Fibroids: Overview of Causes, Symptoms and Treatment

Uterine fibroids are common benign (non-cancerous) growths or swellings or tumors of the uterine smooth muscles.

Uterine Fibroids are also called Myomas and are mostly named according to their location in the uterus

The prevalence of fibroids varies with age, race, geographical location and type and quality of imaging modalities used.

They can be multiple fibroids or single.

Fibroids are classified based on their location.

Here are the types of uterine fibroids i.e. Submucosal Fibroids are found close to the Endometrium which is the innermost lining of the Uterus; Intramural fibroids are located within the smooth muscle of the Uterus; Subserosal fibroids lie in the serosal layer of the uterus ; Cervical fibroids are located within the walls of the cervix; pedunculated fibroids have a stalk that is called a peduncle that attaches them to the uterine wall. They may be found with a peduncle in the broad ligament and named as such.

Many times the question of what is the cause of uterine fibroids arises.
The exact cause of uterine fibroids remains unclear; However, different theories have been advanced to explain how fibroids come about.

• Hormone Dependence where fibroids are thought to develop due to hormones. Estrogen and progesterone are hormones that are thought to be involved in the pathogenesis of uterine fibroids.
• Genetics theory; Fibroids tend to occur in families
• Environmental factors where obesity is thought to play a role in the pathogenesis of uterine fibroids
  Other possible causes may be related to the risk factors shared below.

• Family History

You may be genetically predisposed to getting uterine fibroids. 

• Black women are more predisposed to uterine fibroids than their white women counterparts
• Women aged between 30 and 45 are at an increased of developing uterine fibroids
• Excessive use of Hormonal contraceptives
• Nulliparous Women

The nulliparous woman is a woman who has never given birth

• Women who are overweight
• Early onset of menstruation
• Diet high in red meat and low in vegetables

Uterine fibroids will cause symptoms depending on their location and their size. The common symptoms are mostly related to menstruation and the level of anaemia as a result of the blood loss. Other symptoms are due to the pressure effect of the benign growths on the surrounding structures as the size increases such as the urinary bladder, ureter, bowel, pelvis and abdomen. Sometimes uterine fibroids are found incidentally when one is being evaluated for other gynaecological conditions or other diseases involving the pelvis or during well-woman checkups.

About 6 out of 10 women will experience one or more symptoms of uterine fibroids.

Menstrual irregularities is one of the common uterine fibroid symptoms. This can be in the form of:

• Heavy menstrual bleeding(menorrhagia)
• Prolonged menstrual bleeding
• Bleeding between periods (metrorrhagia)
• Painful menses/period pain
• Pain during sexual intercourse may also be felt depending on the location of the fibroids
• Lower back pains
• Pelvic pressure or Feeling of fullness in the lower Abdomen
• Chronic Pelvic pain
• Urinary symptoms such as Frequency, Urgency & retention of urine
• Constipation
• Firm mass or abdominal swelling arising from the pelvis
• Signs and symptoms resulting from the menstrual irregularities such as anemia(low blood levels)-fatigue, dizziness, palpitations; iron deficiency etc
• Subfertility
• Incidental finding on examination or imaging e.g on Ultrasound in an asymptomatic patient

Three to five women out of ten will seek treatment for uterine fibroids

Different treatment modalities may be employed depending on the factors illustrated below. Therefore treatment may be customized for you

Choice of management is dependent on these factors:

1. Patient’s Age
2. Symptoms
3. Desire for fertility
4. Location of the fibroids
5. Available Treatment Options
6.  Physician’s Experience

Treatment for uterine fibroids can be supportive or definitive

1. Myomectomy is a surgical procedure for removal of the uterine Fibroids
2. Hysterectomy (Removal of the Uterus)
3. Uterine Artery embolization (Blocking of the Uterine Vessel supplying the fibroids)
4. Medical Management with eg. GNRH analogues- For select patients (nearing Menopause/awaiting surgery)
5. Magnetic Resonance- Guided Focused Ultrasound Surgery
6. Supportive Management to Reduce heavy menstrual bleeding, improve blood levels and pain management