Uterine fibroids overview
- Uterine fibroids are benign tumors that form in a woman’s uterus.
- As many as 1 in 5 women have uterine fibroids, and some types can lead to infertility.
- Uterine fibroids can range in size and are often not painful.
- Uterine fibroids are probably caused by an increase in estrogen or a patient’s genetic predisposition.
What are uterine fibroids?
Uterine fibroids, also knows as leiomyoma or simply myoma, are muscular, noncancerous tumors that grow in the wall of a woman’s uterus. Uterine fibroids will occasionally grow in the cervix as well. They can grow as a single tumor or there can be multiple tumors in the uterus.
Fibroids can be as small as a sunflower seed or as large as a softball. Often the smaller fibroids cause no pain or symptoms and do not affect fertility.
Uterine fibroids are generally classified in three ways:
- Submucosal grow into the uterine cavity
- Intramural grow within the uterine wall
- Subserosal grow on the outside of the uterine wall.
Uterine fibroids can also attach to the bladder, bowel or other nearby organs. They can be attached to the ligaments around the uterus or connected to the uterus by a stalk (pedunculated).
What causes uterine fibroids?
While the exact cause of uterine fibroids is unknown, doctors do know that the hormones estrogen and progesterone affect the growth of the fibroids. Women who develop fibroids and then become pregnant often have fibroids that grow rapidly due to the influx of estrogen and progesterone during pregnancy.
If a woman’s family has a history of uterine fibroids, this may indicate that she has a genetic predisposition to them. Some scientists also think that environmental factors may cause uterine fibroids.
Hormone regulating birth control pills can assist in halting the growth of fibroids, and fibroids also stop growing or shrink once a woman reaches menopause.
About 5-10 percent of infertile women have uterine fibroids, which are thought to decrease fertility by obstructing the flow of sperm in the cervix or uterus. These fibroids may also block the fallopian tubes or affect the flow of blood necessary for implantation of the embryo in the uterus.
What are the symptoms of uterine fibroids?
While many women with uterine fibroids do not experience much pain or discomfort, common symptoms include:
- Heavy menstrual bleeding
- Enlargement of the lower abdomen
- Feeling of pressure in the lower abdomen
- Frequent urination
- Pain during sex
- Lower back pain
- Complications during pregnancy or labor (often requiring a cesarean section)
Pregnancy complications can arise from the presence of uterine fibroids. Women with fibroids are six times more likely to deliver their child via cesarean section. Other pregnancy complications that may be caused by fibroids are a breech delivery position, placental abruption, preterm delivery or a failure of labor to progress.
Treatment for uterine fibroids
Treatment of uterine fibroids depends on the severity of symptoms and the doctor’s evaluation of each specific case. Often, women with fibroids experience no symptoms and a doctor diagnoses the fibroids during a routine pelvic exam.
In order to confirm the size, location and type of fibroid, a doctor will use imaging tests such as an ultrasound, MRI, hysterosalpingogram or a sonohysterogram. Once the doctor knows more about the fibroids, he or she will devise a treatment plan.
Medications are a common treatment for uterine fibroids. Over-the-counter pain medications are often used to treat mild pain. Women with heavy menstrual bleeding as a result of uterine fibroids should take an iron supplement so they do not become anemic due to lack of iron. Low-hormone birth control medication can also help the symptoms of fibroids to subside.
Gonadotropin releasing hormone agonists (GnRHa) are sometimes given to shrink fibroids prior to surgery. GnRHa also causes most women to stop mensuration, which can give relief to women experiencing heavy bleeding due to fibroids. However, GnRHa is only a temporary solution because it can cause loss in bone density and once stopped, fibroids can grow back rapidly.
Surgical removal of uterine fibroids
Women with fibroids that inhibit fertility or cause extreme pain and discomfort may require surgery to remove the fibroid(s). These surgical treatments include:
- Myomectomy is the best surgical option for women who wish to have children after fibroid removal because it leaves the uterus in place and able to sustain a pregnancy. Depending on the size and locations of the fibroids, most surgeons will perform a laparoscopic myomectomy, which is minimally invasive. In rare cases, the surgeon may need to cut into the abdomen in order to remove the fibroids. Fibroids may grow again after a myomectomy.
- Hysterectomy involves the removal of the uterus in order to prevent fibroids from ever returning. Women will not be able to have children after a hysterectomy, so this surgery is usually reserved for women near or past menopause, or for those who do not want to bear more children. Depending on the size of the fibroids, the surgeon may need to open the abdomen in order to remove the uterus, may perform less invasive laparoscopic hysterectomy, or may access the uterus through the vagina.
- Endometrial ablation is a procedure that removes the uterine lining (endometrium) and normally results in a significant reduction in, or cessation of, menstrual bleeding. Women who choose endometrial ablation will no longer be able to get pregnant.
- Myolysis is a surgical treatment in which a doctor inserts a needle into the fibroid and uses electric current or freezing agents to destroy the fibroid. Women who choose myolysis may be able to get pregnant in the future, however the amount of scar tissue and strength of the uterine wall cannot be predicted. Scar tissue and weakness of the uterine wall can make getting pregnant in the future difficult.