Uterine fibroids are non-cancerous growths that develop in or on the muscular wall of the uterus. They are also known as uterine myomas or leiomyomas. Uterine fibroids are extremely common, affecting about 70-80% of women by age 50.
While fibroids are benign tumors, they can cause various symptoms, including heavy menstrual bleeding, pelvic pain and pressure, and reproductive issues. Most women with fibroids have no symptoms at all. But for some women, fibroids can severely impact their quality of life.
In this comprehensive guide, we will cover everything you need to know about uterine fibroids, including:
What are Uterine Fibroids?
Uterine fibroids are benign muscle tumors that grow in the wall of the uterus (womb). They are almost always non-cancerous. The medical term for fibroids is uterine leiomyomas.
Fibroids can grow as a single tumor or in clusters or groups. Their size can range from microscopic to several inches in diameter. Some fibroids grow within the muscular uterine wall. These are called intramural or myometrial fibroids.
Others grow on the outside of the uterus and are called sub serosal fibroids. Some fibroids attach to stalks that grow out from the surface of the uterus. These are called pedunculated fibroids or submucosal fibroids.
The growth patterns of uterine fibroids determine their symptoms:
- Intramural fibroids can distort the uterine cavity and cause heavy periods. They can also cause pain and pressure symptoms.
- Subserosal fibroids often have no symptoms but can grow very large.
- Submucosal fibroids that grow into the uterine cavity are the type that most commonly causes heavy menstrual bleeding and reproductive problems.
Uterine fibroids affect women in their 30s and 40s most often. But they can occur at any age during the reproductive years. Fibroids often shrink and disappear after menopause when estrogen levels decline.
Uterine fibroids are the most common non-cancerous tumors in women of childbearing age. Estimates vary widely, but around 70-80% of women may develop fibroids by age 50. African American women are two to three times more likely to develop fibroids than Caucasian women. Hispanic women also have an increased risk of fibroids.
Having one or more of the risk factors below increases a woman’s chance of developing uterine fibroids:
- Family history of uterine fibroids
- African-American or Hispanic ethnicity
- Early puberty (before age 10)
- High blood pressure
- Never giving birth
- Polycystic ovary syndrome (PCOS)
- Eating a lot of red meat
Types of Uterine Fibroids
There are several types of uterine fibroids classified by location. The different fibroid types have different characteristic symptoms:
Intramural fibroids grow within the muscular uterine wall. “Intra” means inside, and “mural” refers to the uterine wall. Intramural fibroids are the most common type, making up about 70% of diagnosed cases. If large enough, they can distort the shape of the uterine cavity.
Symptoms: Heavy menstrual bleeding, pelvic pain and pressure, bladder pressure, pregnancy complications
Subserosal fibroids grow on the outer uterine wall. They can become very large and sometimes press on the bladder or rectum, causing symptoms. However, subserosal fibroids often cause no symptoms at all.
Symptoms: Anemia from heavy bleeding if pedunculated, back pain, abdominal pressure
Submucosal fibroids grow just underneath the uterine lining and into the uterine cavity. Even small submucosal fibroids can lead to heavy menstrual bleeding and problems conceiving.
Symptoms: Heavy menstrual bleeding, infertility, early pregnancy loss
Pedunculated fibroids grow on small stalks projecting out from the surface of the uterus or inside the uterine cavity. They are considered subserosal or submucosal fibroid. Pedunculated fibroids can sometimes twist and cause extreme sudden pain.
Symptoms: Severe sudden pain if stalk twists, anemia from heavy bleeding
Cervical fibroids grow in the wall of the cervix or neck of the uterus. They make up less than 5% of uterine fibroids overall. Cervical fibroids may cause pain during sexual intercourse.
Symptoms: Pain during sexual intercourse, urinary tract obstruction if large
Symptoms of Uterine Fibroids
The majority of women with uterine fibroids have no bothersome symptoms at all. However, for some women, fibroid symptoms can severely degrade their quality of life. The most common fibroid symptoms include:
- Heavy menstrual bleeding – This is the #1 symptom of uterine fibroids and can lead to anemia. Heavy periods are defined as soaking through a pad or tampon every 1-2 hours or passing large clots.
