What are Uterine Fibroids?

Fibroids, also known as uterine fibroids or leiomyomas, are noncancerous growths that develop within a woman’s uterus. They are made up of muscle and fibrous tissue and can vary in size, ranging from small, pea-sized growths to larger masses that can distort the shape and size of the uterus.

Fibroids can appear as a single growth or there can be multiple growths that develop in the uterus. Their shape, size, and location can vary significantly. In some cases, fibroids are tiny and do not cause any problems, while in other instances, they can grow to a size that allows healthcare providers to feel them during a pelvic examination.

Uterine fibroids are most common in women of childbearing age, generally between 30-40 years old but can show up at any age. The exact cause of fibroids is not well understood, but it is believed that they originate from the smooth muscle cells found within the uterine wall. Hormones, particularly estrogen, and progesterone, play a role in their growth.

What are the types of Fibroids?

The three main types of fibroids include

  • Subserosal fibroids: They grow on the outer surface of the uterus and can protrude into the pelvis. Sometimes, they have a stalk that attaches them to the uterus, called a pedunculated fibroid.
  • Intramural fibroids: These fibroids develop within the muscular wall of the uterus. They are the most common type and can cause the uterus to enlarge.
  • Submucosal fibroids: These fibroids are less common. They grow into the inner cavity of the uterus and may also have a stalk. Submucosal fibroids can cause heavy or prolonged menstrual bleeding and may interfere with fertility or pregnancy.

Who is most likely to have Uterine Fibroids?

The exact cause of uterine fibroids is not fully understood, but some factors can increase the risk of developing them. These include

  1. Age: Fibroids become more common as women age, especially during their 30s and 40s. However, they can occur at any age.
  2. Family history: If a woman’s mother, sister, or grandmother has had fibroids, her risk of developing them is higher. This suggests a genetic predisposition to the condition.
  3. Obesity and a higher body weight
  4. Nulliparity:  Women who have not given birth to a child
  5. Early onset of menstruation:  Starting menstruation at an early age, particularly before the age of 10
  6. Late age for menopause.

What are the symptoms of uterine fibroids?

Most women with smaller fibroids do not cause any symptoms, though larger fibroids can lead to various signs and symptoms, including:

  • Heavy or prolonged menstrual periods
  • Bleeding between periods
  • Pelvic pain or pressure
  • Frequent urination (caused by pressure on the bladder)
  • Difficulty emptying the bladder
  • Constipation
  • Low back pain
  • Enlargement of the lower abdomen
  • Pain during sexual intercourse

The symptoms of uterine fibroids often stabilize or subside after menopause as hormone levels decline. During this stage, fibroids may shrink or become less symptomatic.

How are Uterine Fibroids diagnosed?

Fibroids are typically diagnosed through medical history, physical examination, and imaging tests. Here are the common methods used to diagnose fibroids:

Medical history: Your healthcare provider will inquire about your symptoms, menstrual history, and any family history of fibroids or disease conditions related to the reproductive system.

Pelvic examination: During a pelvic examination, your healthcare provider will feel the size and shape of the uterus, if it is enlarged or irregularly shaped, fibroids may be present. 

Various imaging tests:

  • Ultrasound: Ultrasound is a widely known technique among women as it is used to evaluate a growing baby during pregnancy. This is a safe and reliable way to look for fibroids.
  • Magnetic Resonance Imaging (MRI): In some cases, an MRI may be recommended to obtain more detailed information on the size and location of the fibroids, and identify different types of tumours.  It can help in selecting suitable treatment options. This imaging technique is particularly used in women with a larger uterus or those in the perimenopausal stage, nearing menopause.
  • Hysteroscopy: During a hysteroscopy, a healthcare provider inserts a thin, flexible tube called a hysteroscope through the vagina and cervix into the uterus. The hysteroscope has a camera on the end, allowing for visualization of fibroids within the uterine cavity. This procedure helps in direct visualization and may also involve the removal of small fibroids or tissue samples for further testing.
  • Hysterosalpingography (HSG): HSG is a specialized X-ray procedure that injects contrast material (dye) into the uterus. This allows for better visualization of the uterine cavity and fallopian tubes. HSG may be used to evaluate the presence of fibroids, assess their impact on fertility, and identify any potential abnormalities within the uterus.
  • Hysterosonography: Hysterosonography is an imaging test where a small catheter is inserted through the vagina, and saline water is injected through the catheter into the uterine cavity. This additional fluid helps enhance the ultrasound images of the uterus, making it easier to get images of submucosal fibroids and the lining of the uterus in women attempting pregnancy or who have heavy menstrual bleeding.
  • Laparoscopy is a diagnostic test that involves making a small incision in the lower abdomen. Through this incision, a thin and flexible tube called a laparoscope, equipped with a camera on the end, is inserted to closely examine the internal organs.

