Definition & Overview

Fibroids, also referred to as uterine fibroid, myoma, fibromyoma, fibro leiomyoma, or uterine leiomyoma, are benign growth of cells in the uterus. They are a common occurrence, and it is estimated that three in every four women have the condition. Although fibroids are non-cancerous, and the possibility of them developing into a cancer (leiomyosarcoma) is very small to non-existent, they can cause problems such as abdominal swelling, painful and extended menstruations, urinary problems, and they can prevent a normal childbirth.

Fibroids can be so small that they are not visible to the human eye, and they can be large enough to deform a uterus. It is normal for fibroids to change in size. Some even have growth spurts and then suddenly become smaller. There is also a chance that a fibroid can disappear without any medical treatment.

There are four different types of fibroids:

  • Subserosal Fibroid – this type grows outside the uterus wall
  • Submucosal Fibroid – this type grows under the surface of the uterus but may also protrude into the uterus.
  • Myometrial Fibroid – these can be found in the muscular wall of the uterus
  • Pedunculated Fibroid – This type is located outside the uterus, but attached to a stalk or base

Fibroids are composed mostly of dense muscle fibers that form a mass, but the exact cause of the condition is yet to be determined. They develop after puberty, and their growth seems to depend on estrogen. Women with high estrogen levels experience larger fibroids, but when the estrogen levels fall, the fibroid also decreases in size. It is also typical for fibroids to disappear after pregnancy as the womb returns to its normal size.

One or more fibroids can be present in the uterus. If there are too many fibroids to count, the condition is referred to as diffuse uterine leiomyomatosis.

Cause of Condition

The exact cause of fibroids is unknown. Some experts believe that the condition can be caused by genetic abnormalities, vascular system abnormalities, the way some tissues respond to injuries, and some proteins that affect the rate of cell proliferation.

Family history is also a factor since fibroids are common in the same family. Race can also be a factor since it has been observed that women of African descent have a high occurrence of the tumor.

Key Symptoms

The most common symptoms of fibroids are:

  • Constipation
  • Frequent urination
  • Painful and prolonged menstruation periods that last for seven or more days
  • Heavy menstrual bleeding
  • Pain in the pelvis
  • Difficulty urinating
  • Leg and back pains
  • Pressure on the rectum
  • Difficulty in passing stools
  • Bloating of the abdomen
  • Pain during intercourse

Fibroids can also interfere with pregnancy. Some believe that it is one of the causes of infertility. Women with fibroids may also have problems during pregnancy as these can cause a miscarriage. They can also interfere with childbirth. If the fibroids are too large, it is possible that a caesarean section will be recommended.

Fibroids are usually detected during an internal vaginal examination, after which an ultrasound or other imaging tests will confirm the presence of the fibroids.

  • Ultrasound – the ultrasound probe may be inserted into the vagina or placed over the pelvis to create an image of the fibroid

  • MRI – If the diagnosis is still unclear, an MRI can be used so that a more detailed image can be produced.

  • Uterine Biopsy – If the doctor is skeptical as to the whether the growth is non-cancerous or cancerous, a uterine biopsy may be performed. This involves taking some tissue from the uterus by going through the vagina or surgical means.

  • Hysterosalpingogram – An x-ray detects dye that has been inserted into the vagina and cervix. The dye will produce an outline of the uterus and fallopian tubes.

  • Sonohysterogram – this procedure involves the use of an ultrasound device and water is inserted into the vagina prior to the procedure. Doing so can detect the presence of other fibroids that were not detected during a normal ultrasound.

  • Hysteroscopy – this procedure uses a tube with a video camera attached to its tip, otherwise known as an endoscope. The endoscope is inserted into the vagina to capture the image of the interior of the uterus. However, a hysteroscopy will not be able to detect the fibroids that grow outside the uterus wall.

Who to See & Types of Treatments Available

Majority of fibroid cases do not require any treatment, as they do not pose any problems or create any symptoms. Some may even disappear without any medical intervention.

Fibroids that require treatment are those that create problems or symptoms. These can be treated using a variety of medications or through surgery. Your doctor will prescribe the medicines or refer you to a surgeon if you require surgery. The most common treatments are:

Medications that can reduce the symptoms such as anti-inflammatory drugs, tranexamic acid, oral contraceptive pills, or a levonorgestrel intrauterine system, a device placed inside the womb that acts as a contraceptive.

Medicines can also be prescribed to shrink the fibroids. These are gonadotrophin-releasing hormone (GnRH) analogues. These medicines reduce the levels of oestrogen in the body thus forcing the fibroids to shrink. However, reduced oestrogen levels may result in osteoporosis or may cause menopausal symptoms.

Surgery is also an option when the fibroids have become too large or cause too many problems. The most common types of surgical procedures performed for fibroids are:

  • Myomectomy – this procedure involves removing the fibroid but leaving the womb intact. It is best for women who wish to have children in the future. The procedure can be performed hysteroscopically (through the vagina), laparoscopically (keyhole surgery), or through an incision in the abdomen.

  • Hysterectomy – this procedure involves removing the womb, so it is not advisable for women who still wish to have children.

  • Endometrial Ablation – the lining of the womb is removed during the procedure and is only recommended for women with fibroids that are located near the inner lining.

  • MRI-guided focused ultrasound – pulses of high-powered ultrasound waves targets the fibroids. Although an effective treatment, there have been no studies on the long-term effects on women.
    References:

  • National Uterine Fibroids Foundation

  • Uterine Fibroids | National Women's Health Network
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