- Prolonged menstrual periods – Periods lasting longer than 7 days.
- Pelvic pain and pressure – Dull aching pains in the abdomen are common with uterine fibroids. There may also be constant pelvic heaviness and pressure.
- Urinary Frequency and Urgency – Large fibroids can press on the bladder, increasing urination and urgency.
- Constipation – Bowel movements may be disrupted due to fibroids pressing on the rectum.
- Pain during sexual intercourse – Deep pain may be felt with penetration. Cervical fibroids especially can cause painful intercourse.
- Lower back pain – Pressure from large or pedunculated fibroids can cause referred lower back pain.
- Reproductive problems – Submucosal fibroids that distort the uterine cavity are associated with infertility, miscarriages, and premature labor.
- Anemia – Chronic heavy menstrual bleeding can cause iron-deficiency anemia. Symptoms include fatigue, weakness, dizziness, pale skin, and irritability.
- Enlarged uterus – As fibroids grow, they make the uterus feel enlarged and bloated. This can be mistaken for weight gain or pregnancy.
For many women, uterine fibroids will not impact their day-to-day lives. However, the severe symptoms above can greatly degrade the quality of life when present. Seeking treatment is often appropriate in these cases.
Causes and Risk Factors of Uterine Fibroids
The exact causes of uterine fibroid development are still unclear. However, research has identified many contributing factors:
- Genetic predisposition – Having a mother or sister with fibroids increases your risk. Fibroids are more common in African-American women.
- Hormones – Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells. They appear after puberty and shrink after menopause.
- Extracellular matrix abnormalities – An overproduction of collagen promotes fibroid growth.
- Growth factors – Substances that promote cell growth, like cytokines and angiogenic factors, are increased in women with fibroids.
- Gene mutations – Chromosomal abnormalities involving MED12 and HMGA genes may spur fibroid growth.
Other Risk Factors
- Early onset of menstruation (before age 10)
- Having no pregnancies
- Vitamin D deficiency
- Eating a lot of red meat
- Drinking alcohol
- Uterine injuries or infections
- Polycystic ovarian syndrome (PCOS)
- Family history of uterine fibroids
- African American ethnicity
Diagnosis of Uterine Fibroids
If uterine fibroid symptoms are present, your doctor will perform exams and tests to confirm the diagnosis. These can include:
Medical History – Your doctor will ask about your symptoms, menstrual history, reproductive history, and other medical conditions. A family history of fibroids will be noted.
Pelvic Exam – Your doctor feels for any enlargement of the uterus and surrounding areas. The cervix is also examined.
Ultrasound – A transvaginal or abdominal ultrasound uses sound waves to create images of uterine fibroids. It can map the size, location, and number of fibroids present.
MRI – Magnetic resonance imaging provides a detailed view of the uterus using radio waves and strong magnets. It is the best imaging choice for fibroids.
Hysteroscopy – A small tube with a camera is inserted into the uterus, allowing direct visualization of fibroids inside the uterine cavity. A biopsy can be taken.
Laparoscopy – A thin, lighted camera is inserted through small incisions in the abdomen to view outer uterine surfaces for fibroids. Biopsies are sometimes done.
Endometrial Biopsy – Removing a tissue sample of the uterine lining can help rule out cancer or polyps.
Blood Tests – Complete blood counts, iron studies, and other blood tests may detect anemia or other abnormalities from heavy bleeding.
After diagnosis, your doctor will discuss the best treatment approaches based on your symptoms, plans for pregnancy, and preferences.
Treatment Options for Uterine Fibroids
There are many options available for treating uterine fibroids. The best approach depends on the severity of symptoms and whether pregnancy is desired.
