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One of the most common uterine issues experienced by women is uterine fibroids. In fact, studies suggest they impact 50-70% of the female population throughout their most fertile years. These growths develop inside the womb and can mess around with your periods, cause abdominal pain, and even lead to infertility issues and miscarriages.
For many women, heavy bleeding, abdominal pain, back pain, constipation, and urinary complications are among unpleasant symptoms during their period. However, these symptoms should never be ignored as they are often signalling something is not quite right. There are a number of conditions that could be behind them, such as PCOS, endometriosis, uterine polyps, and more. Today though, we will focus solely on uterine fibroids.
Uterine fibroids, otherwise known as myoma or leiomyoma, are muscular tumors that grow on the wall of the uterus. Although this can be a scary diagnosis to have, it is essential to note that they are usually non-cancerous.
Uterine fibroids are more common in women between the ages of 30 and 50, and depending on the severity of symptoms and size of the fibroids, different treatment types are available.
In many cases, women don’t experience any symptoms or issues from having leiomyoma fibroids throughout their life. They often go unchecked and may not need medication or surgery to treat. However, in certain instances, the situation is quite different and the pain they cause in the abdomen, during periods, or sexual intercourse, can be very challenging.
If you experience any of the following symptoms frequently, it may be worth going to the doctor for a check-up to investigate fibroids or other causes.
Currently, the medical world has identified four specific types of uterine fibroids that a person may develop over their life; these are;
Subserosal: The fibroid grows outside the uterus and can, when significant, push on nearby organs.
Submucosal: The fibroid grows just underneath the uterine lining.
Intramural: The fibroid grows inside the wall of the uterus. This type is the most common.
Pedunculated: This type of fibroid grows on stalks connected to the inside or outside of the uterus.
As well as for your own health and wellbeing, one reason to get checked for uterine fibroids is that they can impact fertility and pregnancy. In the most severe cases, developing uterine fibroids can result in miscarriages as well as make it harder to get pregnant, especially if they grow big enough to block the fallopian tubes or uterus.
Other ways that leiomyoma of the uterus can impact pregnancy are an increased risk of preterm labor, abnormal attachment of the placenta, an increased likelihood of delivery by cesarean section, and postpartum hemorrhaging.
If you do discover you have fibroids, a specialist clinician can offer you a treatment plan that maximizes your chances of pregnancy and carrying your child to term.
Currently, the medical world has yet to find the overall cause of why people develop uterine fibroids. However, some common factors that have been seen to impact them are:
Estrogen: Fibroids develop due to abnormal muscle cells in the uterus lining and then rapidly multiply due to coming into contact with estrogen, which can promote tumor growth. This is why it is more common for women to develop uterine fibroids during their fertile years and even during pregnancy when their estrogen levels are at their highest, and why the uterine fibroids tend to get smaller after menopause, as estrogen levels drop.
Insulin: Using substances that help the body maintain tissues, such as insulin, may affect fibroid growth.
Extracellular matrix (ECM): This material makes cells stick together, like mortar between bricks. Fibroids have an increased ECM, which makes them fibrous. ECM also stores growth factors and causes biological changes in the cells themselves.
As well as the above, race seems to be a factor for the likelihood of developing fibroids. It is not clear why, but black women are the most likely racial group to develop uterine fibroids.
Fibroids are usually first identified by having a pelvic floor exam (an ultrasound), and if any are found, a biopsy might be needed to rule out the possibility of cancer.
If your doctor finds an ultrasound does not give enough information, then you may be sent for more tests and scans, such as:
MRI: These are used to show the fibroids’ size and location in more detail. They can also identify different types of tumors and help determine treatment options.
Hysterosonography: In this test, saline will be injected into the uterus cavity and a sonogram is done to map out where and how big the growths are.
Hysterosalpingography: This approach uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. The test can help determine whether your fallopian tubes are open or blocked and show some submucosal fibroids. This is usually recommended if infertility is a concern.
Your doctor may recommend several different types of treatment depending on the severity of your symptoms and the size of your uterine fibroids.
