Fibroids are the most frequently seen tumours of the female reproductive system. They are non-cancerous tumours that grow from the muscle layers of the uterus (womb).
Fibroids also known as uterine fibroids, leiomyomas, or myomas or fibromas, are firm, compact tumours that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus, and can vary from the size of a bean to as large as a melon.
Fibroids affect at least 20 percent of all women at some point in their life. Women of reproductive age are the most likely to develop them. Also, overweight and obese women have a significantly higher risk of developing fibroids, compared with women of normal weight.
Types of Fibroids
Fibroids are characterized by their location in the uterus:
Intramural - located in the wall of the uterus, this is the most common type.
Subserosal fibroids - located outside the wall of the uterus but underneath the tissue layer that surrounds the uterus. They can develop into pedunculated fibroids (stalks) and become quite large.
Pedunculated fibroids - grow on small stalks inside or outside the uterus.
Submucosal fibroids - located in the muscle beneath the lining of the uterus wall. This type can protrude into the cavity of the uterus.
Cervical fibroids - located in the neck of the womb (the cervix).
Intraligamentary fibroids – located in the connective tissue next to the uterus. The fibroids are implanted at the pelvic ligament resulting to the displacement of the uterus and sometimes the bladder.
It's possible to have more than one type of fibroid.
Causes of Fibroids
While it is not clearly known what causes fibroids, it is believed that each tumour develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of oestrogen.
During a woman's reproductive years, oestrogen and progesterone levels are high. When oestrogen levels are high, especially during pregnancy, fibroids tend to swell. When oestrogen levels are low, fibroids may shrink, for example, during a woman's menopause.
Heredity may also be a factor; women whose close relatives have had fibroids have a higher risk of developing them.
There is also some evidence that red meats, alcohol, and caffeine could increase the risk of fibroids. Also, an increased intake of fruit and vegetables might reduce the risk.
Who Is at Risk for Fibroids?
Women are at greater risk for developing fibroids if they have one or more of the following risk factors:
a family history of fibroids
being over the age of 30
being of African-American descent
having a high body weight
Symptoms of Uterine Fibroids
Most women have no symptoms, but around 1 in 3 will experience symptoms, which may include:
Anaemia (as a result of heavy periods)
Discomfort in the lower abdomen (especially if fibroids are large)
Heavy, painful periods
Pain in the legs
Swelling in the lower abdomen (especially if fibroids are large)
Other possible symptoms of uterine fibroids include:
Diagnosis of Fibroids
In most cases, the symptoms of fibroids are rarely felt, and the patient does not know she has them. They are usually discovered during a vaginal examination.
X-ray. Electromagnetic energy used to produce images of bones and internal organs onto film.
Transvaginal ultrasound (also called ultrasonography). An ultrasound test using a small instrument, called a transducer, that is placed in the vagina.
Magnetic resonance imaging (MRI). A non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
Hysterosalpingography. X-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction.
Hysteroscopy. Visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Endometrial biopsy. A procedure in which a sample of tissue is obtained through a tube which is inserted into the uterus.
Blood test (to check for iron-deficiency anaemia if heavy bleeding is caused by the tumour).
Treatments for Fibroids
If the woman has no symptoms and the fibroids are not affecting her day-to-day life, she may receive no treatment at all. Even women who have heavy periods but whose lives are not badly affected by this symptom may also opt for no treatment.
Since most fibroids stop growing or may even shrink as a woman approaches menopause, the health care provider may simply suggest "watchful waiting." With this approach, the health care provider monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. When treatment is necessary, it may be in the form of medication or surgery.
Treatment will be determined by your health care provider(s) based on:
Your overall health and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Your desire for pregnancy
In general, treatment for fibroids may include:
Treating fibroids with medication
GnRHA (gonadotropin-releasing hormone agonist) makes the woman's body produce much lower quantities of oestrogen, which shrinks the fibroids. GnRHA stops the menstrual cycle but does not affect fertility once treatment stops.
GnRHAs can cause menopause-like symptoms, including hot flashes, a tendency to sweat more and vaginal dryness.
Although thinning of the bones (osteoporosis) is a possible side-effect, it is rare.
GnRHAs may be administered to the patient before surgery in order to shrink the fibroids. GNRHAs are for short-term use only.
Other drugs may be used, but they are less effective for larger fibroids; these include:
Anti-inflammatory drugs - including mefenamic and ibuprofen. Anti-inflammatory medications reduce the production of prostaglandins, which are normally associated with heavy periods. Anti-inflammatory drugs are also painkillers. They do not affect fertility.
The contraceptive pill - oral contraceptives help regulate the ovulation cycle, and may help reduce heavy menstrual bleeding associated with fibroids when a woman is on her period.
