Uterine fibroids are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are many times denser than normal myometrium.
Uterine fibroids are usually round or semi-round in shape. Most women with uterine fibroids have no symptoms. However, abnormal uterine bleeding is the most common symptom of a fibroid. If the tumors are near the uterine lining, or interfere with the blood flow to the lining, they can cause heavy periods, painful periods, prolonged periods or spotting between menses. Women with excessive bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are deteriorating can sometimes cause severe, localized pain.
Types of Uterine Fibroids
Uterine fibroids are sometimes classified by where they grow in the uterus:
- Myometrial (intramural) fibroids are in the muscular wall of the uterus.
- Submucosal fibroids grow just under the interior surface of the uterus, and may protrude into the uterus.
- Subserosal fibroids grow on the outside wall of the uterus.
- Pedunculated fibroids usually grow outside of the uterus, attached to the uterus by a base or stalk.
Symptoms of Uterine Fibroids
Most fibroids do not cause any symptoms, but some women with fibroids can have:
- Heavy bleeding (which can be heavy enough to cause anemia) or painful periods
- Feeling of fullness in the pelvic area (lower stomach area)
- Enlargement of the lower abdomen
- Frequent urination
- Pain during sex
- Lower back pain
- Complications during pregnancy and labor, including a six-time greater risk of cesarean section
- Reproductive problems, such as infertility, which is very rare
Diagnosis of Uterine Fibroids
Moderate and large-sized uterine fibroids are often felt by a doctor during a manual pelvic examination. Imaging tests are often done to confirm the presence of uterine fibroids.
- Magnetic resonance imaging (pelvic MRI)
- Uterine biopsy
Risk Factors of Uterine Fibroids
Factors that can have an impact on fibroid development include: –
- Heredity. If your mother or sister had fibroids, you’re at increased risk of also developing them.
- Race. Black women are more likely to have fibroids than are women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.
- Pregnancy and childbirth. Pregnancy and childbirth seem to have a protective effect and may decrease your risk of developing uterine fibroids.
Complications from Uterine Fibroids
- Uterine Fibroids can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen.
- Fibroids usually don’t interfere with conception and pregnancy. However, it’s possible that fibroids could distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo, and in these cases, doctors often recommend removing these fibroids before attempting pregnancy.
Treatment of Fibroids
Treatment for fibroids depends on the symptoms, the size and location of the fibroids, age (how close the person is to menopause), the patient’s desire to have children, and the patient’s general health. There’s no single best approach to uterine fibroid treatment. Many treatment options exist.
- Watchful waiting
Many women with uterine fibroids experience no signs or symptoms. If that’s the case for you, watchful waiting (expectant management) 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 for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids, but may shrink them. Medications include:
- Gonadotropin-releasing hormone (GnRH) agonists. Medications called GnRH agonists (Lupron, Synarel, others) treat fibroids by causing your natural estrogen and progesterone levels to decrease, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a GnRH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using GnRH agonists.
- Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding and pain caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear.
- Androgens. Danazol, a synthetic drug similar to testosterone, may effectively stop menstruation, correct anemia and even shrink fibroid tumors and reduce uterine size. However, this drug is rarely used to treat fibroids. Unpleasant side effects, such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.
- Other medications. Oral contraceptives or progestins can help control menstrual bleeding, but they don’t reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don’t reduce bleeding caused by fibroids.
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you also elect to have your ovaries removed, it brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there’s a risk of fibroid recurrence.
Myomectomy options include:
- Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
- Laparoscopic or robotic myomectomy. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a remote monitor via a small camera attached to one of the instruments. Use of a surgical robot now allows for removal of more fibroids or larger fibroids.
- Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.
- Focused ultrasound surgery
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.
- Scientists Uncover Genetic Link for Uterine Fibroids (nlm.nih.gov)