What Are Uterine Fibroids?

Uterine fibroids, medically referred to as leiomyomas, are non-malignant tumors consisting of muscle and connective tissue that form on or within the walls of the uterus. These growths are the most frequently occurring benign tumors in women. Although many fibroids do not cause any symptoms, some can lead to discomfort, pain, and heavy or irregular menstrual bleeding. The approach to treating fibroids depends on the specific symptoms experienced.

Where do fibroids grow?

Fibroids, also known as uterine leiomyomas or myomas, can grow in different locations within or on the uterus. They can vary greatly in size, from as small as a seed to as large as a watermelon. The main locations where fibroids can develop are:

1. Intramural Fibroids: These grow within the muscular wall of the uterus and are the most common type.

2. Submucosal Fibroids: These develop just underneath the lining of the uterine cavity. They can protrude into the uterine cavity and are less common but can cause severe symptoms.

3. Subserosal Fibroids: These grow on the outer surface of the uterus, projecting outward. They can sometimes become very large and press against other organs.

4. Pedunculated Fibroids: These are attached to the uterus by a thin stalk and can develop either inside the uterine cavity (pedunculated submucosal fibroid) or outside the uterus (pedunculated subserosal fibroid).

Fibroids can grow as a single growth or in clusters, and their size can range from very small (1 millimeter) to very large (over 20 centimeters in diameter).

Are fibroids common?

Yes, fibroids are quite common. Approximately 40% to 80% of people with a uterus will develop fibroids at some point in their lives. These non-cancerous growths occur most frequently in people aged 30 to 50. Typically, individuals who haven't had their first period (menarche) do not have fibroids, and the occurrence of fibroids tends to decrease in people who have entered menopause.

Symptoms and Causes

Symptoms of Fibroids

Fibroids, also known as uterine leiomyomas, can cause a range of symptoms depending on their size, location, and number. While small fibroids may remain asymptomatic, larger ones can lead to various issues, including:

1. Menstrual Changes:
   • Excessive or painful bleeding during periods
   • Bleeding between periods
2. Pelvic Symptoms:
   • Pelvic pain
   • A feeling of fullness or bloating in the lower abdomen
3. Urinary Symptoms:
   • Frequent urination (due to pressure on the bladder)
   • Inability to completely empty the bladder
4. Gastrointestinal Symptoms:
   • Constipation
   • Feeling pressure on the rectum
5. Sexual Symptoms:
   • Pain during sex
6. Other Symptoms:
   • Low back pain
   • Chronic vaginal discharge
   • Increased abdominal distention, making the abdomen appear pregnant

Causes of Fibroids

The exact cause of fibroids is not well understood, but several factors are believed to play a role:

• Hormonal Changes: Estrogen and progesterone, hormones that regulate the menstrual cycle, are thought to promote the growth of fibroids. These hormones can cause fibroids to grow, and their levels fluctuate during the menstrual cycle, pregnancy, and menopause.
• Genetic Factors: A family history of fibroids can increase the likelihood of developing them, suggesting a genetic component.
• Growth Factors: Substances in the body that help maintain tissues, such as insulin-like growth factor, may also affect fibroid growth.
• Extracellular Matrix (ECM): ECM is the material that makes cells stick together. Fibroids have more ECM than normal uterine muscle cells, making them fibrous and contributing to their growth.

Post-Menopause

The symptoms of uterine fibroids often stabilize or diminish after menopause because the body's hormone levels, particularly estrogen and progesterone, decrease significantly.

What does uterine fibroid pain feel like?

