Uterine fibroids or leiomyomas or myomas are non-cancerous growths of the uterine muscles.
They most often appear in women during their childbearing years. The uterus is a lemon-sized inverted pear-shaped organ in the pelvic area. During pregnancy, a baby grows and develops in the uterus.
Uterine fibroid can be a single isolated growth or may occur in a cluster. The diameter of nodules can range from 1mm to more than 8 inches. Sometimes, the lesion can be as large as a watermelon.
Are fibroids in the uterus wall common?
Fibroid growth in the pelvis is common. According to various studies, more than 50 percent of women may have fibroids. However, these fibroids do not cause any symptoms in most women.
What are risk factors for uterine fibroids development?
Fibroids most commonly happens in women of childbearing age. Typically, young women who have not got their first period do not show fibroids.
Though doctors cannot attribute any cause for the development of fibroids, some risk factors may increase chances of developing fibroids:
- Family history of fibroids
- Higher body weight or obesity
- No children.
- Menstruation started at a young age.
- Late age for menopause.
Where are fibroids usually grow in the uterus?
Fibroids can occur at any location inside and outside of your uterus.
The location and size of the fibroid may determine the treatment modality.
We can categorize the fibroids based on their location of occurrence
- Submucosal fibroids: Fibroids growing inside the uterine cavity.
- Intramural fibroids: Fibroids embedded into the uterine wall.
- Sub-serosa fibroids: Fibroids connected to the outside wall of the uterus.
- Pedunculated fibroids: Fibroids located outside the uterus. A thin stem connects pedunculated fibroids to the uterus.
Can all uterine fibroids develop into cancer?
Rarely a uterine fibroid undergoes a malignant (cancerous) transformation. No one can predict that whether a uterine fibroid will develop into cancer or not. But if gynecologists observe rapid growth in the size of fibroids, they evaluate it further to rule out malignancy.
What are the most common signs and symptoms of uterine fibroids?
Signs and symptoms of uterine fibroids depend on their size and location. Small, isolated fibroids may escape diagnosis as they do not cause any symptoms.
Larger fibroids can cause a variety of symptoms, including but not limited to:
- Excessive bleeding during menstruation
- Pain during the menstrual cycle
- Bleeding outside the menstrual cycle
- Lower abdomen fullness or bloating.
- Frequent urination or inability to empty your bladder as a fibroid may put pressure on the bladder
- Pain during sexual intercourse
- Low back pain
- Vaginal discharge.
- Abdominal distention (enlargement)
The symptoms usually diminish after menopause due to a decrease in hormone levels within the body.
How do you test for uterine fibroids?
Asymptomatic fibroids may often escape any diagnosis.
A gynecologist may discover some fibroids during a regular or prenatal exam. Sometimes the history of pain and heavy menstrual bleeding may alert your doctor to go for further investigations.
Tests that can diagnose the size and location of fibroids are:
- Magnetic resonance imaging (MRI)
- Computed tomography (CT)
- Hysteroscopy: Your doctor inserts a thin, flexible tube with a camera on the end through the vagina and cervix and further moves into the uterus.
- Hysterosalpingography (HSG): After injecting contrast material, an X-ray of the uterus is done.
- Sono-hysterography: The doctor inserts a small catheter transvaginally to administer saline into the uterine cavity. The saline creates a clearer image of your uterus on USG.
- Laparoscopy: Through a small incision in the lower abdomen, the doctor inserts a flexible tube with a camera on the end to have a better visualization of your internal organs.
What is the treatment of choice for uterine fibroids?
Treatment of the fibroids depends on the following:
- Number of fibroids
- size of the fibroids
- Location of the fibroids
- The severity of the symptoms related to the fibroids
- Desire for pregnancy
- The desire for uterine preservation
Medications for symptomatic relief:
- Pain killers to manage discomforts and pain caused by the fibroids
- Iron supplements for anemia due to excessive bleeding,
- Gonadotropin-releasing hormone (GnRH) agonists for shrinking the fibroids making it easier for a surgeon to remove them.
Some surgical options may preserve the uterus while others can either damage or remove the uterus. Therefore the desire to preserve the uterus or chances of future pregnancy is also an important factor in determining the type of surgical option for treating fibroids.
Myomectomy: It removes the fibroids without damaging the uterus. There are three types of myomectomy procedures.
The surgeon inserts a scope a thin, flexible tube-like tool through the vagina and cervix into the uterine cavity and removes the fibroids without making any incision.
The surgeon makes few small incisions in the abdomen and inserts a scope to remove the fibroids.
A larger incision is made in the abdomen to remove the fibroids.
There are some surgical options for patients, who do not want to have future pregnancies or do not desire to protect the uterus.
- Hysterectomy: Surgical removal of the uterus.
- Uterine fibroid embolization: Small particles inserted through a small catheter in the uterine artery or radial artery blocks the flow of blood to the fibroids. Loss of blood shrink the fibroids
- Radiofrequency ablation (RFA)
Magnetic resonance imaging (MRI)-guided focused ultrasound