Medications for Uterine Fibroids
Medications are the most conservative treatment choice. Fibroid medications include:
Non-steroidal anti-inflammatory drugs like ibuprofen are used for symptomatic relief of pelvic pain and cramps associated with fibroids. They do not treat the fibroids themselves.
Iron tablets can help improve anemia and low iron levels caused by heavy menstrual bleeding from fibroids. This helps boost energy and relieve exercise intolerance.
Hormonal Birth Control
Birth control pills and patches help lighten excessive menstrual bleeding by thinning the uterine lining. They may help temporarily shrink fibroids by regulating hormones.
Gonadotropin-releasing Hormone (GnRH) Agonists
Injections of GnRH agonists such as Lupron Depot and Synarel put the body in a temporary postmenopausal state. This pauses periods, shrinks fibroids, and relieves symptoms. Six months is the maximum treatment length due to risks like bone loss. These hormones are primarily used pre-surgically to shrink fibroids, allowing a less invasive procedure.
Medications like tranexamic acid (Lysteda) slow blood loss from heavy menstrual bleeding by promoting clotting. They provide symptom relief only and do not treat the fibroids themselves.
The levonorgestrel IUD (Mirena) releases a small hormone dose directly into the uterus. This can lighten bleeding and cramping from fibroids.
Surgical Procedures for Uterine Fibroids
Various surgical options are available if medications do not adequately relieve fibroid symptoms. They include:
This surgery removes the fibroids but leaves the uterus intact. It is an option for women who still wish to have children. During the procedure, your doctor will make small incisions in your abdomen to access and remove each fibroid.
Laparoscopy uses a camera for minimally invasive access. One larger incision is sometimes needed for open abdominal myomectomy to extract larger fibroids. Recovery time is 1-3 weeks for laparoscopic and 6-8 weeks for open surgery.
This surgery removes the entire uterus along with the fibroids. You will no longer have menstrual periods. Hysterectomy can be performed through several techniques:
- Vaginal hysterectomy accesses the uterus through the vagina without any external incisions. It is only an option when the uterus is small.
- Laparoscopic hysterectomy uses a camera through abdominal cuts for uterus removal.
- Robotic hysterectomy uses a specialized machine the surgeon controls to extract the uterus through tiny incisions.
- Open hysterectomy fully opens the abdomen for uterus removal.
Hysterectomy has the longest recovery time of 6-8 weeks. However, it provides the most complete treatment for fibroids since the uterus is removed.
Uterine Fibroid Embolization
In this minimally invasive procedure, the blood vessels feeding the fibroids are blocked. This cuts off blood flow, causing the fibroids to shrink. It has over a 90% success rate for symptom improvement. Risks include pain, fever, infection, and premature menopause. Recovery takes 1 week.
MRI-focused Ultrasound Surgery
High-intensity ultrasound waves are directed at fibroids through the abdominal skin. This heats and destroys the fibroids while sparing healthy tissue. No incisions are needed. It improves symptoms in 85-90% of patients.
This surgery destroys the uterine lining to control heavy menstrual bleeding from fibroids. It is an option for women who do not wish to have children in the future. Risks include uterine scarring and difficulty conceiving after surgery.
Kapeefit Natural and Alternative Therapies for Uterine Fibroids
Some women use natural medicine approaches to improve uterine fibroid symptoms:
Herbs like turmeric, milk thistle, and ginger help regulate estrogen and inflammation levels to shrink fibroids. They may relieve symptoms, but evidence of fibroid shrinkage is weak. Talk to your doctor before using herbs for fibroids.
Supplements like vitamin D, B complex, and E can help replace nutrients lost through heavy menstrual bleeding. Vitamin C promotes hormone balance to help relieve symptoms.
Acupuncture improves circulation and provides pain relief. Some studies show it provides symptom relief, but more evidence is needed on actual fibroid shrinkage.
Homeopathic remedies claim to stimulate the body’s self-healing properties. However, there is no scientific evidence they shrink or eliminate uterine fibroids.
Caution: The natural remedies above lack strong clinical proof of effectiveness and safety. Discuss alternatives with your gynecologist first to avoid complications. Report any side effects.
