What Are Uterine Fibroids?
If you have a uterus, you have a 70 to 80% chance of developing uterine fibroids at some point in your lifetime. Don’t worry, most uterine fibroids are asymptomatic and only cause for concern when they result in painful or otherwise inconvenient symptoms. Understanding the what, how, and why behind this condition is critical for keeping an eye on your body’s overall wellness.
What are Fibroids? And What Causes them?
In most cases fibroids are benign. They are solid, compact, non-life-threatening tumors made of fibrous connective tissue and muscle cells commonly found inside of the wall of the uterus. There is a 70-80% chance you will have a uterine fibroid in your lifetime.
Although uterine fibroids are tumors, they are usually non-cancerous and have not been proven to increase the risk of uterine cancer. However, these fibroids, also known as leiomyoma and myoma, sometimes cause excessive bleeding or discomfort. Treatment may result in a myomectomy, which is a surgical procedure to remove the fibroid.
As common as uterine fibroids are, only one third of fibroids grow large enough to be detected by a doctor during a routine exam. They can be as large as a grapefruit or as small as a pea.
Are there Different Types of Fibroids?
Fibroids are generally classified by where they grow within or around the uterine cavity. There are several types of uterine leiomyoma:
- Intramural Fibroids grow within the wall of the uterus and, at their worst, can grow to stretch the uterine womb. Intramural fibroids are one of the most common forms of uterine fibroids.
- Subserosal Fibroids grow on the outside of the uterus and sometime expand to make the womb appear larger on one side.
- Submucosal Fibroids project inwards, towards the uterine cavity. Submucosal has been linked to impaired fertility.
- Pedunculated Fibroids form when subserosal fibroid tumors develop a stalk, or pedunculate, that projects into the inside of the uterus.
Prevalence and Risk Factors
Certain demographics and characteristics make some women at higher risk of developing fibroids including:
- Race – African-American women are at a higher risk of developing fibroids, more than women of other ethnic groups. Black women are also more likely to develop more leiomyomas at a younger age, in higher quantities and greater size of tumor.
- Heredity – a family history of uterine fibroids increases personal risk.
- Early Menopause – women approaching menopause experience extends periods of high estrogen levels, which has been linked to growth of uterine fibroids.
Researchers are investigating possible links between fertility and uterine fibroids, as the tumors tend to appear less frequently in women who have early pregnancies.
How Can I Prevent Fibroids?
Because the exact cause of uterine fibroids remains unknown, healthy lifestyle choices remain the best preventative care. Some evidence links exercise to lowered risk of developing uterine fibroids, possibly because exercise reduces the circulation of insulin levels and sex hormones.
Scheduling routine checkups and pelvic exams with your primary care physician and gynecologist can help you find early fibroids and determine the best form of treatment, if needed.
Signs and Symptoms of Fibroids
Most women will not notice the presence of uterine fibroids, but for some women these small tumors can bring varying degrees of complication or discomfort.
Pain and Discomfort
Pelvic pain is particularly common if the myoma tumor grows large enough to press on pelvic organs. This sometimes manifests as abdominal pressure or a sense of fullness or bloating in the stomach and/or pelvis.
Uterine fibroids can impact the menstrual cycle, leading to heavy bleeding, prolonged periods, bleeding between periods, blood clots, and sometimes anemia, even anemia requiring blood transfusion.
High Blood Pressure/Hypertension
Women diagnosed with fibroids are at risk of high blood pressure and heart disease.
Other Common Symptoms
While discomfort and period irregularities are the most common and noticeable symptoms, other uterine fibroid symptoms can also include:
- Lower back pain
- Painful intercourse
- Frequent urination
Some women report feeling fibroids externally. They can sometimes appear as firm masses near the center of the pelvis.
Potential Risks and Complications
Uterine fibroids generally don’t require any kind of medical attention, but if they continue growing, they can lead to prolonged or intensified discomfort. Fibroids grow by seizing the blood supply of nearby organs. Uterine fibroids that outgrow or deplete their blood supply will start to die on their own. Your doctor will want to monitor the development of the leiomyoma, as rapid growth may be a sign of a rare cancerous fibroid, leiomyosarcoma. Continued growth can also lead to prolonged or intensified discomfort, requiring removal.
