Introduction
What are uterine fibroids?
Fibroids, are growths that are made of muscle and tissue, and they are formed in or on the walls of the uterus in women and people assigned female at birth (AFAB). They can grow as either single or multiple growths; one growth (single nodule) or multiple growths (clusters). These clusters usually vary from one (1) to greater than 20 centimeters- 8 inches- in diameter. Sometimes, they can be larger than that.
Fibroids are also known as;
- Uterine fibroids
- Leiomyomas
- Myomas
- Uterine myomas
- Fibromas
How do uterine fibroids look like?
- Rounded growths
- Smooth bumps
- Mushrooms (in some cases, such as pedunculated fibroids).
Facts & Statistics
What are the key facts & statistics surrounding uterine fibroids?
Uterine fibroids are the most common non-cancerous tumors in women.
Approximately 4-8 out of 10 females suffer from fibroids. They are a very common form of growth.
Types
Forms of uterine fibroids
- Different types of uterine fibroids exist depending on their location and mode of attachment.
- Specific types of uterine fibroids are:
- Intramural fibroids.
- Submucosal fibroids.
- Sub-serosal fibroids.
- Pedunculated fibroids.
- Cervical fibroids.
Intramural fibroids.
Intramural fibroids are the most common type of fibroids, and they are embedded into the muscular wall of the uterus. These can grow larger and stretch the uterus.
Submucosal fibroids.
Submucosal fibroids are fibroids that grow under the lining of the uterus. They may grow large enough to make the uterus appear bigger on one side.
Sub-serosal fibroids.
Sub-serosal fibroids grow under the lining of the outer surface of the uterus.
Pedunculated fibroids.
Pedunculated fibroids, the least common form of uterine fibroids, attach to the uterus with a stalk or a stem. They are described as mushroom-like.
Cervical fibroids.
Cervical fibroids are rare, and they develop on the cervix which connects the uterus to the birth canal/ vagina.
Causes
What causes uterine fibroids?
The exact causes of fibroids are not yet known. They are thought to be caused by:
- Hormones. Ovaries produce estrogen and progesterone, which cause regeneration of the uterine lining during each menstrual cycle and stimulation of growth of fibroids.
- Genes
Risk Factors
What are the risk factors for uterine fibroids?
- Family history of fibroids.
- Race. Black people are more likely to develop and suffer from fibroids as compared to people to other races.
- Early age of onset of menstruation. For example, starting periods at the age of 10 years.
- Late age for menopause.
- Obesity and a high BMI (body mass index)
- Not having children.
Signs & Symptoms
What are the most common signs and symptoms?
Most small fibroids do not cause any symptoms.
They rarely need treatment.
Regular observations by a qualified specialist are enough.
However, larger fibroids are associated with various symptoms, such as:
- Frequent urination (fibroids put pressure on the bladder)
- Pain during intercourse.
- Constipation.
- Long-term vaginal discharge.
- Increased abdominal distention.
- Inability to completely empty the bladder during urination.
- Excessive, painful menses.
- Bleeding in between periods.
- Bloating.
- Low back pain.
After a woman with fibroids has underwent menopause, the symptoms usually stabilize or go away because of reductions in hormone levels within her body.
Diagnostic Procedures
Diagnostic tests & procedures
How are uterine fibroids diagnosed?
Patient-history taking (anamnesis). Mentioning of heavy bleeding among other related factors can alert the medical practitioner to consider fibroids as part of the diagnosis.
Most of the times, uterine fibroids are discovered during pelvic examination.
Several tests can be carried out in order to:
- Confirm a suspected diagnosis of fibroids
- Check its size
- Determine where it is located
These tests are:
- Magnetic resonance imaging (MRI)
- Ultrasonography
- Computer tomography scan
- Laparoscopy
- Sonohysterography
- Hysterosalpingography
- Hysteroscopy
Magnetic resonance imaging (MRI)
MRI utilizes radio and magnetic waves to create detailed images of internal body tissues.
Ultrasonography
It is a non-invasive imaging test that creates pictures/images of internal body organs with the use of sound waves.
Computed tomography scan
A CT scan utilizes X-ray images to make detailed images of internal organs from several angles.
Laparoscopy
An incision is made on the lower abdomen, where a thin and flexible tube with a camera on one end is inserted to look closely at the internal organs.
Sonohysterography
This is an imaging test where a small catheter is placed into the vagina and saline injected into the uterus. The extra fluid aids to create a clearer image of the image of the uterus, clearer than ones seeing during a standard ultrasound.
Hysterosalpingography
A HSG is a detailed X-ray. Contrast media is injected and X-rays of the uterus are captured.
Hysteroscopy
A scope (a thin, flexible tube with a thin camera on the end) is passed through the vagina, cervix and then into the uterus to look for fibroids.
Treatment & Management
Options for treatment & management
Treating fibroids varies depending on several factors. These are:
- Size of the fibroids.
- Number of the fibroids.
- Location of the fibroids.
- Presenting symptoms caused by the fibroids.
The factors stated above also affect choice of the treatment options.
Small fibroids can often be left alone.
People who do not experience any symptoms from the fibroids may not require treatment.
Treatment plans can be arranged for women experiencing symptoms such as pain, urinary tract problems and excessive bleeding which leads to anaemia.
Medications
- Over-the-counter (OTC) pain medications. For example acetaminophen and ibuprofen.
- Iron supplements. For anemia that is due to excess haemorrhage.
- Birth control options such as oral contraceptive pills (OCPs) and intra-uterine devices (IUDs).
- Gonadotropin-releasing hormone (GnRH) agonists that are used to shrink a fibroid before surgery is performed.
- Oral therapies. Tranexamic acid treats heavy menstrual bleeding in women with fibroids.
Fibroid surgery
Myomectomy. In this procedure, fibroids are usually removed. Several types of myomectomy procedures exist, such as:
- Hysteroscopy
- Laparoscopy
- Laparotomy.
The following surgical treatment options are very effective, but they prevent future pregnancies from occurring:
- Hysterectomy.
- Uterine fibroid embolization.
- Radiofrequency ablation (RFA).
Complications
What are the complications caused by uterine fibroids?
This condition is not associated with serious health complications. However, the following are the most common complications;
- Anemia. Anaemia can occur due to heavy menses or bleeding in between periods.
- Infertility
- Excessive haemorrhage
- Swollen abdomen and pelvis
- Unmanageable pain
Preventive Measures
Prevention strategies for uterine fibroids
It seems quite impossible to completely prevent fibroids. However, one can lower the chances by:
Attending regular health check-ups for regular pelvic exams.
Maintaining a healthy body weight.
Fibroids & Cancer, Pregnancy
Are fibroids cancer?
It is extremely rare for a fibroid to transition into a cancerous (malignant) tumor. According to statistics, 1 out of 350 women with fibroids will develop cancer. It is difficult to detect fibroid-related cancers. There is no test which is 100% predictive in detecting rare fibroid-related cancers.
Pregnancy
Can a woman get pregnant if she has fibroids?
Yes, a woman can conceive even if she has uterine fibroids.
It is important to let your doctor develop a plan for the fibroids if you are planning to become pregnant.
During pregnancy, the female body releases elevated levels of hormones, and the hormones support and maintain the pregnancy. The disadvantage is that the hormones can also make the fibroids to grow bigger.
In pregnancy, larger fibroids may cause:
- Placental abruption.
- Preterm delivery.
- Increased risk for a C-section delivery.