Uterine fibroid pain can manifest in various ways, depending on the size, number, and location of the fibroids. Here's a detailed look at the types of pain and discomfort that can occur:

1. Asymptomatic:
   • Small fibroids often cause no symptoms, and many people may not even realize they have them.
2. Abdominal Pain:
   • Larger fibroids can cause significant discomfort in the lower abdomen.
   • Pain may be described as a constant, dull ache or intermittent, stabbing pains.
3. Back Pain:
   • Some individuals experience lower back pain due to the pressure fibroids exert on surrounding organs and nerves.
4. Pain During Sex (Dyspareunia):
   • Fibroids located near the cervix or in certain positions can cause pain during intercourse.
5. Pelvic Pressure and Pain:
   • A sensation of heaviness or pressure in the pelvic area is common.
   • This pressure can also lead to bloating and an increase in the need to urinate if the fibroid presses on the bladder.
6. Menstrual Pain:
   • Heavier and more painful periods are common, leading to severe cramping and discomfort.
7. Leg Pain:
   • In some cases, fibroids can press on nerves leading to the legs, causing pain or a feeling of numbness and weakness in the legs.

The intensity and nature of the pain can vary widely from person to person. If you experience significant pain or other symptoms, it's important to consult with a healthcare provider for an accurate diagnosis and appropriate management.

What do fibroids look like?

Fibroids are indeed characterized by their rounded shape and can vary in size from as small as a pea to as large as a grapefruit. They are usually firm, smooth to the touch, and can sometimes have a whitish or pinkish coloration. Their appearance can resemble that of a small ball or lump embedded in the uterine wall.

What causes uterine fibroids?

The specific cause of uterine fibroids remains unclear, although medical experts suggest that hormones such as estrogen and progesterone are significant factors. These growths commonly occur in individuals of reproductive age. Research indicates that fibroids tend to enlarge in response to elevated hormone levels, such as during pregnancy, and may decrease in size when hormone levels decline, such as during menopausal transition.

Risk Factors

Risk Factors Numerous factors can heighten the likelihood of developing fibroids, such as:

• Being overweight
• Having a family history of fibroids
• Starting menstruation at an early age
• Never having been pregnant Fibroids tend to affect women most frequently between the ages of 30 and 50.

Can fibroids cause anemia?

Fibroids have the potential to induce anemia. Anemia arises when the body lacks sufficient healthy red blood cells to transport oxygen to organs. This condition can affect individuals who experience frequent or excessively heavy menstrual periods. Fibroids often contribute to increased menstrual bleeding or intermittent bleeding episodes. If you notice symptoms of anemia alongside fibroids, it's advisable to consult your healthcare provider promptly.

Complications

Although the majority of fibroids do not result in severe complications, they can give rise to significant problems such as pain, excessive bleeding, and, in rare instances, infertility. Additionally, they may contribute to anemia owing to the heavy flow during menstruation.

Diagnosis and Treatment

At Infinity Health Care in Balagere, Bangalore, our Gynecology Department provides comprehensive diagnostic services for uterine fibroids. Typically, healthcare providers detect uterine fibroids during routine pelvic exams, especially when patients present with symptoms such as heavy bleeding. To confirm the presence, size, and location of fibroids, several diagnostic tests are available:

1. Ultrasonography: This noninvasive procedure uses sound waves to generate images of internal organs.
2. Magnetic resonance imaging (MRI): Detailed images of internal organs are produced using magnets and radio waves.
3. Computed tomography (CT) scan: X-ray images from various angles create detailed internal organ images.
4. Hysteroscopy: A thin, flexible tube with a camera examines fibroids inside the uterus after insertion through the vagina and cervix.
5. Hysterosalpingography (HSG): Contrast material is injected for detailed X-rays of the uterus.
6. Sonohysterography: Saline injection enhances ultrasound images of the uterus for clearer visualization.
7. Laparoscopy: A minimally invasive procedure where a camera-equipped tube is inserted through a small abdominal incision to examine internal organs closely.

Management and Treatment

How are uterine fibroids treated?

Treatment options for uterine fibroids can vary based on factors such as the size, number, and location of the fibroids, as well as the symptoms they cause. If you do not experience symptoms, treatment may not be necessary, and small fibroids can often be monitored without intervention. Some individuals with fibroids may never develop symptoms or encounter complications. In such cases, healthcare providers might suggest regular monitoring through pelvic exams or ultrasounds.