Some studies indicate that some uterine fibroids are linked to impaired fertility. Submucosal fibroids are especially susceptible. These tumors sometimes cause recurrent miscarriages. If this is the case, they likely will need to be surgically removed in order to carry a pregnancy. See your doctor if this is a potential concern.
Fibroid Diagnosis and Treatment Options
Talk to your gynecologist about including a pelvic exam for uterine fibroids during your next routine checkup. If you are concerned that you may have a fibroid, your doctor may schedule an ultrasound, or an MRI-guided exam following a regular pelvic exam. Women experiencing challenges in becoming pregnant may be eligible for either a hysterosalpingography, a form of x-ray used to examine the uterus and fallopian tubes and investigate miscarriages, or a diagnostic hysteroscopy to take a look inside the uterus with a small camera.
Most uterine fibroids will stop growing or shrink on their own. If you do have a fibroid, your doctor will likely first monitor the growth of the fibroid before scheduling treatment or removal.
Fibroid treatment options include a variety of non-surgical options with low risk factors or surgical procedures including a common myomectomy. The following treatments aim to reduce blood supply and eliminate pain:
- Over-the-counter pain medication, such as ibuprofen
- Birth Control Pills
- Iron Supplements – Iron supplements can help combat anemia as a symptom.
- Selective Estrogen Receptive Modulators (SERMs) – A type of medication that works on your estrogen levels and may reduce uterine fibroids without causing menopause-like symptoms.
- Gonadotropin-releasing hormone agonists (GnRH therapy) – Gn-RH is a hormone naturally produced by the brain's hypothalamus. When Gn-RH agonists are introduced as therapy, estrogen and progesterone levels fall, menstruation stops, anemia improves and uterine fibroids shrink. This is basically termed a short-course “medical menopause”, because the side effects of the Gn-RH agonists mimic those of natural menopause (hot flashes, vaginal dryness)
- RU-486 (the abortion pill) – Currently being researched and tested as a form of fibroid treatment. The abortion pill has been shown to reduce the size of fibroids by up to 50%.
- Endometrial Ablation – A procedure that destroys a thin layer of the uterine lining, while reducing menstrual bleeding to normal levels. Side-effects may include cramping and frequent urination.
- Depo-Provera – Depo-Provera is a progesterone-like injection normally used to prevent pregnancy and sometimes used to treat myoma. It decreases the size of the uterine lining, thereby reducing heavy bleeding and tissue size.
- Uterine Artery Embolization (UAE) – In UAE, an x-ray is used in conjunction with a catheter to deliver particles that block the uterus's blood supply. Uterine Artery Embolization has been proven to reduce the size of fibroids with a 90% success rate.
- Myomectomy – Unlike a hysterectomy, a myomectomy removes the symptom-causing fibroids and leaves the uterus intact. Myomectomy is the preferred choice for women who still plan to have children. While myomectomy is often a safe, low-risk procedure, rare cases of complications in myomectomy can result in a need for a hysterectomy.
- Hysterectomy – A hysterectomy is the complete removal of the uterus. This may be the preferred option for menopausal women or women who do not plan to have children.
Misdiagnosis and Other Growths
While fibroids are a growth formed from muscle tissue, polyps are an overgrowth of uterine tissue within the uterine cavity. Fibroids are benign, but polyps can be cancerous. Both polyps and fibroids cause similar abnormalities in menstruation and result in some similar symptoms. Because polyps and fibroids also look similar in an ultrasound, polyps are sometimes misdiagnosed as fibroids. The best way to diagnose a malignant polyp is to remove it and send the polyp to a pathologist for routine testing.
Continued Research and Preventative Health
Researchers are still growing their understanding behind the causes of uterine fibroids, but experts are certain that most of these benign tumors are no cause for alarm. Making responsible choices in eating a healthy diet and participating in regular exercise can have lifelong benefits that may help combat fibroids or prevent uterine leiomyoma.
Talk to your general practitioner about the risks of uterine fibroids or schedule routine checkups to be safe. If you have a uterine fibroid, talk to your doctor about different treatment options for alleviating any pain or discomfort.