Uterine fibroids are extremely common benign tumours that grow in or on the muscular walls of the uterus. It’s estimated that 70-80% of women will develop fibroids by age 50. But despite how frequent these tumours are, not all women have noticeable symptoms or problems from fibroids.
This article provides an extensive overview of uterine fibroids, including their symptoms, causes, risk factors, diagnostic testing, and all available treatment options.
What are Uterine Fibroids?
Uterine fibroids, also called uterine leiomyomas or myomas, are noncancerous growths of smooth muscle cells and fibrous connective tissue in the uterus. They can grow as a single nodule or in clusters.
The medical terminology for uterine fibroids includes:
- Fibroids – benign tumors in the uterus
- Leiomyomas – benign smooth muscle tumors
- Myomas – benign tumours from muscle tissue
So fibroids, leiomyomas and myomas all refer to the same type of tumour.
These growths often develop within the muscular uterine wall but can also grow on the outside surface or push into the inner uterine cavity. Certain subtypes include:
- Intramural – within the thickness of the uterine wall. Most common.
- Submucosal – extends into the uterine cavity. It can cause heavy bleeding.
- Subserosal – project out from the uterine surface. It can become large.
- Pedunculated – connected to the uterus by a long stalk.
Fibroids range greatly in size – from microscopic to the size of a melon. There can be just one or multiple fibroids present.
Do All Women with Fibroids Have Symptoms?
The short answer is no. Many women with fibroids experience no symptoms at all and may not even realize they have fibroids unless detected on imaging for other reasons.
Up to 70-80% of reproductive-aged women have one or more uterine fibroids. However, only about 25-30% of women with fibroids have problematic symptoms that affect their quality of life and require treatment.
So, while fibroids are extremely common, the majority do NOT cause major issues or require treatment. However, symptoms can sometimes appear or worsen as fibroids grow larger.
Common Symptoms of Uterine Fibroids
When uterine fibroids do cause symptoms, they may include:
Heavy, prolonged menstrual bleeding
- Menorrhagia – periods longer than 7 days or soaking through a pad or tampon every 1-2 hours. Causes anemia in some cases.
- Passing large clots during menses
- Bleeding between periods
- Metrorrhagia – irregular heavy bleeding
Related Post: Late Miscarriage: Causes, Definitions, and Treatments
Pelvic pressure and pain
- Dull ache or feeling of heaviness in the pelvis
- Fullness, bloating, pressure on the bladder or rectum
- Abdominal swelling or distension
- Leg pain due to pressure on nerves
- Pain during sexual intercourse – dyspareunia
- Urinary frequency, urgency, incontinence
- Recurrent miscarriage
- Labor complications like breech presentation
- Increased risk of placental abruption
- Higher chance of cesarean delivery
- Constipation, painful bowel movements
- Backache, leg pain
- Fatigue from anaemia if bleeding is excessive
- Abdominal tenderness and pain
Symptoms often fluctuate with the menstrual cycle, worsening just before or during menses when the uterus swells from hormonal changes. Fibroids typically gradually increase in size over the years. Seeking treatment is recommended if quality of life is substantially affected.
What Causes Uterine Fibroids?
The exact causes of why fibroids develop are still unclear, but research has identified many contributing factors:
- Genetics – Having a first-degree relative with fibroids increases your risk. Certain genetic mutations affect smooth muscle growth.
- Hormones – Estrogen and progesterone stimulate fibroid growth. Tumours can enlarge during pregnancy when hormone levels are high.
- Ethnicity – African American women are 2-3 times more likely to have symptomatic fibroids. Hispanic and Asian women are also at increased risk versus Caucasians.
- Obesity – Higher lifetime estrogen exposure.
- Diet – Eating more red meat and fewer fruits & vegetables may increase risk.
- Early menstruation – Periods before age 10 result in greater lifetime estrogen exposure.
- Age – Fibroids become more common in the 30s-40s. Shrink after menopause when estrogen decreases.
- Pregnancy – Never being pregnant seems to increase risk.
- Prior pelvic infections – having conditions like endometriosis or PID.
