Uterine fibroids are an extremely common condition where solid tumors develop in the uterus. These growths are typically not cancerous (benign) and do not become cancerous. They are made of smooth muscle cells and fibrous connective tissue, developing in the uterus and appearing alone or in groups. They can range in size from as small as a grain of rice to as large as a melon and can grow into the uterine cavity or outward from the uterus on stalks.
An estimated 20% to 50% of women of reproductive age currently have fibroids, and up to 77% of women will develop fibroids during their childbearing years. Only about one-third of these fibroids are large enough to be detected by a healthcare provider during a physical exam, so they are often undiagnosed. In more than 99% of fibroid cases, the tumors are not cancerous.
The exact cause of fibroids is unknown, but they are thought to be linked to:
• Hormones in the body (particularly estrogen)
• Genetic factors (may run in families)
Women in their reproductive age are most likely to be affected by fibroids. Other risk factors include:
• Family history of fibroids
• Obesity
• Diet high in red meat
• High blood pressure
Black women are more likely to develop fibroids, are diagnosed at younger ages, and more often require treatment compared to other racial groups. The reasons for this disproportionate impact are not clearly understood.
Many women with fibroids do not experience noticeable symptoms. When symptoms do occur, they can include:
• Heavy or prolonged periods
• Bleeding between periods
• Abdominal discomfort and/or fullness
• Pelvic pain
• Lower back pain
• Frequent urination or difficulty emptying the bladder
• Constipation or excessive straining with bowel movements
• Pain during intercourse
Other potential symptoms include infertility and complications during pregnancy. In rare cases, fibroids may cause severe pain or very heavy bleeding that requires emergency surgery.
Fibroids are often found during a routine pelvic exam. To confirm the diagnosis, your doctor may order tests such as:
• Pelvic Ultrasound: Uses sound waves to create images of the uterus.
• MRI: Provides detailed images of the internal organs.
• Saline Infusion Sonogram (Hysterosonography): Uses saline injected into the uterus to enhance ultrasound images.
• Hysteroscopy: A visual exam using a hysteroscope inserted through the vagina.
• Endometrial Biopsy: Removes a small piece of the uterine lining to check for cancer if there is unusual bleeding.
Treatment may not be necessary if you have fibroids without symptoms or if symptoms are mild. Options include:
• Anti-inflammatory Painkillers: Such as ibuprofen or naproxen to reduce menstrual bleeding and provide pain relief.
• Hormonal Treatments: Including birth control pills, progestin-releasing IUDs, and GnRH agonists to shrink fibroids and control bleeding.
• Tranexamic Acid: To reduce blood flow during periods.
• Iron Supplements: To prevent or treat anemia caused by heavy periods.
• Hysteroscopy: Removes fibroids growing inside the uterus.
• Endometrial Ablation: Treats heavy bleeding by removing the uterine lining.
• Uterine Artery Embolization (UAE): Cuts off blood supply to fibroids, causing them to shrink.
• Myomectomy: Surgical removal of fibroids, preserving the uterus.
• Hysterectomy: Surgical removal of the uterus, typically recommended for severe cases where other treatments have failed.
Newer treatments, such as focused ultrasound, are being evaluated in clinical studies.
Fibroids can cause complications, including:
• Severe pain or heavy bleeding
• Twisting of the fibroid, leading to blocked blood vessels
• Anemia from heavy bleeding
• Urinary tract infections due to pressure on the bladder
• Infertility (rare)
Fibroids can affect fertility and pregnancy in several ways, including:
• Increased risk of miscarriage and preterm labor
• Abnormal attachment of the placenta
• Increased likelihood of delivery by cesarean section
• Postpartum hemorrhage
Typically, fibroids shrink after menopause due to decreased hormone levels. However, if a fibroid grows during menopause, it might indicate an unexpected cancer such as leiomyosarcoma, and additional testing is needed.
If you have fibroids without symptoms, you may not need treatment. If treatment is required, various options are available depending on the severity of symptoms, your age, and your desire for future pregnancies.
Dear Patients,
If you have prolonged menstrual periods, heavy bleeding, pelvic pain, or any other symptoms related to uterine fibroids, it is important to seek medical advice. Uterine fibroids are common and treatable, with various options available depending on your symptoms and personal circumstances. Early diagnosis and appropriate treatment can improve your quality of life and reproductive health.