LNG-IUS (Levonorgestrel intrauterine system) - a plastic device is placed inside the uterus. LNH-IUS releases levonorgestrel (progestogen hormone). The hormone stops the lining of the uterus from growing too fast, which reduces bleeding. One of the side-effects is irregular bleeding for up to 6 months, headaches, breast tenderness, and acne. In very rare cases, it can stop periods.
Surgery to treat fibroids
Depending on symptoms and whether medical therapy has failed, the patient may have to undergo surgery. The following surgical procedures may be considered:
Hysterectomy - removing the uterus. This is only considered if the fibroids are very large, or if the patient is bleeding too much. Hysterectomies are sometimes an option to prevent fibroids coming back. Hysterectomy side effects include reduced libido and early menopause (if they also remove the ovaries and fallopian tubes during the surgery).
Myomectomy - fibroids are surgically removed from the wall of the uterus. This option is more popular for women who want to get pregnant. Women with large fibroids, or fibroids located in particular parts of the uterus, may not be able to benefit from this surgery.
Endometrial ablation - removing the lining of the uterus. This procedure may be used if the patient's fibroids are near the inner surface of the uterus; it is considered an effective alternative to a hysterectomy.
Uterine artery embolization(UAE) - this treatment cuts off the fibroid's blood supply, effectively shrinking the fibroid. A chemical is injected through a catheter into a blood vessel in the leg, guided by X-ray scans.
Magnetic-resonance-guided percutaneous laser ablation - an MRI scan is used to locate the fibroids. Then, very fine needles are inserted through the patient's skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the fiber-optic cable and shrinks the fibroids.
Magnetic-resonance-guided focused ultrasound surgery - an MRI scan locates the fibroids, and sound waves are used to shrink the fibroids.
Most experts say magnetic-resonance-guided percutaneous laser ablation and magnetic-resonance-guided focused ultrasound surgery are both effective - however, there is some uncertainty regarding their benefits vs. risks.
Some websites and consumer health books promote alternative treatments, such as specific dietary recommendations, magnet therapy, black cohosh, herbal preparations or homeopathy. So far, there's no scientific evidence to support the effectiveness of these techniques.
Complications Associated with Fibroids
It is important to stress that in the vast majority of cases, fibroids do not result in complications for patients. However, for a tiny minority, they do. Complications may include:
Menorrhagia (heavy periods) - the most common complication is a disruption of the woman's ability to function normally when periods are present, and also the possibility of depression because of this. In some cases, menorrhagia can lead to anaemia and fatigue.
Abdominal pains - if the patient's fibroids are large, she may experience swelling and discomfort in the lower abdomen. She may also have a sensation of being constipated. Some women with large fibroids say their bowel movements are painful.
Premature birth, labour problems, miscarriages - as oestrogen levels rise significantly during pregnancy, and as oestrogen can speed up fibroid growth, some women may experience early labour, miscarriages, or complications during labour.
Infertility - in some cases, fibroids can make it more difficult for the fertilized egg to attach itself to the lining of the uterus. A fibroid that grows outside the uterus (submucosal fibroid) may change the uterus' shape, making it harder for the woman to get pregnant.
Leiomyosarcoma - this is extremely rare. This is a form of cancer, and it can develop inside the fibroids.
What are the risks of uterine fibroids during pregnancy?
Some studies have shown an increased risk of pregnancy complications in the presence of fibroids, such as first trimester bleeding, breech presentation, placental abruption, and problems during labour. Fibroids have also been associated with an increased risk of caesarean delivery. The size of the fibroid and its precise location within the uterus are important factors in determining whether a fibroid causes obstetric complications.
When to See a Doctor
See your doctor if you have:
Pelvic pain that doesn't go away
Overly heavy, prolonged or painful periods
Spotting or bleeding between periods
Difficulty emptying your bladder
Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.
What questions should I ask my doctor if I have fibroids?
How many fibroids do I have?
What size is my fibroid(s)?
Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
Can I expect the fibroid(s) to grow larger?
How rapidly have they grown (if they were known about already)?
How will I know if the fibroid(s) is growing larger?
What problems can the fibroid(s) cause?
What tests or imaging studies are best for keeping track of the growth of my fibroids?
What are my treatment options if my fibroid(s) becomes a problem?
What are your views on treating fibroids with a hysterectomy versus other types of treatments?
Uterine Fibroids Facts
Uterine fibroids are benign tumours that originate in the uterus (womb).
It is not known exactly why women develop uterine fibroids.
Most women with uterine fibroids have no symptoms. However, fibroids can cause a number of symptoms depending on their size, location within the uterus, and how close they are to adjacent pelvic organs. These are most commonly abnormal bleeding, pain and pressure.
Uterine fibroids are diagnosed by pelvic exam and by ultrasound.
If treatment for uterine fibroids is required, both surgical and medical treatment options are available.
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