- Environment – May be affected by diet, toxin exposure, and stress.
- Other – Diabetes, hypertension, and blood coagulation disorders may play a role.
But even with one or more risk factors, most women do NOT develop symptomatic fibroids. And there is nothing that can be done to prevent the formation of these noncancerous tumours. Hormonal modulation or diet changes may help slow growth, but fibroids can still appear.
Who Gets Fibroids? Key Risk Factors
The following factors can increase the risk of developing uterine fibroids:
- Genetics – Family history, African American heritage
- Age – Over 30, with risk increasing until menopause
- Obesity – High BMI
- Early first period – Before age 10
- Diet – Eating more red meat, fewer fruits/vegetables
- Birth control pills – Earlier adolescent use
- Alcohol use
- Pregnancy – Nulliparous women have higher risk
- Prior pelvic infections like endometriosis
While risk factors like genetics and age cannot be changed, maintaining a healthy weight through diet and exercise may help reduce fibroid formation.
Diagnosis of Uterine Fibroids
If abnormal uterine bleeding or pelvic pain occurs, uterine fibroids often come into the differential diagnosis. These diagnostic tests help confirm a fibroid diagnosis:
A pelvic exam may detect an enlarged or irregular uterine shape, but many fibroids cannot be felt manually.
An abdominal or transvaginal pelvic sonogram provides images of the uterus. Fibroids usually appear as round, well-circumscribed masses distinct from the uterine tissue. Sonography can map the size, location, and position of each tumour.
It is very sensitive for detecting even small fibroids. Provides detailed views of the uterine anatomy without radiation. Better images than ultrasound for mapping fibroids.
A camera on a thin tube enters the uterus through the cervix, allowing direct visualization of fibroids in the cavity. Performed with anaesthesia. It can also be used to remove accessible tumours.
X-ray test that injects dye into the uterus and tubes. It outlines the size and shape of the uterine cavity and can detect filling defects caused by fibroids.
Minimally invasive surgery with a camera into the abdomen allows visualization of the external surface of the uterus and confirmation of fibroids. It can be used to remove growths.
Samples the uterine lining to evaluate abnormal bleeding and rule out cancer when fibroids cause heavy, irregular periods.
Once uterine fibroids are confirmed, the only additional testing needed is based on the severity of symptoms. Watchful waiting is an option for mild cases.
Fibroid Treatment Options – An Overview
There is a wide variety of treatment options for uterine fibroids, ranging from watchful waiting to medication use to surgical interventions. The benefits and risks vary greatly. Key factors in selecting fibroid treatment include:
- Location, number and size of tumours
- Type – whether submucosal, intramural, etc
- Symptoms – degree of problems like bleeding and pain
- Impact on reproductive function and fertility
- Age – nearing menopause when fibroids shrink naturally
- Need for future pregnancy
- Desired speed of treatment effect
- Personal preferences – the desire to preserve the uterus or avoid surgery
- Coexisting medical conditions – anaemia, adenomyosis, endometriosis
Discuss all the pros and cons with your gynaecologist to select the optimal management plan for your scenario. Here is an overview of the treatment options:
Fibroid Treatment Types
- Also called expectant management.
- No active treatment, only routine monitoring.
- Best for minimally symptomatic or small incidental fibroids.
- Disadvantages – Symptoms may increase over time as tumours grow.
- Help control heavy bleeding, pelvic pain and anaemia, but do not shrink existing fibroids.
- Often used short-term before surgery to help correct anaemia from blood loss.
- Types: Non-steroidal anti-inflammatories (NSAIDs), hormonal contraceptives, gonadotropin-releasing hormone (GnRH) agonists.
MRI-guided ultrasound surgery
- Noninvasive procedure using high-intensity ultrasound waves directed at fibroids while being monitored by MRI imaging. The ultrasound heat destroys fibroid tissue.
- Avoids incisions through the abdomen.
- Best for symptomatic intramural fibroids under 10cm in size.
- Outpatient same-day procedure with fast recovery.
Uterine artery embolization
- Minimally invasive procedure that cuts off blood flow to fibroids, causing them to shrink. It was done by interventional radiology.
