Fibroids

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Uterine fibroids, also known as uterine leiomyoma or fibroids, are benign smooth muscle tumors of the uterus. Most women have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bladder causing a frequent need to urinate. They may also cause pain during sex or lower back pain. A woman can have one uterine fibroid or many. Occasionally, fibroids may make it difficult to become pregnant, although this is uncommon.

Causes

It remains unclear exactly what causes fibroids. However, below are possible causes:

  • May be related to estrogen levels. During the reproductive years, estrogen and progesterone levels are higher. When estrogen levels are high, especially during pregnancy, fibroids tend to swell. They are also more likely to develop when a woman is taking birth control pills that contain estrogen. Low estrogen levels can cause fibroids may shrink, such during and after menopause.

  • Genetic factors are thought to impact the development of fibroids. Having a close relative with fibroids increases the chance of developing them.

  • There is also evidence that red meat, alcohol, and caffeine could increase the risk of fibroids, and that an increased intake of fruit and vegetables might reduce it.

  • Being overweight or obese increases the risk of fibroids.

Symptoms​

The majority of the women could be asymptomatic to the fibroids, however 1 in 3 women with fibroids experience following symptoms:

These may include:

  • heavy, painful periods, also known as menorrhagia

  • anemia from heavy periods

  • lower backache or leg pain

  • constipation

  • discomfort in the lower abdomen, especially in the case of large fibroids

  • frequent urination

  • pain during intercourse, known as dyspareunia

Other possible symptoms include:​

  • labor problems

  • pregnancy problems

  • fertility problems

  • repeated miscarriages

Diagnosis

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such as MRI scan and CT scan may also be employed. 

Treatment

Treatment is only recommended for those women experiencing symptoms as a result of fibroids. If the fibroids are not affecting quality of life, treatment may not be necessary. Fibroids can lead to heavy periods, but if these do not cause major problems, one may choose not to have treatment.

During menopause, fibroids often shrink, and symptoms often become less apparent or even resolve completely. When treatment is necessary, it can take the form of medication or surgery. The location of the fibroids, the severity of symptoms, and any future childbearing plans can all affect the decision. 

Medication

The first line of treatment for fibroids is medication.Severe fibroids may not respond to more conservative treatment options, and surgery may be necessary.​

Your doctor may consider the following procedures:

  • Hysterectomy: A hysterectomy is the partial or total removal of the womb. This is considered for treating extremely large fibroids or excessive bleeding. A total hysterectomy can prevent the return of fibroids. If a surgeon also removes the ovaries and fallopian tubes, side effects can include reduced libido and early menopause.

  • Myomectomy: This is the removal of fibroids from the muscular wall of the womb. It can help women who still want to have children. Women with large fibroids, or fibroids located in particular parts of the womb, may not benefit from this surgery.

  • Endometrial ablation: Removing the lining inside of the womb may help if fibroids are near the inner surface of the womb. Endometrial ablation may be an effective alternative to a hysterectomy for some women with fibroids.

  • Uterine artery embolization (UAE), more specifically uterine fibroid embolization (UFE): Cutting off the blood supply to the area shrinks the fibroid. Guided by fluoroscopic X-ray imaging, a chemical is injected through a catheter into the arteries supplying blood to any fibroids. This procedure reduces or removes symptoms in up to 90 percent of people with fibroids but is not suitable for women who are pregnant and typically not for those who still wish to have children.

  • MRI-guided percutaneous laser ablation: An MRI scan is used to locate the fibroids. Fine needles are then inserted through the skin and body tissues of the patient and pushed until they reach the targeted fibroids. A laser fiber device is inserted through the needles. A laser light is sent through the device to shrink the fibroids.

  • MRI-guided focused ultrasound surgery: An MRI scan locates the fibroids, and high energy ultrasound waves are delivered to shrink them.