Uterine fibroids, also known as uterine leiomyomas or myomas, are benign (non-cancerous) growths of muscle cells in the uterine (womb) wall. They are the most common tumour found in the pelvis, and they occur in around 70% of women by the age of 50. This is a condition that occurs most commonly in women of childbearing age, but it can affect women of any age. Fibroids can range in size, from being undetectable with the human eye to the size of a grapefruit or larger. The majority of women with fibroids will not experience any symptoms and do not require therapy. However, some women may experience heavy or prolonged menstrual bleeding, pelvic pain, and urinary issues due to the size and location of the fibroids.
Risk factors for uterine fibroids include:
- African-American descent
- Diet including lots of red meat and alcohol, and low vitamin D
- Family history of uterine fibroids
- First menstruation period starting prior to the age of 10
- Never having given birth
Uterine fibroids are abnormal growths of the uterus. The causes of uterine fibroids are unknown, but it is thought to be related to hormones such as estrogen, progesterone, and growth hormones. Genetic changes and environmental factors such as diet may also be related to fibroid growth. Fibroids occur when normal uterine muscle cells change into abnormal muscle cells and develop into benign growths. Fibroids are not cancerous and most of them are small and do not cause any symptoms. However, they can cause problems based on their size, number, or location. For example, fibroids can push against the bladder, or push the uterus against the bladder, and cause the urge to urinate frequently. They can also push against the bowel and cause constipation.
Symptoms and Complications
Many women usually do not experience symptoms caused by uterine fibroids. However, you may experience symptoms due to the size, number, or location of the fibroid(s) which may be severe enough to impact your quality of life.
These symptoms can include:
- Abnormal uterine bleeding, such as heavy or prolonged menstruation
- Anemia from the blood loss
- Constipation or rectal pain
- Enlarged abdomen caused by large fibroids
- Frequently urinating or having difficulty urinating
- Menstrual pain
- Pain during intercourse
- Pelvic pressure
- Lower back pain
- Reproductive problems (e.g., infertility, miscarriages)
- Vaginal bleeding not due to menstruation
Of these symptoms, abnormal uterine bleeding and menstrual pain (cramps) are the most common.
Many women with uterine fibroids can still get naturally pregnant. However, some may experience reproductive problems such as infertility, multiple miscarriages, or premature birth, as the fibroid may distort the surface of the uterus. Some women will need to deliver via caesarean due to fibroids.
Making the Diagnosis
Usually uterine fibroids are detected when your doctor does a routine pelvic examination. Your doctor may require imaging tests to confirm diagnosis. These tests include ultrasound, magnetic resonance imaging (MRI), X-rays, cat scans (CT), and hysterosalpingogram (HSG). Your doctor may ask you questions about your symptoms to evaluate the impact of the fibroid. This can include questions about urinary issues, constipation, fertility issues, abdominal pressure or pain, painful menses, and pain during intercourse.
Treatment and Prevention
For women with mild symptoms, the symptoms are monitored but no specific treatment is given. For women who are pre-menopausal and have moderate-to-severe symptoms, fibroids may be managed with medication or surgery. If you are experiencing painful or prolonged menstrual bleeding due to uterine fibroids, your doctor may prescribe medications to reduce the severity of the bleeding. Treatments may also include a medication called ulipristal that can slow growth and shrink fibroids. A surgery called myomectomy to remove the uterine fibroid may also be possible. Since myomectomy leaves the uterus intact, women who have the surgery can still have children. Uterine artery embolization, also known as uterine fibroid embolization, blocks the blood supply to fibroids to also slow growth, shrink fibroids, and reduce heavy menstrual bleeding.
If you are near menopause with mild symptoms, your doctor may recommend waiting for menopause as your fibroid may shrink after this time.
If you have reached menopause, or if other treatments have not worked, your physician may recommend a surgery called a hysterectomy to remove the uterus. This is the most effective treatment for uterine fibroids and it prevents further fibroids from forming.
There are other treatments that work by destroying rather than removing fibroid tissues. Radiofrequency ablation uses heat to destroy fibroids without harming surrounding normal tissues. Most women can go home on the same day of the procedure, and can resume their daily activities within a few days. Ultrasound-guided, high-intensity focused sonography and magnetic resonance-guided focused ultrasonography use sound waves to destroy fibroids.
Helpful tips for managing symptoms of uterine fibroids:
- Nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen can help manage pain.
- Increasing iron intake through diet or supplements can help treat or prevent the occurrence of anemia due to blood loss.
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