Uterine fibroids, also known as leiomyomas or simply myomas, are the most common benign tumors of muscle cells (fibrous tissues) of the uterus of the female genital tract. These are non-cancerous that never develop into cancer and often appear in women of childbearing age. It rarely occurs under the age of 20. Approximately 50-80% of women develop fibroids in their life.
Uterine fibroid does not cause any symptoms until it grows enough to enlarge the uterus, so many women of their childbearing age might not know about their presence in the uterus. It is mostly diagnosed or discovered during an antenatal ultrasound or any pelvic examinations by the doctor.
Fibroids can grow as a single mass or in clusters and vary in size and number present inside and outside the uterus.
The exact cause for its development is not known, but some of the factors that might cause them are-
- Hormones such as estrogen, progesterone, and possibly human placental lactogen are involved in the growth of fibroids.
- It mostly develops in women between 25-50 years of age.
- It regresses after menopause due to a decrease in hormone production.
- Genetic factors and hereditary(mother and sister had fibroids) may increase the risk of developing them.
- Most common in black women than in other racial groups, women with cystic disorders, obese and infertile women.
Types of Uterine Fibroids
Fibroids are classified depending upon the location. The majority of the fibroids develop in the uterus, but they may also arise from the round ligaments, so these tumors can be classified as uterine(in the body of the uterus) and extra uterine (outside the uterus).
- Intramural fibroids(interstitial) present in 75% and develop in the muscular wall of the uterus.
- Submucous fibroids present in 15%, arise under the surface of the uterine lining and bulge into the uterine cavity.
- Subserosal fibroids present in 10%, develop under the outside lining of the uterus and project outside.
- Pedunculated fibroids are the least common and occur outside the uterus and are connected with a long stalk.
The majority of the women with fibroids remain asymptomatic, but if there is the presence of a huge tumor, women may develop symptoms depending on the location, size, and condition of the tumor. Common symptoms of uterine fibroids are-
- Heavy menstrual bleeding during periods and periods may last longer than normal.
- Bleeding in between periods.
- Pain and cramping during menstrual periods.
- Feeling of heaviness and pressure in the lower abdomen.
- Increased frequency of urination, retention of urine, or constipation due to enlargement of the tumor, which exerts pressure on the bladder and bowel.
- Low backache.
- Pain during sexual intercourse.
- Palpable mass.
- The abdomen looks enlarged like a pregnant abdomen.
- Other symptoms include fatigue due to anaemia, palpitations, and difficulty in breathing due to a distended abdomen.
A health care provider may perform various tests to identify the size and location of fibroids. The following investigations may be carried out.
- Hemoglobin and complete blood count.
- Ultrasound- It helps to identify the size and location of the tumor by using sound waves.
- MRI uses radio waves and magnets to create images of the tumor.
- CT scan
- Hysteroscopy helps to recognize the tumor of the uterus and also allows its excision under direct vision.
- Hysterosalpingography helps to identify the mass and checks the pattern of fallopian tubes in case of infertility.
- Laparoscopy- During this procedure, a laparoscope is inserted through an incision made on the abdominal wall to detect the tumors and associated pelvic inflammatory diseases and endometriosis.
- Dilatation and curettage to rule out any endometrial cancer.
Small and asymptomatic uterine fibroids do not require removal or medical treatment but can be observed every six months. Pelvic exams and ultrasounds are performed to check the fibroid’s growth regularly.
Usually, treatment depends on the symptoms, general health of the woman, age, desire to have children, type, location, and size of the tumor. Fibroids are estrogen sensitive, so hormone suppression is required.
Iron therapy to treat anaemia caused by heavy bleeding.
Analgesics such as acetaminophen, naproxen, or ibuprofen can be used to get relief from pain and discomfort due to fibroids.
Mifepristone dose for 3 months can cause amenorrhea and shrink of the tumor.
Low dose oral contraceptive such as gestrinone were also found effective in controlling heavy bleeding. Tranexamic acid can be used during heavy menstrual bleeding.
Progestin releasing IUD can be used to relieve heavy bleeding caused by tumors.
GnRH(Gonadotropin- Releasing Hormone) Therapy
GnRH analogues are used for 6 months to reduce the tumor size by blocking the hormones(estrogen and progesterone) production.
It includes depot (3.6mg), leuprolide acetate, and triptorelin to shrink the tumor mass.
Minimal invasive procedures
In recent years, many newer minimally invasive procedures have been successfully introduced to treat uterine fibroids. It includes-
- Uterine artery embolization– In this procedure, embolic agents are introduced into the arteries that supply the uterus and fibroids; these agents block the blood flow and result in shrinkage and death of the fibroid tissue.
- MRI guided laser ablation– This treatment uses a laser to target and treats the tumors during the MRI procedure.
- Laparoscopic myolysis- This method is also very effective in shrinking the tumor. It uses laser, cryoprobe, or diathermy to coagulate the fibroid and is used most commonly in multiparous women.
- Myomectomy– It refers to the removal of fibroid leaving the uterus behind and may be chosen to preserve fertility. It can be done surgically through an abdominal or vaginal incision or with a laser and indicated in infertile women or those who desire to have children.
- Hysterectomy is a surgical procedure to remove the uterus and indicated in large and numerous tumors. It can be done through the abdomen or vagina. Women who do not want children or medical treatment is not effective can go for it.
Fibroid and pregnancy
A woman can get pregnant with fibroid associated with intense risk. During pregnancy, the body releases a high level of hormones which cause an increase in the size of the tumor and put pressure on the fetus. In such cases, watchful waiting is done, and the case is required to be monitored by the health care provider. There is an increased risk of pre-term delivery or cesarean section delivery. Some fibroids can shrink after the delivery of the baby.
In some cases, fibroids can cause infertility. If a woman gets treatment for fibroids, then she can conceive pregnancy and can have a baby.
In the above post, we discussed uterine fibroids, their causes, types, symptoms, diagnosis, and various treatment modalities.