Uterine fibroids, also known as myomas or leiomyomas, are noncancerous (benign) growths that develop in or on the muscular wall of the uterus. They are common in women of reproductive age, particularly during the 30s and 40s. Fibroids can vary greatly in size, from small, pea-sized growths to large masses that can distort the shape of the uterus.
Types of Uterine Fibroids
There are different types of fibroids, classified based on where they are located in the uterus:
- Intramural Fibroids: These are the most common type, located within the muscular wall of the uterus. They can grow larger and stretch the uterine walls.
- Submucosal Fibroids: These fibroids grow just beneath the inner lining of the uterus (the endometrium) and can protrude into the uterine cavity. They are often associated with heavier menstrual bleeding and can interfere with fertility.
- Subserosal Fibroids: These fibroids grow on the outer surface of the uterus, and they may grow outward, potentially pressing on surrounding organs. Subserosal fibroids may or may not cause symptoms.
- Pedunculated Fibroids: These are fibroids that are attached to the uterus by a stalk or peduncle. They can be subserosal fibroids that develop a stem-like structure. In some cases, pedunculated fibroids may twist, causing pain.
Symptoms
Many women with uterine fibroids may not experience any symptoms and may only discover them during a routine pelvic exam or ultrasound. When symptoms do occur, they can vary depending on the size, location, and number of fibroids. Common symptoms include:
- Heavy or prolonged menstrual bleeding: This is one of the most common symptoms, leading to anemia in some cases.
- Pelvic pain or pressure: A feeling of fullness, pain, or pressure in the pelvic region, particularly with larger fibroids.
- Frequent urination: Large fibroids may press on the bladder, causing the need to urinate more often.
- Back or leg pain: If fibroids are pressing on nerves or the lower back.
- Pain during sex: Fibroids, particularly submucosal ones, may cause pain or discomfort during sexual intercourse.
- Difficulty getting pregnant: Submucosal fibroids and large intramural fibroids can interfere with implantation or lead to miscarriage.
Causes and Risk Factors
The exact cause of uterine fibroids is not fully understood, but several factors are believed to contribute to their development:
- Hormones: Estrogen and progesterone, the hormones that regulate the menstrual cycle, are thought to stimulate the growth of fibroids. This is why fibroids tend to shrink after menopause when hormone levels drop.
- Genetics: A family history of fibroids increases the likelihood of developing them.
- Age: Women in their 30s and 40s are more likely to develop fibroids, and the risk decreases after menopause.
- Race: African-American women are more likely to develop fibroids, and they tend to develop them at a younger age and with more severe symptoms.
- Obesity: Being overweight or obese increases the risk of developing fibroids, possibly due to higher estrogen levels.
- Vitamin D deficiency: Some studies suggest that women with lower levels of vitamin D may have a higher risk of developing fibroids.
Diagnosis
Uterine fibroids are typically diagnosed through one or more of the following methods:
- Pelvic Exam: A healthcare provider may feel a firm, irregularly shaped mass during a pelvic examination.
- Ultrasound: The most common imaging method used to detect fibroids. It uses sound waves to create images of the uterus and fibroids.
- Magnetic Resonance Imaging (MRI): MRI may be used if more detailed images are needed to assess the size and location of fibroids, especially if the treatment options are being considered.
- Hysteroscopy: A procedure where a thin tube with a camera is inserted into the uterus to visually examine the inside of the uterus and fibroids, especially submucosal ones.
- Sonohysterogram: A special type of ultrasound where fluid is injected into the uterus to make the fibroids easier to see.
Treatment
Many women with fibroids do not need treatment if the fibroids are small and not causing symptoms. However, if treatment is necessary, options include:
- Medications:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): For pain relief, such as ibuprofen.
- Hormonal treatments: Such as birth control pills, intrauterine devices (IUDs), or hormone therapy to control heavy bleeding and shrink fibroids.
- Gonadotropin-releasing hormone (GnRH) agonists: These drugs temporarily shrink fibroids by lowering estrogen and progesterone levels, often used before surgery.
- Tranexamic acid: To reduce heavy menstrual bleeding.
- Non-Surgical Procedures:
- Uterine artery embolization (UAE): A procedure that blocks the blood vessels feeding the fibroids, causing them to shrink.
- MRI-guided focused ultrasound: Uses high-frequency sound waves to destroy fibroid tissue.
- Endometrial ablation: A procedure to destroy the lining of the uterus, which can help reduce heavy bleeding caused by fibroids.
- Surgical Treatment:
- Myomectomy: A surgery to remove the fibroids while preserving the uterus. This is typically recommended for women who want to preserve fertility.
- Hysterectomy: The removal of the uterus. This is the most definitive treatment for fibroids, often recommended for women who no longer wish to have children or have severe symptoms that are not controlled by other methods.
Prevention
There is no known way to prevent fibroids, but managing risk factors (such as maintaining a healthy weight, regular exercise, and avoiding excessive alcohol consumption) may reduce the likelihood of developing them. Regular gynecological exams and pelvic ultrasounds can help in early detection.
Prognosis
- Fibroids are typically benign and do not lead to cancer.
- Symptoms may improve after menopause, as fibroids often shrink due to reduced hormone levels.
- In some cases, fibroids may continue to grow or cause symptoms even after menopause, especially if hormone therapy is used.
In many cases, treatment can effectively manage fibroid symptoms, allowing women to maintain a good quality of life.