Kapeefit Lifestyle Changes and Self-Care for Uterine Fibroids
Certain lifestyle changes, diet modifications, and self-care measures may help provide symptom relief in women with uterine fibroids:
- Take iron supplements to prevent anemia from heavy periods
- Apply heating pads to ease pelvic pain and cramps
- Maintain a healthy body weight – obesity is a risk factor
- Exercise moderately – aerobic exercise improves pelvic pain
- Limit alcohol, coffee, red meat, fatty and processed foods
- Stay hydrated to prevent constipation from fibroids pressing on the rectum
- Use sanitary pads instead of tampons to quantify heavy bleeding
- Track periods in a journal to identify triggers for pain and heavy flow
- Practice stress reduction techniques like meditation, yoga, or Tai Chi
- Get adequate rest and sleep nightly
- Ask for help with household tasks when in pain or tired
Fertility and Pregnancy with Fibroids
Most uterine fibroids do not directly impair fertility or pregnancy. However, submucosal fibroids growing into the interior cavity can negatively impact conception and early pregnancy outcomes.
Effects on Fertility
Submucosal fibroids distort the uterine shape, impair sperm migration, interfere with embryo implantation, and make miscarriage more likely. Intramural fibroids may compress fallopian tubes, affecting fertility. Large fibroids can block fertilization by displacing the cervix.
Effects During Pregnancy
Pregnancy hormones make most fibroids grow larger, especially during the first trimester. But they rarely cause problems. Some complications include:
- Miscarriage – Due to distorted uterine cavity or restricted blood flow
- Preterm labor and delivery – From inflammation and uterine irritability
- Fetal malpresentation – Baby doesn’t move into birthing position due to obstructing fibroid
- Placental abruption – Detachment of the placenta from the uterine wall
Labor and Delivery with Fibroids
Vaginal delivery is usually possible with fibroids. C-sections may be recommended for large or obstructing fibroids. Postpartum hemorrhage risk may be increased.
- Myomectomy to remove problem fibroids often improves fertility and pregnancy outcomes.
- Uterine fibroid embolization is an alternative to shrink fibroids before pregnancy, but its effects on fertility are unknown.
- Certain medications help shrink fibroids temporarily but are not safe during pregnancy.
- Close monitoring during pregnancy is warranted for women with uterine fibroids.
Outlook and Prognosis
The outlook for uterine fibroids is generally positive, as they are non-cancerous tumors. Symptoms often resolve with appropriate treatment.
Without treatment – Fibroids usually continue growing and causing worsening symptoms if left untreated. After menopause, fibroids often shrink away as estrogen levels fall.
With medication – Medications can temporarily control heavy bleeding and pain, but fibroids keep growing once stopped.
With surgical treatment – Myomectomy and uterine artery embolization have over 85-90% long-term success for shrinking fibroids and relieving symptoms. But there is a chance of recurrence.
With hysterectomy – Removing the uterus eliminates fibroids permanently and has a high satisfaction rate. But it ends fertility.
Being diagnosed with uterine fibroids can be frightening. But the condition is very manageable. There are many effective treatment options to suit individual needs. Most women with treated fibroids go on to have a high quality of life.
When to Seek Medical Advice for Uterine Fibroids
Consult your gynecologist promptly if you experience:
- Sudden severe abdominal or pelvic pain
- Heavy periods lasting over 7 days
- Menstrual bleeding with clots larger than a quarter
- Bleeding between periods or after sex
- Feeling faint, dizzy, or heart palpitations from anemia
- Inability to empty the bladder completely
- New onset constipation unresponsive to laxatives
- Pelvic pain or cramping that worsens
- Infertility or multiple miscarriages
- Significantly enlarged or distended abdomen
Seeking timely medical advice allows for proper diagnosis and treatment of symptomatic uterine fibroids. With appropriate management under a doctor’s supervision, most women with fibroids have an excellent long-term outlook.