Uterine Fibroids: Symptoms, Causes and Treatment

Overview

Uterine fibroids can also be called leiomyomas, uterine myomas, myomas, fibromas, etc. Uterine fibroids are the most common non-cancerous tumors that can grow in or on the wall of the uterine cavity. Uterine fibroids are usually benign in nature. It is mostly seen during the childbearing age of the females. The size of the uterine fibroids varies from person to person.

Types of uterine fibroids

There are several types of uterine fibroids. They are listed below:

• Intramural fibroids- it is the most common type of uterine fibroids. These fibroids most appear within the muscular walls of the uterus. Intramural fibroids can usually grow larger in size, resulting in stretching of the uterus.
• Subserosal fibroids- these fibroids mostly grow on the serosa layer of the uterus. Subserosa fibroids form on the outside of the uterus.
• Submucosal fibroids- submucosal fibroids usually do not appear as common as other uterine fibroids. These types of tumors usually develop in the myometrium.
• Cervical fibroids- it is one of the rare forms of uterine fibroids. These cervical fibroids usually develop on the cervix (which connects the uterus to the vagina).
• Pedunculated fibroids- these fibroids usually develop on the serosal layer of the uterus. These fibroids usually develop a stem, with a slender base that supports the uterus 

Causes of uterine fibroids

Although, the exact cause of uterine fibroids is not known (idiopathic nature), however, there are a few factors that can influence their formation. They are listed below:

• Genetic changes
• Hormones- estrogen and progesterone are the two hormones that play an important role in stimulating the development of the uterine lining during each menstrual cycle. These hormones appear to promote the growth of uterine fibroids.
• Extracellular matrix- extracellular matrix is the material that makes cells stick to each other. An increase in the quantity of extracellular matrix results in the formation of uterine fibroids.
• Other growth factors- other growth factors such as insulin-like growth factors, may help in the formation of uterine fibroids

Risk factors responsible for uterine fibroids

The risk factors which are responsible for uterine fibroids are listed below:

• Hereditary- patients who are diagnosed with uterine fibroids, have an increased risk of having uterine fibroids.
• Age- it most commonly affects women 30-50 years of age.
• Race- the incidence is high in African American women, compared to white people.
• Obesity- women who are obese, have an increased risk of having uterine fibroids.
• Early onset of menstruation
• High blood pressure
• Fibroids are more common in women aged 30-40 years

Symptoms of uterine fibroids

Most of the females who are diagnosed with uterine fibroids are asymptomatic. While a few females notice symptoms. They are listed below:

• Heavy menstrual bleeding
• Severe pelvic pain or pressure
• Menstrual cycle lasting for more than a week
• Frequent urination
• Constipation
• Backache or leg pain
• Difficulty in emptying the bladder
• Anemia due to severe blood loss
• Pain during sexual intercourse
• Miscarriage or infertility

Diagnosis of uterine fibroids

In majority of the cases, uterine fibroids are diagnosed incidentally during a routine pelvic examination. Tests done to diagnose uterine fibroids are:

• Physical examination- During the physical examination, the doctor will palpate (press) the abdomen to feel for irregularities in the shape of the uterus. In order to confirm the uterine fibroids, the doctor will advise the patient to undergo a couple of tests, which includes
• Laboratory tests- they include complete blood count, to look for hemoglobin levels (anemia), thyroid tests, etc.
• Investigational scans- they include ultrasonography of the abdomen, and a pelvic MRI scan of the abdomen to look for the size of the uterine fibroids, and the location of the fibroids.
• Hysterosonography- this procedure is also known as saline infusion sonography, during which saline is used to expand the uterine cavity which will help in getting images of the submucosal fibroids.
• Hysterosalpingography- during this procedure, a dye is used to highlight the uterine cavity and fallopian tubes on the X-ray images.
• Hysteroscopy- Durig this procedure, the doctor places a thin tube along with the camera through the cervix into the uterus

Treatment of uterine fibroids

The treatment plan for uterine fibroids depends upon the location of the fibroids, the size of the fibroids, and the overall condition of the patient. The treatment plans include:

• Wait and watch: For patients who are asymptomatic and if the size of the fibroids is too small, in such cases doctor advises the patient to wait and watch and get repeated ultrasonography scans of the abdomen and pelvis to look for the growth of the fibroids.
• Medications: medications help in targeting the hormones that regulate the menstrual cycle, treating their symptoms such as minimizing pelvic pain or pressure or reducing heavy bleeding. A few of the medications are listed below:

a) Gonadotropin-releasing hormone agonists- These medications are also known as GnRH agonists which help block the production of estrogen and progesterone. Medications include leuprolide, goserelin, and triptorelin. These medications help in reducing the size of the fibroids.