- Small incision in the groin to thread a catheter into the uterine artery, which is injected with embolic agents.
- Complications like post-embolization syndrome cause pain, nausea and fever in some women. Rarely leads to a hysterectomy later.
- Fibroids are removed while preserving the uterus. It is done through an abdominal incision or laparoscopically.
- Allows the ability to become pregnant after surgery.
- Only removes current fibroids; new ones may grow later. Recurrence risk 10-30%.
- Surgical removal of the uterus. Several approaches – abdominal, vaginal, laparoscopic.
- Definitive cure for fibroids since all uterine tissue is removed.
- Uterus cannot be preserved. Permanent infertility results.
- Considered only when childbearing is completed.
- Last resort for persistent symptomatic fibroids.
- Destruction of the uterine lining to reduce heavy bleeding from submucosal fibroids.
- Various techniques – microwave, radiofrequency, heated fluid, electrosurgery, cryoablation.
- Uterus remains, but pregnancy afterwards is unlikely.
- Laparoscopic procedure using laser, electricity or ultrasound to destroy fibroids.
- Less invasive than myomectomy but may not remove fibroids completely.
- Newer technique with an ongoing study of efficacy.
Some non-medical and natural treatment options are covered next. Your OB-GYN can help determine the optimal treatment route for your case based on a full evaluation.
Medication Options for Uterine Fibroids
Medications are used to help provide temporary relief of fibroid symptoms. They do not remove or shrink existing tumours. Medication choices include:
- NSAIDs like ibuprofen and naproxen help alleviate pelvic pain and cramping.
- Stronger narcotic pain pills are usually not recommended long-term.
- Used to treat or prevent anaemia from excessive bleeding.
- Oral iron pills or intravenous iron infusions.
- Birth control pills help stabilize menstrual cycles and control heavy bleeding. The progesterone decreases fibroid growth.
- The levonorgestrel IUD (e.g. Mirena) reduces heavy vaginal bleeding as well.
- Best temporary option for women wanting contraception.
- Antifibrinolytic drug that helps slow excessive menstrual bleeding. It is often used short-term before surgery.
- Comes as a pill or intravenous infusion.
- Helps prevent anaemia from blood loss.
- Gonadotropin-releasing hormone agonists block estrogen production through a process called pseudomenopause. This shrinks fibroids by about 30-50% over 3-6 months by depriving them of estrogen stimulation.
- Drugs include Lupron, Synarel, and Zoladex. They are given by injection or nasal spray.
- Fibroids regrow when treatment is stopped and only used short term.
- Side effects like menopausal symptoms – hot flashes, vaginal dryness, bone loss. It cannot be used long-term. Add-back therapy with low-dose hormones helps minimize side effects.
DIY natural remedies
- Some women try natural herbs, supplements and teas that claim to control symptoms like heavy bleeding from uterine fibroids. These are not medically proven.
- Choices include yellow dock root, milk thistle seed, red raspberry leaf, castor oil packs, fish oil, turmeric, and vitamins.
- Acupuncture, massage, meditation, and yoga may help alleviate fibroid pain and stress in some cases.
- Benefits are theoretical and lack robust data but are unlikely to cause harm. Discuss trying any natural remedies with your doctor first.
Uterine artery embolization
- Minimally invasive uterine-sparing procedure done by interventional radiology
- Catheter inserted through a small groin incision into the uterine artery
- Microspheres injected to block the uterine artery branches that supply blood flow to the fibroids
- Fibroids shrink from lack of blood supply. About 50% size decrease.
- Done as an outpatient procedure with conscious sedation. 3-5 day recovery.
- Complications like pain, cramping, and nausea about 10% after the procedure. Incomplete treatment, about 10%.
- Less invasive than surgery, but fibroids may regrow over time.
- Allows the ability to try to conceive after the procedure. 60-70% of women report improvement in symptoms.
- Select patients under 50 who want to preserve the uterus and have multiple symptomatic fibroids. It’s not best for women wanting future pregnancy.
