Uterine fibroids, also called leimyomas, are noncancerous growths of the uterus that often appear during childbearing years. Uterine fibroids is not linked to an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can alter and enlarge the uterus. Fibroids can appear in single or multiple forms. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage.
Most women don’t know they have uterine fibroids because they often cause little or no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.
Symptoms of Uterine fibroid
The most common symptoms of uterine fibroids include:
- Heavy menstrual bleeding
- Backache or leg pain
- Frequent passing of urine
- Menstrual bleeding which last more than a week
- Pelvic pressure or pain
- Difficulty emptying the bladder
Rarely, a fibroid can cause acute pain when it gets too large for its blood supply, and begins to die.
Fibroids are generally classified by their location;
Intramural fibroids grow within the muscular uterine wall.
Submucosal fibroids extend into the uterine cavity.
Subserosal fibroids project to the outside of the uterus.
Causes of Uterine fibroid
Doctors don’t know the exact cause of uterine fibroids, but research and clinical experience point to the following factors:
- Hormones:The two hormones – estrogen and progesterone, which stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to stimulate the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to contract after menopause due to a decrease in hormone production.
- Genetic changes:Many fibroids contain changes in genes that vary from those in normal uterine muscle cells.
- Other growth factors:Substances that help the body maintain tissues, such as insulin-like growth factor, may affect growth of fibroid.
Uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium), according to experts. A single cell divides repeatedly, eventually creating a firm, rubbery mass different from nearby tissue.
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The growth patterns of uterine fibroids vary — they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own. Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus returns back to a normal size.
There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:
- If your mother or sister had fibroids, you’re at increased risk of developing them.
- Black women are more likely to have fibroids than women of other racial groups.
- Environmental factors.Your risks of developing fibroid may increase if you started menstruation at an early age. Other factors are obesity, use of birth control; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer.
Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss.
Pregnancy and fibroids
Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids — especially submucosal fibroids — could cause infertility or pregnancy loss. Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.
When to see a doctor
See your doctor if you have:
- Pelvic pain that doesn’t go away
- Overly heavy, prolonged or painful periods
- Spotting or bleeding between periods
- Difficulty emptying your bladder
Uterine fibroids are frequently discovered during a routine pelvic exam. Your doctor may feel anomalies in the shape of your uterus, pointing to the presence of fibroids. If you have symptoms of uterine fibroids, you doctor may order these tests:
- Ultrasound:Your doctor may order an ultrasound where sound waves are used to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids.
- Lab tests:If you have abnormal menstrual bleeding, your doctor may order other tests to investigate potential causes. These might include a complete blood count (CBC) to determine if you have anemia because of chronic blood loss and other blood tests to rule out any form of bleeding disorders.
Other imaging tests
If traditional ultrasound doesn’t provide enough information, your doctor may order other imaging studies, such as:
- Magnetic resonance imaging (MRI).This imaging test can show the size and location of fibroids, identify different types of tumors and help determine appropriate treatment options.
- Hysterosonography also called a saline infusion sonogram, uses sterile saline to expand the uterine cavity, making it easier to get images of submucosal fibroids and the endometrium.
- Hysterosalpingography uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. Your doctor may recommend it if infertility is a concern. In addition to revealing fibroids, it can aid your doctor determine if your fallopian tubes are open.
- Hysteroscopy: For this, your doctor inserts a small, lighted telescope called a hysteroscope through your cervix into your uterus and injects saline into your uterus, expanding the uterine cavity and allowing your doctor to examine the walls of your uterus and the openings of your fallopian tubes.
Treatment of Uterine fibroid
Medications for uterine fibroids target hormones that control your menstrual cycle, treating symptoms such as pelvic pain or pressure, and heavy menstrual bleeding. They only shrink fibroids, but don’t eliminate them. Medications include:
- Gonadotropin-releasing hormone (Gn-RH) agonists. These medications treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before a planned surgery.
Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone.
- Progestin-releasing intrauterine device (IUD).A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn’t shrink fibroids or make them disappear. It also prevents pregnancy.
- Tranexamic acid (Lysteda).This nonhormonal medication is taken to ease heavy menstrual periods. It’s taken only on heavy bleeding days.
- Other medications.Your doctor might recommend other medications. For example, 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. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia.
- A noninvasive treatment optionfor uterine fibroids that preserves your uterus, requires no incision and is done on an outpatient basis.
- Performed while you’re inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The images give your doctor the precise location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses sound waves (sonications) into the fibroid to heat and destroy small areas of fibroid tissue.
Minimally invasive procedures
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
- Uterine artery embolization.Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised.
- In this laparoscopic procedure, radiofrequency energy, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids.
- Laparoscopic or robotic myomectomy.In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place. If the fibroids are few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. The fibroids can be removed through those same small incisions by breaking them into smaller pieces, a process called morcellation, or one incision can be extended to remove whole fibroids.
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Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Robotic myomectomy gives your surgeon a magnified, 3-D view of your uterus, offering more precision, flexibility and dexterity than is possible using some other techniques.
- Hysteroscopic myomectomy.This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
- Endometrial ablation.This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow.
Typically, endometrial ablation is effective in stopping abnormal bleeding. Submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this doesn’t affect fibroids outside the interior lining of the uterus.
Traditional surgical procedures
Options for traditional surgical procedures 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. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead. However, scarring after surgery can affect future fertility.
- This surgery — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery.
Hysterectomy ends your ability to bear children. If you also elect to have your ovaries removed, the surgery brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women with uterine fibroids may be able to choose to keep their ovaries.
According to recent research, you may also face an increased long-term risk of heart and blood vessel (cardiovascular) diseases and certain metabolic conditions after a hysterectomy, especially if you have the surgery before age 35. Talk with your doctor about treatment options for your condition, to see if there are any alternatives that you might go for.