b) Progestin- Releasing intrauterine devices (IUD)

c) Tranexamic acid- They include cyklokapron, lysteda. These medications are advised to take only during heavy menstruation.

d) other medications- They include oral contraceptives to help in controlling heavy bleeding, NSAIDs to help giving relief from pain abdomen associated with fibroids, and multivitamins to treat anemia

• Non-invasive or minimally invasive procedures: They include

1. Forced ultrasound surgery- it is a new and completely non-invasive technology used to treat uterine fibroids. During this procedure, the patient is placed under the special MRI machine table, this MRI machine will help the doctor to visualize inside the uterus. A high-frequency and high-energy sound wave is directed at the fibroids to destroy and ablate them.
2. Myolysis procedure- During this procedure, the size of the fibroids is shrinked using the heat sources which include laser or electric current or cryomyolysis which freezes the fibroids.
3. Uterine fibroid embolization- During this procedure, small particles (embolic agents) is injected into the arteries which is supplying the uterus, which will result in cut off blood supply to the fibroids causing them to shrink and die

• Surgical procedures:

1. Laparoscopic or robotic myomectomy- During this procedure, the surgeon removes the fibroids leaving the uterus in place.
2. Hysteroscopic myomectomy- During this procedure, the surgeon places an instrument along with a camera through the vagina and cervix into the uterus to remove the fibroids. This procedure is generally preferred only in case the of submucosal fibroids.
3. Endometrial ablation- During this procedure, a special instrument is placed inside the uterus followed by using heat, hot water, electric current, or microwave energy to destroy the lining of the uterus. This procedure is generally preferred and is effective in stopping abnormal bleeding.

• Traditional Surgical procedures:

1. Abdominal myomectomy- This procedure is generally preferred in cases where the size of the fibroids is large or the location of the fibroids is too deep.
2. Hysterectomy- Is it considered the last resort to treat uterine fibroids This procedure is usually advised to patients who have not responded to above-mentioned treatment methods to those women who do not want to conceive in the future or for those women who have attained their menopause. This procedure is proven to be the permanent solution for uterine fibroids. During this procedure, the surgeon removes the uterus completely followed by the patient is advised to take hormone replacement therapy postoperatively if required.  

Complications associated with uterine fibroids

The complications associated with uterine fibroids are listed below:

• Anemia
• Severe abdominal or pelvic pain
• Fatigue due to heavy blood loss
• Urinary tract infections
• Fibroids may cause blockage of the fallopian tubes or interfere with the passage of sperm from the cervix to the fallopian tubes
• Miscarriage in a few cases 

Prevention of uterine fibroids

Although uterine fibroids cannot be prevented completely, there are a few measures that can help in minimizing the risk. They include:

• Maintain a healthy diet
• Maintain a healthy weight, and avoid becoming obese
• Increase in physical activity
• Avoid smoking
• Decrease in alcohol and caffeine intake
• Manage stress levels
• Control blood pressure
• Have a regular follow-up with the doctor in case of a family history of uterine fibroids.
• A few of the research has concluded that using hormonal contraceptives may minimize the risk of developing uterine fibroids.

The outcome of uterine fibroids

The majority of the patients respond well to the treatment. Uterine fibroids have an overall good prognosis for the patients post-treatment. Patients do not require any treatment when they are asymptomatic and if the size of the fibroids is too small.

FAQ's

Q) Can fibroids turn into cancer?

In majority of the cases, uterine fibroids are non-cancerous (benign). According to the research less than 1 in 1000 population females, these uterine fibroid turns cancerous. These cancerous tumors are called leiomyosarcoma.

Q) What are the benefits of non-surgical treatment for uterine fibroids?

The benefits of non-surgical treatment of uterine fibroids are listed below:

• These procedures are generally performed under local anesthesia
• Duration of hospital stay is minimal
• Smaller incisions are made for these procedures if required.
• The recovery period is faster compared to open surgeries
• Recurrent growth of uterine fibroids is rare

Q) How common are uterine fibroids?

Uterine fibroids are the most common condition seen in females of reproductive age. Approximately 40-80% 0f the females are diagnosed with uterine fibroids, however, most of the females are asymptomatic. They are diagnosed incidentally during the pelvic examination

Q) Can uterine fibroids go away on their own?

There is a possibility that uterine fibroids can shrink on their own after the female attains menopause. Since there is a decrease in hormone levels during menopause, hence the fibroids can shrink on their own.