What are Uterine Fibroids?
Uterine fibroids (leiomyomas) are muscular tumors that grow within or on the uterus. These tumors are typically benign, though they can sometimes be cancerous. Uterine fibroids are most commonly found in women of reproductive age, but they tend to disappear once a woman reaches menopause.
Types of uterine fibroids
There are various types of uterine fibroids, and each can vary in size and shape:
Intramural fibroids form within the uterine wall. They have the ability to grow to large sizes and can stretch the uterus.
Subserosal fibroids form on the outside of the uterus. They can sometimes be pedunculated, meaning that they grow on a stalk (stem) extending from the uterus.
Submucosal fibroids develop in the middle layer of the uterus called the myometrium. They can extend into the uterine cavity and can be pedunculated.
Cervical fibroids develop on the cervix
Symptoms of Uterine Fibroids
Uterine fibroid symptoms can range from severe to mild to non-existent. Some women are unaware that they have fibroids.
In some situations, uterine fibroids can cause any or all of the following:
heavy/prolonged menstrual bleeding, which can lead to anemia in serious cases
painful menstruation
pelvic pressure and/or pain
Back pain
Abdominal swelling
pain with intercourse
frequent urination
Constipation
rectal discomfort
Infertility or pregnancy loss, though fibroids often do not interfere with pregnancy
Cancer (if they are cancerous)
Causes of uterine fibroids
The exact cause of uterine fibroids is unknown, but they may be the result of:
Hormonal fluctuations during the menstrual cycle, which cause the uterine lining to grow and shed each cycle
A genetic predisposition (family history). Of note, African American women have the highest incidence of uterine fibroids, though the exact reason for this is unknown.
An abnormal overgrowth (hyperplasia) of the muscular tissue in the uterine wall
Diagnosis of fibroids
Larger fibroids may be palpable via a pelvic exam, but most fibroids are diagnosed via imaging such as an ultrasound, MRI, hysterosonogram, hysterosalpingogram (HSG), or hysteroscopy.
Treatment of fibroids
If fibroids are small and not interfering with pregnancy or day-to-day life, treatment is not necessary since fibroids are typically not cancerous and dissipate during menopause.
Medications such as GnRH agonists may be prescribed for a few months to shrink fibroids. These medications prevent the normal hormone fluctuations during the menstrual cycle. Oral contraceptives and intrauterine devices (IUDs) can also prevent heavy periods, though they do not shrink fibroids.
If necessary, fibroids can be treated surgically via:
A myomectomy: fibroids within the muscular wall are surgically removed. This can be done laparoscopically (incisions are made in the stomach) or hysteroscopically (a device is inserted through the vagina into the cervix)
A uterine artery embolization: the blood supply to the fibroids is cut off so they degenerate
An ablation: heat is used to remove the fibroids and shrink the blood vessels leading to them. At times, the entire endometrium can be ablated, but pregnancy is not likely to occur following this procedure.
A hysterectomy removes the entire uterus
A morcellation breaks fibroids into small pieces
Can fibroids be prevented?
There is no known method for preventing fibroids from forming, but it’s recommended that women maintain a healthy diet (limiting sugars and refined foods) and exercise routine to reduce their formation.
Sources:
Uterine fibroids - Diagnosis and treatment - Mayo Clinic
Uterine Fibroids: Causes, Symptoms, and Treatment (webmd.com)