Other tests: In certain situations, additional tests may be utilized to evaluate specific symptoms or rule out other conditions. These can include blood tests to check for anaemia (low red blood cell count) due to excessive bleeding or hysteroscopy, which involves inserting a thin, lighted tube into the uterus to examine the uterine cavity.

How are fibroids treated?

The treatment for fibroids depends on various factors, such as the severity of symptoms, the size and location of the fibroids, and the woman’s age and desire for future fertility. Treatment options may include:

  • Watchful waiting: If fibroids are small and not causing symptoms, a healthcare provider may recommend monitoring the condition without active treatment.
  • Medications: Certain medications can help manage the symptoms of fibroids. These may include hormonal contraceptives, GnRH agonists, progestin-releasing intrauterine devices (IUDs), or antifibrinolytic drugs like tranexamic acid to reduce heavy menstrual bleeding.
  • Minimally invasive procedures (surgery that is done using small cuts and few stitches)
  • Uterine artery embolization (UAE): This procedure blocks the blood supply to the fibroids, causing them to shrink. It is performed by injecting tiny particles into the arteries that supply blood to the fibroids.
  • Magnetic resonance-guided focused ultrasound surgery (MRgFUS): This noninvasive procedure uses focused ultrasound waves to heat and destroy the fibroids while sparing the surrounding tissues. It is guided by real-time MRI imaging.
  • Radiofrequency ablation: This technique uses radiofrequency energy to destroy the fibroids. It can be performed laparoscopically or hysteroscopically.
  • Surgical treatments
  • Myomectomy: This surgery involves the removal of fibroids while preserving the uterus. It can be performed through different approaches, such as laparotomy (open surgery), laparoscopy (minimally invasive), or hysteroscopy (for submucosal fibroids).
  • Hysterectomy: In this surgical procedure, the entire uterus is removed. Hysterectomy is considered for women who have severe symptoms, large fibroids, or no desire for future fertility.

Treatment choice depends on individual circumstances and should be discussed with a healthcare provider. They can provide a comprehensive evaluation and recommend the most appropriate treatment option based on the specific needs and preferences of the patient.

What are the complications of Uterine Fibroids?

While many fibroids do not cause health problems, there are potential complications associated with them, including:

  • Iron-deficiency anaemia: Heavy bleeding caused by fibroids can lead to iron-deficiency anaemia due to excessive blood loss.
  • Pressure on surrounding organs: Large fibroids can exert pressure on nearby organs, such as the bladder, leading to recurrent urinary tract infections (UTIs) or urinary retention.
  • Fertility issues: While rare, certain fibroids may affect fertility by interfering with the implantation of a fertilized egg or causing blockage of the fallopian tubes.
  • Pregnancy complications: Fibroids can pose risks during pregnancy, including an increased likelihood of miscarriage, preterm labour, or complications during labour and delivery.
  • Fibroid torsion: Occasionally, a fibroid may twist (torsion), disrupting its blood supply. This can result in severe lower abdominal or pelvic pain.

Can a woman get pregnant if she gets fibroids?

Having uterine fibroids does not necessarily mean you cannot get pregnant. If you have fibroids and plan to conceive, your healthcare provider will work closely with you to develop a monitoring plan for the fibroids during pregnancy.

What If I become pregnant and have fibroids?

Most women with fibroids can have normal pregnancies but it is important to note that having fibroids can increase the likelihood of certain issues during pregnancy and delivery.

  • Cesarean section. The most commonly observed problems in women with fibroids include a higher chance of requiring a cesarean section, with a risk six times greater than in women without fibroids 
  • Baby is breech. The baby presenting for delivery with the buttocks or feet first rather than the head. 
  • Labour 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.

In summary, fibroids, also known as uterine fibroids or leiomyomas, are non-cancerous growths that develop in the uterus. They are quite common among women of reproductive age. While the exact cause of fibroids is not fully understood, hormonal factors and genetic predisposition may play a role. Fibroids can vary in size, ranging from small and undetectable to large enough to cause discomfort and complications. Treatment options depend on factors such as the severity of symptoms, desire for future pregnancies, and overall health. These options range from medication and minimally invasive procedures to surgical removal of the fibroids or, in some cases, the entire uterus. It is important to consult with a healthcare provider to discuss symptoms, diagnosis, and the most suitable treatment approach tailored to individual needs.

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