What are Uterine Fibroids?

Uterine fibroids are benign growths of the uterus that can happen during the childbearing years. They are not associated with higher risk of uterine cancers. They are also called leiomyomas or myomas. Fibroids range in size from small seedings up to bulky masses.

Causes:

The exact cause of fibroids is unknown, however there are factors that are associated with fibroids such as:

Genetic changes causing abnormal uterine tissue

Hormonal changes that cause the uterus to be more sensitive to the effects of Estrogen and Progesterone and cause increased growth of fibroids

Imbalance of growth factors effect on the uterus such as insulin-like growth factor causing fibroids

Abnormal extracellular matrix of the uterus, which is the material that causes the uterine cells to stick together, when damaged it can cause fibroids

Certain people can have factors that increase their risk of developing fibroids such as: African American females tend to have more fibroids at a younger age. Also family history can be strongly associated with developing fibroids.

Symptoms:

He symptoms of fibroids can be variable depending on the location and the size of the fibroid. The most common signs and symptoms include:

Heavy menstrual bleedingMenstrual bleeding that can last more than 7 daysPain and pressure in the pelvisDifficulty emptying the bladderConstipationBack pain and legs pain

It is important to note that fibroids don’t interfere with getting pregnant, however it is possible that fibroids can cause pregnancy loss or infertility, depending on the location.

Diagnosis:

Uterine fibroids can sometimes be found incidentally during a routine pelvic exam, your doctor may find irregularities in the size and shape of your uterus. The doctor may order additional tests to confirm the diagnosis such as:

Ultrasound: which helps to get a picture of the size and the shape of the uterus, and also helps in measuring the sizes of the lesions

Laboratory tests can also be ordered to determine if you have anemia, or investigate for other bleeding disorders

If the initial ultrasound does not provide enough information, then the doctor may order an MRI which is more sensitive than ultrasound

Another test that can be ordered is “Hysterosonography” which uses sterile saline water to inflate the uterus to expand it and get better images of the uterus

Another test which may be ordered is “Hystosalpingography” which uses a dye to highlight the uterus and fallopian tubes on X-ray images.

Also, the doctor may order a “Hysteroscopy” which is done through inserting a small lighted scope into the uterus to examine the walls of the uterus and also the fallopian tubes.

Treatment:

Many treatment options exist for managing uterine fibroids, your doctor will decide the best treatment plan based on your presentation. The treatment options include:

Watchful waiting is usually done in women who demonstrate no signs or symptoms of fibroids, with periodic follow up to assess for the progression of fibroids

If you have symptoms, your doctor may recommend some medications that target hormones to regulate your menstrual cycle, these hormones include:

Gonadotropin-releasing hormone agonists: these medications block the production of estrogen and progesterone, putting the body in a menopause-like state which causes the fibroids to shrink and improve; some women may have hot flashes while using these medications.

Progestin-releasing intrauterine device, which can relieve heavy bleeding caused by fibroids, this only relieves the symptoms but it does not shrink the size of fibroids

There is also Tranexamic acid, which is a non-hormonal medication taked on heavy bleeding days to relieve the bleeding

There is also a non-invasive procedure to treat fibroids which is performed while you are inside an MRI machine equipped with high-energy ultrasound probe to destroy the fibroid tissue.

Also minimally invasive surgery options can be used to destroy or remove the fibroids, such as: uterine artery embolization, radiofrequency ablation, laparoscopic or robotic removal of the fibroids or even endometrial tissue ablation

 There are also traditional surgical treatment options which are saved for more advanced cases, such as hysterectomy which means removal of the uterus especially if no future pregnancy is planned

Prevention:

Fibroids may occur again with all treatment options (except hysterectomy), your doctor will have a full discussion with you regarding your future pregnancy plans and the risks associated with it.  There is no effective way to prevent occurrence of recurrence of fibroids, however routine monitoring after treatment is advised to allow for early detection and treatment.