Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Many women have uterine fibroids sometime during their lives. But you might not know you have uterine fibroids because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.
SYMPTOMS
Many women who have fibroids don’t have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
Heavy menstrual bleeding, menstrual periods lasting more than a week, pelvic pressure or pain, Frequent urination, difficulty emptying the bladder, and Constipation.
BACKACHE OR LEG PAINS
Rarely, a fibroid can cause acute pain when it outgrows its blood supply and begins to die.
Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.
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, Unexplained low red blood cell count (anaemia), Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.
CAUSES
Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to these factors:
Genetic changes. Many fibroids contain changes in genes that differ from those in typical uterine muscle cells.
Hormones. Estrogen and progesterone, two hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids.
Fibroids contain more estrogen and progesterone receptors than typical uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factors, may affect fibroid growth.
Extracellular matrix (ECM). ECM is the material that makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biological changes in the cells themselves.
Doctors believe that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus (myometrium). A single cell repeatedly divides, eventually creating a firm, rubbery mass distinct from nearby tissue.
The growth patterns of uterine fibroids vary — they may grow slowly or rapidly or remain the same size. Some fibroids go through growth spurts, and some may shrink on their own.
Many fibroids that have been present during pregnancy shrink or disappear after pregnancy, as the uterus goes back to its usual size.
RISK FACTORS
There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Factors that can have an impact on fibroid development include:
RACE
Although all women of reproductive age could develop fibroids, black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids, along with more severe symptoms.
HEREDITY
If your mother or sister had fibroids, you’re at increased risk of developing them.
OTHER FACTORS
Starting your period at an early age; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.
COMPLICATIONS
Although uterine fibroids usually aren’t dangerous, they can cause discomfort and may lead to complications such as a drop in red blood cells (anaemia), which causes fatigue, from heavy blood loss. Rarely, a transfusion is needed due to blood loss.
PREGNANCY AND FIBROIDS
Fibroids usually don’t interfere with getting pregnant. However, it’s possible that fibroids — especially submucosal fibroids — could cause infertility or pregnancy loss.
Fibroids may also raise the risk of certain pregnancy complications, such as placental abruption, fetal growth restriction and preterm delivery.
PREVENTION
Preventing uterine fibroids may not be possible, but only a tiny percentage of these tumours require treatment.
But, by making healthy lifestyle choices, such as maintaining a healthy weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.
Also, some research suggests that using hormonal contraceptives may be associated with a lower risk of fibroids.
Watchful waiting
Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that’s the case for you, watchful waiting could be the best option.
Fibroids aren’t cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop.
MEDICATIONS
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don’t eliminate fibroids but may shrink them.
MINIMALLY INVASIVE PROCEDURES
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:
UTERINE ARTERY EMBOLIZATION
Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die.
This technique can be effective in shrinking fibroids and relieving the symptoms they cause. Complications may occur if the blood supply to your ovaries or other organs is compromised. However, research shows that complications are similar to surgical fibroid treatments and the risk of transfusion is substantially reduced.
RADIOFREQUENCY ABLATION
In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. This can be done during a laparoscopic or transcervical procedure. A similar procedure called cryomyolysis freezes the fibroids.
With laparoscopic radiofrequency ablation (Acessa), also called Lap-RFA, your doctor makes two small incisions in the abdomen to insert a slim viewing instrument (laparoscope) with a camera at the tip. Using the laparoscopic camera and a laparoscopic ultrasound tool, your doctor locates fibroids to be treated.
After locating a fibroid, your doctor uses a specialized device to deploy several small needles into the fibroid. The needles heat up the fibroid tissue, destroying it. The destroyed fibroid immediately changes consistency, for instance from being hard like a golf ball to being soft like a marshmallow. During the next three to 12 months, the fibroid continues to shrink, improving symptoms.
Because there’s no cutting of uterine tissue, doctors consider Lap-RFA a less invasive alternative to hysterectomy and myomectomy. Most women who have the procedure get back to regular activities after 5 to 7 days of recovery.
The transcervical — or through the cervix — approach to radiofrequency ablation (Sonata) also uses ultrasound guidance to locate fibroids.
LAPAROSCOPIC OR ROBOTIC MYOMECTOMY
In a myomectomy, your surgeon removes the fibroids, leaving the uterus in place.
If the fibroids are few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Larger fibroids can be removed through smaller incisions by breaking them into pieces (morcellation), which can be done inside a surgical bag, or by extending one incision to remove the fibroids. Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Robotic myomectomy gives your surgeon a magnified, 3D view of your uterus, offering more precision, flexibility and dexterity than is possible using some other techniques.
HYSTEROSCOPIC MYOMECTOMY
This procedure may be an option if the fibroids are contained inside the uterus (submucosal). Your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus.
Endometrial ablation. This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Typically, endometrial ablation is effective in stopping abnormal bleeding. Submucosal fibroids can be removed at the time of hysteroscopy for endometrial ablation, but this doesn’t affect fibroids outside the interior lining of the uterus. Women aren’t likely to get pregnant following endometrial ablation, but birth control is needed to prevent a pregnancy from developing in a fallopian tube (ectopic pregnancy).
With any procedure that doesn’t remove the uterus, there’s a risk that new fibroids could grow and cause symptoms.
TRADITIONAL SURGICAL PROCEDURES
Options for traditional surgical procedures include:
Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids. Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead. However, scarring after surgery can affect future fertility.
Hysterectomy. This surgery removes the uterus. It remains the only proven permanent solution for uterine fibroids. Hysterectomy ends your ability to bear children. If you also elect to have your ovaries removed, the surgery brings on menopause and the question of whether you’ll take hormone replacement therapy. Most women with uterine fibroids may be able to choose to keep their ovaries.
RISK OF DEVELOPING NEW FIBROIDS
For all procedures except hysterectomy, seedlings — tiny tumours that your doctor doesn’t detect during surgery — could eventually grow and cause symptoms that warrant treatment. This is often termed the recurrence rate. New fibroids, which may or may not require treatment, also can develop.
Also, some procedures — such as laparoscopic or robotic myomectomy, radiofrequency ablation, or MRI-guided focused ultrasound surgery (FUS) — may only treat some of the fibroids present at the time of treatment.
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