However, if you do experience symptoms like anemia due to heavy bleeding, significant pain, or issues with urinary or bowel function, treatment becomes necessary. The approach to treatment will be tailored based on several factors:

• Number of fibroids present
• Size of the fibroids
• Location of the fibroids
• Specific symptoms associated with the fibroids
• Your preference regarding the preservation of your uterus

The best treatment option for you will also depend on your plans for pregnancy in the future. Talk to your healthcare provider about your fertility goals when discussing treatment options. Treatment options for uterine fibroids can include:

Medications

1. Non-prescription pain relievers: These medications are effective for alleviating the pain and discomfort associated with fibroids. Common over-the-counter options include acetaminophen and ibuprofen.
2. Iron supplements: If you develop anemia due to excessive bleeding, your healthcare provider might recommend iron supplements to address this issue.
3. Hormonal contraceptives: Birth control methods can help manage fibroid symptoms such as heavy bleeding and menstrual cramps. Options include oral contraceptive pills, rings, injections, and intrauterine devices (IUDs).
4. Gonadotropin-releasing hormone (GnRH) agonists: These medications are used to shrink fibroids, often before surgical removal to facilitate the procedure. However, their effects are temporary, and fibroids may regrow after treatment cessation.
5. Oral treatments: Elagolix is a newly developed oral therapy designed to manage heavy uterine bleeding in premenopausal individuals with symptomatic fibroids, suitable for use up to 24 months. Another option, tranexamic acid, targets heavy menstrual bleeding in those with uterine fibroids.

It's crucial to discuss any medications with your healthcare provider. Always seek their advice before starting a new medication to understand potential risks and benefits.

Fibroid surgery

When discussing the various surgical options for removing fibroids, several factors come into play. These include the size, location, and number of fibroids, as well as your future pregnancy desires, which are crucial in devising a treatment plan. Certain surgical approaches aim to preserve fertility, while others may involve the removal or potential damage to the uterus. Myomectomy is a procedure designed to remove fibroids, with several types available depending on individual circumstances. These types include:

1. Hysteroscopy: This involves the insertion of a scope through the vagina and cervix into the uterus, allowing the surgeon to remove fibroids.
2. Laparoscopy: Unlike hysteroscopy, this procedure requires a few small abdominal incisions through which a scope is inserted to remove fibroids.
3. Laparotomy: In this procedure, a single larger abdominal incision is made through which fibroids are removed.

Each type of myomectomy is chosen based on factors such as fibroid location, size, and number, tailored to meet the patient's specific medical needs and fertility considerations. If you're not considering future pregnancies, your healthcare provider may suggest additional treatment options that can effectively manage uterine fibroids without preserving fertility:

1. Hysterectomy: This surgical procedure involves the removal of the uterus, which is the only definitive cure for fibroids. By completely removing the uterus, fibroids are permanently eliminated, alleviating associated symptoms. Depending on your condition, options such as vaginal, laparoscopic, or robotic-assisted hysterectomy may be considered to minimize recovery time and complications.
2. Uterine Fibroid Embolization (UFE): Conducted by an interventional radiologist in collaboration with a gynecologist, UFE involves inserting a small catheter into the uterine artery to inject particles that obstruct blood flow to the fibroids. Without a steady blood supply, fibroids shrink, leading to symptom improvement. However, this procedure may not be suitable for everyone.
3. Radiofrequency Ablation (RFA): Utilizing microwave energy, RFA effectively treats smaller uterine fibroids and is recommended for individuals who have not yet entered menopause. This non-surgical technique offers a safe alternative for symptom management.

Each of these options provides distinct benefits and considerations based on individual health needs and preferences. Consulting with your healthcare provider can help determine the most appropriate treatment plan for you.

