Uterine fibroids are common among women of childbearing age. It is estimated that over 50% of women have them between the start of puberty and the onset of menopause. Uterine fibroids are rare among those who have not yet had their first period and also among those who have reached menopause.

What Are Uterine Fibroids?

Uterine fibroids (also known as leiomyomas) are growths of tissue and muscle that form in or on the wall of the uterus. The growths are normally benign (non-cancerous). In many cases, they cause no symptoms and women go through life without even knowing they have them. However, they can also cause various symptoms that can result in severe pain and urinary and bowel problems.

Types of Uterine Fibroids

There are several categories of uterine fibroids which depend on where and how they develop:

• Intramural fibroids are the most common type. They are embedded in the wall of the uterus.
• Submucosal fibroids grow in the inner lining of the uterus.
• Subserosal fibroids develop on the outer surface of the uterus, under the external lining. These fibroids often grow to a large size and may even extend into the pelvic region.
• Pedunculated fibroids are mushroom-shaped and attach to the uterus using a stem.

Symptoms of Uterine Fibroids

In many cases, small fibroids do not produce any symptoms and require no treatment. They do not affect a woman’s ability to become pregnant. However, that does not mean that they can be ignored. If the presence of uterine fibroids is noted during a routine gynecological examination, the condition needs to be monitored so that any future growth may be noted and treatment for possible medical issues begun at an early stage where the results are quicker.

If the fibroids grow to a large size, a range of symptoms may develop. These include:

• Irregular bleeding between menstrual periods.
• Heavier than normal bleeding during menstrual periods.
• Pain during sexual intercourse.
• Painful urination and/or difficulty urinating.
• Unusual and continuous vaginal discharge.
• Constipation.
• Lower back pain.
• If the fibroids become very large, the abdomen can become distended.

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Also Read: What causes low back pain in women?

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The Causes of Uterine Fibroids

The causes of uterine fibroids have not been definitively established. However, many healthcare professionals and medical researchers think that the female hormones estrogen and progesterone play a role in fibroid development. Many studies show that fibroids tend to develop (or grow if they already exist) when hormone levels are high as when a woman is pregnant. The studies also show that uterine fibroids shrink at the onset of menopause when hormone levels drop. Research also indicates that various factors may increase the risk of uterine fibroids. These include:

• A family history of uterine fibroids.
• Early onset menstruation – when periods start at an unusually young age.
• Late onset menopause.
• Not becoming pregnant during the years when a woman is fertile.
• Having a diet that is low in vegetables, fruit and dairy products and high in red meat.
• Excessive alcohol consumption and smoking.
• Low levels of vitamin D.

Diagnosis of Uterine Fibroids

Uterine fibroids are often discovered during routine gynecological examinations. Heavy bleeding, unusual vaginal discharge and other similar symptoms may also alert the doctor to the possibility of uterine fibroids. Various tests are available to determine the location and size of the fibroids. These include:

• Ultrasound imaging
• Magnetic resonance imaging (MRI)
• CT scans
• Hysteroscopy and other specialized imaging tests to look for fibroids inside the uterus
• Blood tests

Treatment of Uterine Fibroid

If the uterine fibroids cause no symptoms, treatment is typically not required. If there are very minor symptoms that cause only minimal pain or discomfort, patients may decide to forego treatment. However, in both cases, a wait-and-watch policy is normally adopted so that any changes in the situation can be responded to without delay. If treatment is required, various factors including the size, number and location of the fibroids, the symptoms that the patient experiences and other health issues will determine the right course of treatment.

Non-Surgical Options: 

These include:

• Pain relief medication - depending on the severity of the pain, these could be either over-the-counter medicines or prescription ones.
• Iron and vitamin supplements to treat anemia caused by heavy bleeding and general weakness.
• Birth control medicines or devices can help reduce the symptoms of uterine fibroids.
• Hormone therapies.
• Oral therapies to control heavy bleeding.

Surgical Options:

In case the doctor decides that medication is not a viable treatment option, then surgery is usually advised. The procedures include:

Myomectomy - A type of surgery to remove the fibroids. This can be done in several ways, including:

• Hysteroscopy - A procedure where a special tool with a camera is inserted through the vagina into the cervix. The surgeon will then cut and remove the fibroids.
• Laparoscopy – A procedure similar to hysteroscopy but in this case, the tool is inserted through a few small incisions in the abdomen.
• Laparotomy - A variation of laparoscopy where a single larger incision is used to cut away and remove the fibroids.

If the patient is not planning to become pregnant in the future, then there are other surgical options which are very effective. These include:

• Hysterectomy, a procedure which involves the removal of the uterus. The ovaries may or may not be removed.
• Uterine fibroid embolization is a procedure where the blood flow to the fibroids is blocked, causing them to shrink.
• Radiofrequency ablation (RFA) uses microwave energy to destroy the uterine fibroids. It is most effective in treating smaller growths.

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Also Read: What You Need to Know About Ovarian Cyst

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As already stated, in many cases, uterine fibroids produce no symptoms and require no treatment. However, regular gynecological examinations are the best way to find any fibroid growth at an early stage. Once noted, the possible growth of the fibroids can be monitored and, if required, treatment started without any delay. This will produce the best and quickest results. The gynecology department of a multispecialty hospital is the best option for both, regular examinations to look for uterine fibroids and other gynecological problems, and for treatment if the condition has progressed to the stage where medical intervention is required. The multispecialty hospital will have the best doctors, and a full range of specialized departments so that consultation with other specialists, if required, is immediately available and it is also where the most advanced diagnostic and treatment facilities will be available.

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