Over-the-counter anti-inflammatory painkillers such as ibuprofen may be recommended for those with less severe symptoms or pain. Your doctor may also recommend hormonal treatments or the oral contraceptive pill to help stop the bleeding. Gonadotropin-releasing hormone agonists might be used to reduce estrogen levels and trigger a temporary “medical menopause” to help shrink the fibroids.
If the fibroids are found to be too big or cause any severe pain and fertility issues, then a more invasive treatment will be recommended to remove the fibroids. When it comes to uterine fibroid removal, there are a few different surgery options your doctor might recommend, including:
Traditional open myomectomy: The procedure is performed via an abdominal incision, where the doctor leaves the uterus intact but removes the fibroids. This procedure carries some risks, including bleeding and scar tissue formation at the incision site.
Laparoscopic or robotic myomectomy: Using keyhole surgery, slender instruments are placed through minor cuts in the abdomen to remove the fibroids from the uterus. This results in less bleeding or scarring than open myomectomy.
Hysteroscopic myomectomy: A camera is inserted through the vagina and an instrument is uded to shave off visible portions of the fibroid tumors. This method only treats fibroids that have formed inside the uterine cavity.
Endometrial ablation: This procedure reduces heavy menstrual flow. A device is inserted into the uterus and emits heat, microwave energy, hot water, cold water, or an electric current to destroy the tissue that lines the inside of the uterus.
Uterine artery embolization (UAE): This minimally invasive procedure shrinks fibroids by cutting off their blood flow. An interventional radiologist performs UAE, using X-rays for guidance.
Magnetic resonance-guided focused ultrasound: This focuses sound waves on fibroids in the front of the uterus.
Radiofrequency ablation of fibroids: Under laparoscopic and ultrasound guidance, heat is applied to the fibroids to shrink them and soften them.
Hysterectomy: This is only recommended for those whose fibroids are too big and/or causing too many complications for another treatment option to be viable. Although extreme, it is one of the best treatment options for those who suffer badly from fibroids, as it eliminates the chance of recurrence.
To wrap up, uterine fibroids are a common issue for women within their most fertile years, with abnormal cells in the uterus causing (usually) non-cancerous tumors to grow and estrogen causing them to multiply quickly.
In severe cases, fibroids can not just impact the menstrual cycle, causing heavy and long periods, but also run the risk of causing infertility and miscarriages.
If you have been diagnosed with fibroids, your doctor should offer you a range of treatments, including medicinal prescriptions, non-invasive and invasive surgery, depending on your level of symptoms, the severity and size of the fibroids, and what your fertility plans are for the future.
References:
Ahmad, A., Kumar, M., Bhoi, N., Badruddeen, Akhtar, J., Khan, M., Ajmal, M. & Ahmad, M. (2023). Diagnosis and management of uterine fibroids: current trends and future strategies. Journal of Basic and Clinical Physiology and Pharmacology, 34(3), 291-310. https://doi.org/10.1515/jbcpp-2022-0219
Coutinho L.M., Assis W.A., Spagnuolo-Souza, A. et al. Uterine Fibroids and Pregnancy: How Do They Affect Each Other?. Reprod. Sci. 29, 2145–2151 (2022). https://doi.org/10.1007/s43032-021-00656-6
Freytag D, Günther V, Maass N, Alkatout I. Uterine Fibroids and Infertility. Diagnostics. 2021; 11(8):1455. https://doi.org/10.3390/diagnostics11081455
Giuliani, E., As-Sanie, S. and Marsh, E.E. (2020), Epidemiology and management of uterine fibroids. Int J Gynecol Obstet, 149: 3-9. https://doi.org/10.1002/ijgo.13102
Levy, B. S. (2008). Modern management of uterine fibroids. Acta Obstetricia et Gynecologica Scandinavica, 87(8), 812–823. doi.org/10.1080/00016340802146912
Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124: 1501–1512.
Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A, Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment, Endocrine Reviews, Volume 43, Issue 4, August 2022, Pages 678–719, https://doi.org/10.1210/endrev/bnab039
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