Risks to uterine fibroid treatment

All treatments carry potential risks. Medications can cause side effects, and not all may be suitable for every individual. It's crucial to disclose all current medications and your complete medical history to your healthcare provider before starting any new treatment. If you encounter side effects from a new medication, promptly contact your provider to explore alternative options.

Surgical interventions for fibroids also pose risks. Any surgical procedure carries risks of infection, bleeding, and complications related to anesthesia. Specifically, procedures to remove fibroids may impact future pregnancies, as some options could affect fertility. A myomectomy, which selectively removes fibroids while preserving the uterus, allows for potential future pregnancies but may necessitate delivery via cesarean section in subsequent pregnancies.

How large do uterine fibroids need to be before being surgically removed?

There is no specific size threshold for fibroids that automatically mandates their removal. The decision to undergo surgery depends on individual symptoms and their impact on your health. For instance, even small fibroids can cause significant bleeding depending on where they are located. Your healthcare provider will assess your symptoms and discuss whether surgical intervention is necessary.

What happens if fibroids go untreated?

If you don’t have symptoms, treatment for fibroids may not be necessary. If you have large fibroids or your symptoms are causing you pain and discomfort, getting treatment may be the best option. Only you and your provider can decide the best course of treatment or if treatment is necessary.

Prevention

Can fibroids be prevented?

Fibroids generally cannot be completely prevented. However, you can lower your risk by maintaining a healthy weight and scheduling regular pelvic exams. If small fibroids are detected, working closely with your healthcare provider to establish a monitoring plan is advisable.

Outlook / Prognosis

Can I get pregnant if I have uterine fibroids?

Yes, it is possible to conceive if you have uterine fibroids. If you are aware of your fibroids prior to becoming pregnant, your healthcare provider will collaborate with you to establish a monitoring strategy for them. During pregnancy, your body experiences heightened hormone levels that support the pregnancy but may also contribute to fibroid growth. Larger fibroids can pose several challenges during pregnancy, including:

• Increased likelihood of requiring a C-section due to the fetus being unable to assume a head-down position.
• Slower progression of labor.
• Risk of placental abruption.
• Higher chance of preterm delivery.

Can fibroids change over time?

Fibroids have the ability to fluctuate in size over time, either increasing or decreasing gradually. These changes are typically influenced by hormonal fluctuations within the body. Elevated hormone levels, such as during pregnancy, can cause fibroids to enlarge. Conversely, a decrease in hormone levels, particularly after menopause, often leads to shrinkage of fibroids. It's common for symptoms associated with fibroids to improve following menopause as well.

Will fibroids go away on their own?

Fibroids have the potential to decrease in size post-menopause due to reduced hormone levels. This natural shrinkage can alleviate associated symptoms. If small fibroids are asymptomatic, they may not require any treatment.

Do fibroids make you tired?

Feeling tired isn’t a common symptom of uterine fibroids. However, it’s a common symptom of anemia, which can occur when you lose too much blood. Talk to a healthcare provider if you feel excessively tired so they can determine the cause.

Do fibroids make your stomach big?

Yes, it’s possible that large uterine fibroids can cause your stomach to bloat or appear larger.

Living With

When should I contact my healthcare provider?

Contact your healthcare provider if you have symptoms of uterine fibroids, such as:

• Heavy and irregular vaginal bleeding.
• Bleeding between periods.
• Pelvic pain.
• Pain during sex.
• A feeling of pressure or fullness in your belly.

Because these symptoms are common symptoms of other gynecological conditions, discussing them with a healthcare provider is important.

Why Choose Infinity Health Care?

Infinity Health Care is committed to female health and provides expert care for those struggling with uterine fibroids. Our team of specialists in the Gynecology Department ensures personalized and compassionate care for every patient. Regular checkups at Infinity Health Care can help monitor and manage fibroids effectively, ensuring a better quality of life.