Uterine Fibroids

Overview

Uterine fibroids are noncancerous growths that develop in the uterus, typically during childbearing years. They are also known as leiomyomas or myomas. These growths are not associated with an increased risk of uterine cancer and rarely turn into cancer. Fibroids can vary in size, from small, undetectable seedlings to large masses that can significantly enlarge the uterus. They can occur singly or in multiple numbers. Hormones such as estrogen and progesterone are thought to promote their growth, and they tend to shrink after menopause due to a decrease in hormone production. Many women have uterine fibroids at some point in their lives, but they often cause no symptoms. Symptoms can include heavy menstrual bleeding, prolonged periods, pelvic pain, and backache or leg pain, among others. If you experience severe vaginal bleeding or sudden sharp pelvic pain, seek prompt medical care.

Understanding the disease

Symptoms

The symptoms of uterine fibroids may include heavy menstrual bleeding, menstrual periods lasting more than a week, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, constipation, backache or leg pains. Some rare cases may also experience acute pain if a fibroid outgrows its blood supply and begins to die. It's important to see a doctor if you experience pelvic pain that doesn't go away, overly heavy, prolonged, or painful periods, spotting or bleeding between periods, difficulty emptying your bladder, or unexplained low red blood cell count (anemia).

Risk Factors

Risk factors for developing uterine fibroids include being a woman of reproductive age, having a family history of fibroids (if your mother or sister had fibroids), starting your period at an early age, being obese, having a diet higher in red meat and lower in green vegetables, fruit, and dairy, and drinking alcohol. Black women are more likely to develop fibroids than women of other racial groups and are also more likely to have more or larger fibroids with more severe symptoms.

Development

Uterine fibroids develop from a single cell in the smooth muscular tissue of the uterus (myometrium) that repeatedly divides, eventually forming a firm, rubbery mass distinct from nearby tissue. This process can occur due to genetic changes and hormonal influences. Fibroids contain more estrogen and progesterone receptors than typical uterine muscle cells, and these hormones promote their growth. Additionally, substances that help maintain tissues, such as insulin-like growth factor, may affect fibroid growth. The extracellular matrix (ECM) in fibroids is increased, making them fibrous and storing growth factors that cause biologic changes in cells.

Assessment and Diagnosis

Triage

You should see a doctor if you have symptoms such as pelvic pain that doesn't go away, overly heavy, prolonged, or painful periods, spotting or bleeding between periods, difficulty emptying your bladder, or unexplained low red blood cell count (anemia). Additionally, seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

Diagnosis

To diagnose uterine fibroids, your doctor may start with a routine pelvic exam where they feel the shape of your uterus to check for irregularities. If you have symptoms, your doctor may order additional tests such as an ultrasound, which uses sound waves to create images of your uterus to confirm the diagnosis and map the fibroids. In some cases, other tests like hysterosalpingography, hysteroscopy, or MRI may be recommended for a more detailed evaluation. It's essential to discuss your symptoms with your doctor and ask questions about your diagnosis to ensure you understand the next steps in your treatment plan.

Management and Treatment

Complications

Potential complications of uterine fibroids include:

1. Anemia: Heavy menstrual bleeding caused by fibroids can lead to a decrease in red blood cells (anemia), resulting in fatigue and weakness.
2. Infertility: Although rare, submucosal fibroids may interfere with implantation of the fertilized egg, leading to infertility or pregnancy loss.
3. Pregnancy complications: Fibroids can increase the risk of placental abruption, fetal growth restriction, and preterm delivery.
4. Difficulty emptying the bladder or constipation: Large fibroids can press against the bladder or rectum, causing difficulty in emptying the bladder or constipation.
5. Acute pain: In extreme cases, a fibroid that has outgrown its blood supply may cause acute pain as it begins to die. Remember that not all women with fibroids experience complications, and many fibroids do not cause any symptoms. If you experience any concerning symptoms, consult your doctor for evaluation and advice.

Prevention

While there is no scientific evidence on how to prevent uterine fibroids, making healthy lifestyle choices may help decrease your risk. Maintaining a healthy weight, eating fruits and vegetables, and using hormonal contraceptives, which may be associated with a lower risk of fibroids, are potential ways to potentially lower your risk. However, it is important to note that preventing uterine fibroids may not be possible, and most tumors do not require treatment.

Home Remedies

It is important to consult with a healthcare professional for proper diagnosis and treatment of uterine fibroids.

Treatment

Treatments for uterine fibroids depend on the severity of symptoms and the desire to preserve fertility. Some treatment options include:

1. Watchful waiting: If fibroids are small and not causing significant symptoms, your doctor may recommend monitoring them with periodic checkups. This approach is often preferred if you are nearing menopause or if you wish to preserve your fertility.
2. Medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help relieve fibroid-related pain. Hormonal medications, like birth control pills, can also help manage symptoms by decreasing hormone levels. In certain cases, progestin-releasing intrauterine devices (IUDs) may be recommended to shrink fibroids.
3. Fibroid embolization: A minimally invasive procedure that cuts off the blood supply to fibroids, causing them to shrink and die. This treatment is typically recommended for women who wish to preserve their fertility or who have severe symptoms but don't want to undergo a hysterectomy.
4. Myomectomy: A surgical procedure to remove fibroids while leaving the uterus intact. This option is typically recommended for women who wish to preserve their fertility or who have severe symptoms and don't want to take hormonal medications.
5. Hysterectomy: A surgical procedure to remove the uterus. This is the most effective way to eliminate fibroids, but it results in infertility and carries a risk of complications. Hysterectomy is usually considered when other treatments are ineffective or when fibroids are causing severe, life-altering symptoms. It's important to discuss your options with your healthcare provider to determine the most appropriate treatment for your individual case.

Preparing for medical consultation

To prepare for an appointment for uterine fibroids, make a list of your symptoms, including all of them, even if you don't think they're related. List any medications, herbs, and vitamin supplements you take, including doses and how often you take them. Bring a family member or close friend with you, as well as a notebook or electronic device to take notes. Prepare a list of questions to ask your doctor, such as the number and size of fibroids, their location, the tests you may need, available medications, potential side effects, and when surgery might be recommended. Make sure you understand everything your doctor tells you, and don't hesitate to ask follow-up questions or have them repeat information.