What are uterine fibroids?
Uterine fibroids, also called leiomyomas (lie-o-my-O-muhs) or myomas, are growths inside the muscle of the uterus. They are not associated with cancer, and they often occur in women of childbearing age. The most common types of uterine fibroids are:
- Intramural fibroids: Developing in the uterine wall.
- Submucosal fibroids: Protruding into the uterine cavity.
- Subserosal fibroids: Bulging outside of the uterus and into the abdominal cavity.
How big are uterine fibroids?
Fibroids range in size from very small – so small they can’t be seen without magnification – to so large that they distort and increase the size of the uterus. Women can have one fibroid or multiple fibroids. Fibroids can sometimes grow big enough that they put pressure on other structures in the pelvis and abdomen. These can include the bladder, ureters, bowel and blood vessels. Women with large fibroids can feel as though they are several months pregnant, while smaller fibroids may not cause any significant symptoms.
What causes uterine fibroids?
The exact cause of uterine fibroids is not known. Some experts believe they begin in a stem cell (undifferentiated cell) of the smooth muscles of the uterus. As this cell divides, it creates a mass that is different from the nearby tissue.
This mass becomes a uterine fibroid.
Other factors may also play a role in the development of fibroids:
Ovarian hormones such as estrogen and progesterone, may promote the growth of uterine fibroids. This may have something to do with the fact that these hormones play a role in preparing the lining of the uterus for pregnancy each menstrual cycle.
Many uterine fibroids have genetic differences from the normal cells that make up uterine muscles.
Some substances that help the body build and maintain tissue may contribute to fibroid growth.
How are uterine fibroids detected?
Some may never be detected, but larger fibroids or those that cause symptoms are often felt during a pelvic exam or seen on an imaging
test, like an ultrasound.
Common Uterine Fibroids Symptoms
Many women have fibroids. Most fibroids do not cause symptoms, so they often go undetected. Women who do experience symptoms may notice:
- Heavy bleeding during menstruation.
- Longer than normal menstrual cycles (more than a week).
- Pelvic pain.
- Pelvic pressure.
- Urinary problems, like frequent urination or difficulty emptying the bladder all the way.
- Back or leg pain.
Women who bleed excessively from fibroids may become anemic due to blood loss.
There are not many known risks for developing uterine fibroids. Any woman of reproductive age may develop them. A few factors that may increase your risk include:
- Family history and heredity: If your mother or a sister has or had fibroids, your risk may be greater.
- Race: African American women are at higher risk for developing uterine fibroids, and if they do develop them, they’re more likely to have larger fibroids or multiple fibroids.
Other factors that may have an impact on developing fibroids:
- Early onset of menstruation.
- Hormonal birth control use.
- Vitamin D deficiency.
- Alcohol consumption.
- A diet high in red meat and low in fruit, green vegetables, and dairy.
Is there a way to avoid uterine fibroids?
There is no known way to avoid developing uterine fibroids Maintaining a healthy weight and making certain lifestyle choices (like eating a diet high in vegetables and fruits and low in red meat) may decrease your risk.
Who treats uterine fibroids?
Many women who have uterine fibroids do not need treatment. If you have fibroids, and they are
causing concerning symptoms, you should talk with a physician. Treatment options for uterine fibroids can be discussed with your OB/GYN or an interventional radiologist.
Uterine Fibroids Treatment
Medications can be used to reduce symptoms like heavy menstrual periods and pressure or pain in the pelvic region. Medications do not remove fibroids, but they may reduce them in size or minimize the symptoms they cause. Medication options include:
- Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists, which decrease or block the production of estrogen and progesterone in your body. When estrogen levels drop due to the medications, the fibroids tend to shrink.
- Progestin-releasing intrauterine device (IUD), which can reduce fibroid-induced bleeding.
- Tranexamic acid, which helps ease heavy bleeding during menstruation. It is only taken on days when you experience heavy bleeding.
- Other medications may be recommended to help control bleeding or reduce pain, including oral contraceptives and non-steroidal anti-inflammatory medications.
Minimally invasive procedures treat uterine fibroids by destroying or shrinking them, and they do not require traditional surgical incisions. They include:
- Endometrial ablation is an outpatient procedure where the lining of the uterus is heated and the tissue is destroyed to decrease menstrual bleeding. Depending on the size and location of the fibroids, this may not be an option for some patients.
- Hysteroscopic myomectomy is an outpatient procedure used to treat smaller, submucosal fibroids located in the lining of the uterus or uterine cavity. It involves using a mechanical blade or an electric element that can remove tissue without an incision.
- Radiofrequency fibroid ablation with ultrasound guidance is a newer technique that is used to treat smaller submucosal fibroids through the vagina or larger intramural or subserosal fibroids laparoscopically by heating the fibroid tumors and shrinking them. These are outpatient procedures, usually with minimal associated pain and high success rates. Laparoscopic myomectomy is a minimally invasive surgical procedure often performed with the assistance of robot technology that allows the complete removal of one or multiple fibroids through small laparoscopic incisions.
- Uterine fibroid embolization (UFE) (also known as UFE, uterine artery embolization or UAE) is a minimally invasive procedure done to block blood flow to fibroids with the goal of shrinking them and reducing or eliminating associated symptoms. It is performed by an interventional radiologist (a physician who specializes in using radiology to perform medical procedures without a surgical incision).
- Laparoscopic hysterectomy is usually robotically assisted minimally invasive removal of the uterus through the birth canal after releasing its attachments through very small surgical incisions in the abdomen.
Some women may need to have traditional surgery to remove or otherwise treat uterine fibroids. The most common traditional surgical options are:
- Abdominal myomectomy: An abdominal incision is performed and fibroids are surgically removed. The uterus is repaired and remains inside.
- Hysterectomy: An abdominal incision is performed and the uterus is surgically removed. Unless another issue exists, the ovaries remain in place.