Uterine Fibroids
The uterus, or the womb, is a pear-shaped organ in your pelvis.
It is a dynamic organ and an essential part of the female reproductive system. Its key functions include:
- Preparing a lining each month for potential pregnancy
- Shedding the lining if fertilization doesn’t occur during menstruation
- Providing a nourishing environment for the fetus to grow and supporting the placenta
- Contracting to help deliver the baby during labor
The uterus has three layers:
- The inner lining, or endometrium, which thickens during the menstrual cycle and sheds during your period.
- The muscular middle layer called the myometrium. It helps push the baby out during childbirth.
- The outer layer, or perimetrium, which protects and supports the uterus.
What are Uterine Fibroids?
Uterine fibroids are non-cancerous growths in or around the uterus, often in the myometrium. Depending on their cell origin, they are medically known as leiomyomas or myomas.
These growths can vary greatly in size. Some are as small as a seed, while others can grow large enough to distort the shape of the uterus. They can grow singularly or in clusters.
Fibroids are made up of muscle and connective tissue. They are typically benign, meaning they are not cancerous and don’t spread to other parts of the body.
Who Gets Uterine Fibroids?
Fibroids can affect anyone with a uterus, but certain factors make them more likely:
- Age. Fibroids are most common in women aged 30-50.
- Family history. If your mother or sister had fibroids, your risk is higher.
- Not having children.
- Ethnicity. African American women are more likely to develop fibroids and often experience more severe symptoms.
- Late onset of menopause.
- Estrogen and progesterone. Hormones that regulate the menstrual cycle promote fibroid growth.
- Lifestyle. Factors like obesity and diet can increase your risk.
Where Do Fibroids Develop?
Fibroids can grow in different parts of the uterus. Their location often determines the symptoms you may experience.
- Intramural fibroids develop within the muscular wall of the uterus. They are the most common type and can cause heavy menstrual bleeding, pelvic pain, and an enlarged uterus.
- Submucosal fibroids grow just beneath the inner lining of the uterus, or endometrium, and protrude into the uterine cavity. Even small submucosal fibroids can cause heavy or prolonged menstrual bleeding and may lead to fertility issues by distorting the uterine cavity.
- Subserosal fibroids form on the outer surface of the uterus. They can project outward and press on surrounding organs, such as the bladder or rectum, leading to urinary symptoms or constipation.
- Pedunculated fibroids attach to the uterus by a stalk, either inside the uterine cavity or on the outer surface. If a pedunculated fibroid twists on its stalk, it can cause severe pain due to reduced blood flow.
Symptoms of Uterine Fibroids
Some women with fibroids have no symptoms; however, others may experience:
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Frequent urination or difficulty emptying the bladder
- Constipation
- Back or leg pain
- Pain during sex
Uterine Fibroids Diagnosis
Diagnosing uterine fibroids begins with a physical exam and a discussion about your symptoms. Your doctor may recommend additional tests, such as:
- A non-invasive, ultrasound imaging test to confirm the presence and size of fibroids.
- MRI or CT for a detailed view of fibroid location and structure.
- Hysteroscopy. A small camera is inserted into the uterus to look for submucosal fibroids.
- Laparoscopy. A small incision is made in your lower abdomen to insert a thin, flexible tube with a camera. It is used to examine your internal organs visually.
- Laboratory blood tests to check for anemia if heavy periods are a concern.
Why Do Fibroids Develop?
The exact cause of fibroids isn’t fully understood, but they’re linked to genetic, hormonal, and environmental factors.
Estrogen and progesterone appear to play a significant role. Fibroids often develop during reproductive years when hormone levels are higher. They tend to shrink after menopause due to decreased hormone production.
Uterine Fibroid Treatment
Treatment for fibroids is based on several things, including your:
- Symptoms
- Age
- Reproductive goals
You may not need immediate treatment if your fibroids aren’t causing symptoms. If you do, options include:
Medications
- Over-the-counter pain relievers like acetaminophen and ibuprofen help manage discomfort.
- Iron supplements if anemia occurs due to heavy bleeding.
- Birth control to reduce heavy bleeding and menstrual cramps.
- GnRH agonists to temporarily shrink fibroids.
- Elagolix to manage heavy bleeding for up to 24 months in premenopausal women.
- Tranexamic acid to treat heavy menstrual bleeding.
Surgery
The choice of fibroid surgery depends on factors like the size, location, and number of fibroids. Different procedures are done depending on whether or not you want to preserve your ability to have children.
Options for preserving fertility
A myomectomy removes fibroids while keeping the uterus intact. Types include:
- Hysteroscopy, where fibroids are removed via a scope inserted through the vagina and cervix.
- Laparoscopy, a minimally invasive approach using small abdominal incisions.
- Laparotomy, a single, larger surgical incision, is made in the abdomen.
Options that prevent pregnancy
- A hysterectomy removes the uterus entirely, providing a cure for fibroids.
- Uterine fibroid embolization (UFE). This procedure eliminates blood supply to fibroids, causing them to shrink.
- Radiofrequency ablation (RFA). RFA uses microwave energy to treat smaller fibroids if you haven’t reached menopause.
Uterine Fibroids FAQs
1. Can fibroids affect fertility?
Yes, fibroids, especially submucosal ones, can interfere with the implantation or growth of a fertilized egg. However, many women with fibroids can conceive and carry a pregnancy to term.
2. Do fibroids always cause symptoms?
No. In fact, many women with fibroids experience no symptoms and only learn about them during routine check-ups or imaging for unrelated issues. Symptoms often depend on the size, number, and location of the fibroids.
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