MRI-guided focused ultrasound
- A completely noninvasive procedure to destroy fibroids without any incisions
- High-intensity focused ultrasound waves directed at each fibroid using live MRI guidance
- The ultrasound heat destroys the fibroid tissue while sparing surrounding structures
- Typically, outpatient procedures are done under conscious sedation with 1-2 day recovery
- Best results for nonpedunculated intramural fibroids under 10 cm size
- Fibroids shrink about 30-60% in size over ensuing months as absorbed by the body
- Symptoms may recur if new fibroids appear later
- Trying to conceive is possible after treatment, although data are limited
- Of all uterus-sparing options, it has the lowest complication rate – under 5%.
The disadvantage is availability – only at specialized treatment centres.
- Procedure to surgically remove uterine fibroids while leaving the uterus intact
- Traditional open abdominal myomectomy is done through horizontal incision
- Mini-laparotomy uses smaller 3-5 inch vertical “bikini” incision.
- Laparoscopic myomectomy is done through keyhole incisions using a camera-less invasive
- Robotic myomectomy is a newer laparoscopic technique with faster recovery
- Intramural and subserosal fibroids can be shaved off the uterine wall. Submucosal tumours can be detached from the surface using hysteroscopy and then removed.
- After removal, the uterine wall is sutured closed in layers.
- Allows women to attempt conception and pregnancy after surgery, unlike hysterectomy.
- Generally successful for symptom relief in 85-90% of patients.
- Recurrence risk is 10-30% over 10 years as new fibroids may grow. Close monitoring is needed.
- Serious complications happen about 4% of the time – bleeding, infection, scarring.
Myomectomy is the best option for symptomatic women who wish to retain fertility potential. But it often requires an inpatient hospital stay and a 4-6 week recovery. The uterus is left intact for future pregnancy, however.
Hysterectomy for fibroids
- Surgical removal of the uterus is a definitive cure for uterine fibroids.
- Performed after childbearing is completed or not desired.
- Very effective – fibroids permanently eliminated along with the uterus. Recurrence is impossible.
- Different techniques: Abdominal (open), vaginal, laparoscopic hysterectomy
- Usually 1-2 night hospitalization with 4-6 week recovery. Laparoscopic approaches may be outpatient.
- Risks include infection, bleeding, damage to surrounding organs, and blood clots. Rarely bowel/bladder dysfunction afterwards.
- Results in permanent sterility since the uterus is removed. Options like surrogacy or adoption are the only ways to become a parent afterwards.
- Potential for estrogen deprivation symptoms if ovaries are also removed – sex drive and arousal changes, hot flashes, vaginal dryness, mood effects. Hormone therapy can minimize symptoms.
For persistent severe fibroid symptoms, a hysterectomy may become necessary after more conservative options fail. This is very effective but obviously comes at the cost of fertility and the uterus itself. Avoiding hysterectomy is ideal if future pregnancy is still desired.
Pregnancy and Delivery with fibroids
Many women with fibroids successfully achieve and sustain healthy pregnancies, but certain risks exist:
- Increased miscarriage rate possible if fibroid distorts uterine cavity
- Higher likelihood of placental abruption where placenta detaches early
- Increased chance of breech presentation
- Labor dystocia – failure to progress due to poor uterine contractions.
In the intricate journey of women’s health, uterine fibroids present a unique challenge. As we’ve explored in this blog, not all women with fibroids exhibit noticeable symptoms. For those who do, the manifestations can range from mild discomfort to significant disruptions in daily life.
The causes of these growths remain a blend of genetic, hormonal, and environmental factors. Fortunately, a myriad of treatments exists, tailored to the severity and individual needs of each patient.
From conservative management to surgical interventions, options are abundant. As we advocate for comprehensive and holistic health, it’s paramount to remember the power of Ayurveda in addressing such concerns.
Ayurvedic principles emphasize balance, and their treatments often focus on root causes rather than just symptoms. For anyone seeking a natural and holistic approach, an online consultation with Kapeefit could be the first step towards understanding and managing uterine fibroids better.
Embark on your Ayurvedic journey today. Book your online consultation with Kapeefit and discover the balance your body deserves.