Fibroids, also known as uterine myomas, are benign, non-cancerous growths that develop inside the uterus or on the uterine walls. Fibroids are common growths that often appear in women during their reproductive years. It is thought that approximately 20-80% of women will develop fibroids by the time they reach age fifty.
Although most fibroids cause no symptoms or problems, in the cases where fibroids grow in size, this can lead to symptoms such as pelvic pain or menstrual cycles that are heavy and prolonged.
What Are Fibroids?
Fibroids are sometimes called uterine myomas, fibromyomas, or leiomyomas. They vary in size and shape and can be as small as a pea or as big as a melon. In the cases where fibroids become large, they can develop into a bulky mass that can distort the entire shape of the uterus and start to affect its function.
Because fibroids can grow in different parts of the uterus, they are often described according to their location. For example, intramural fibroids (the most common) grow within the uterus wall and are usually asymptomatic, while submucosal fibroids are the least common but most likely to cause symptoms.
Causes and Risk Factors
Until today, doctors are not entirely sure what causes fibroids to develop. What we do know is that fibroids are sensitive to estrogen and progesterone (female hormones that are made in the ovaries).
Although the causes of fibroids are not completely understood, the following factors may increase a woman’s chances of developing them:
- Family history of fibroids
- Obesity
- A diet high in red meat
- High blood pressure
Symptoms
When symptoms are present, this can include:
- Heavy menstrual bleeding or painful periods
- Longer or more frequent periods
- Pelvic pressure or pain
- Frequent urination or trouble urinating
- Growing stomach area
- Constipation
- Pain in the stomach area or lower back, or pain during sex
If you experience one or more of these symptoms, speaking to your doctor as soon as possible is important. They can take a full medical history, complete a physical examination, and order tests if necessary to determine if you have fibroids.
Diagnosis
Fibroids are diagnosed using a combination of medical history, physical exams, and imaging tests such as ultrasounds or MRIs. The imaging tests can help to pinpoint the location, size, and number of fibroids.
Management
The management of fibroids depends on many factors, such as the severity of the problem, if symptoms are interfering with your day-to-day activities, and your desire to become pregnant. It will also depend on your medical and obstetric history. Management options may include
Observation
This option is usually only appropriate for women with fibroids that are not causing any symptoms or those with manageable symptoms. Your doctor may recommend that you go for repeat scans to monitor the growth of the fibroid, and if symptoms become worse over time, women can always change their minds and consider more definitive treatments.
Medications
Medications can be used to help shrink the size of the fibroids or minimize the symptoms. Medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Gonadotropin-releasing hormone medications
- Low-dose birth control pills
- Intrauterine device (IUD)
Non-invasive or Minimally Invasive Treatments
The goal of these treatments is to maintain or preserve the uterus and use no cuts or small cuts to shrink the fibroids. They are linked with faster recovery times and fewer complications than traditional open surgery. Examples of non-invasive and minimally-invasive procedures are:
- Uterine artery embolization – Small particles (embolic agents) are injected into the arteries that supply the uterus with blood. This causes the fibroids to shrink and die.
- Radiofrequency ablation – In this procedure, heat from radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them.
- MRI-guided focused ultrasound surgery (FUS) – High-intensity ultrasound waves heat and destroy (ablate) the fibroids.
- Laparoscopic myomectomy – Another surgical option where the doctor attempts to remove the fibroids while leaving the uterus in place.
Other Surgical Options
In some circumstances, more traditional surgical procedures like a hysterectomy (removal of the uterus) or an abdominal myomectomy (removal of very large fibroids or those that are multiple) may be used. These surgeries are usually reserved for specific cases or as a last resort.
Your doctor will be more than happy to discuss all possible treatment options. They will take into account your overall health, your tolerance for specific medications, your desire to get pregnant, and, of course, your circumstances.
Prognosis
Fibroids are generallyl benign, and they rarely interfere with pregnancy. However, they are an extremely common medical condition that sometimes requires treatment. The prognosis for fibroids is generally favorable, as they can be managed using various options.
References
- https://www.womenshealth.gov/a-z-topics/uterine-fibroids
- https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids
- https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
- https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/diagnosis-treatment/drc-20354294