Uterine leiomyomas, or simply Uterine Fibroids, are the most common benign tumours found in a woman’s uterus, usually occurring during her childbearing years. Although they originate from the smooth muscle layer (myometrium) of the uterus, they are denser, forming round masses ranging in size from small seedlings to large melons. Uterine fibroids are not and do not develop into cancer. They are also not associated with an increased uterine cancer risk.
Cause and Types of Uterine Fibroids
Doctors and researchers have yet to identify what causes uterine fibroids to develop inside the uterus. What is known about them is that they thrive in an oestrogenic environment. Once a woman reaches menopause, these uterine fibroids stop growing and ultimately shrink with time.
Women at risk of developing uterine fibroids are…
- Those of reproductive age
- Heredity = having a mother or sister with fibroids increases your risk
- Race = Black women are more likely to have fibroids at younger ages and their fibroids are usually more in number or larger in size
- Woman began menstruating at an early age
- Obesity
- Use of birth control
- Deficiency in Vitamin D
- Eating a diet high in red meat
- Drinking alcoholic beverages
Uterine fibroids are classified according to their location in the uterus…
- Intra-cavitary fibroids = fibroids are found completely inside the uterine cavity
- Submucous fibroids = fibroids bulge from the uterine wall, but only partially filling the cavity
- Intramural or Intramyometrial fibroids = fibroids develop within the substance of the myometrium or muscle layer of the uterus
- Subserous fibroids = fibroids protrude outside the uterus, with its base attached to the uterine surface
- Pedunculated fibroids = fibroids protrude into the pelvic cavity with its base attached to the uterine wall through a stalk
Symptoms of Uterine Fibroids
Although an estimated 50 to 70 percent of women have uterine fibroids, majority of them do not present with symptoms and will not require any form of treatment.
Women commonly develop symptoms when they reach their forties. Among the symptoms reported are…
- Heavy menstrual bleeding
- Painful menstrual periods persisting for more than a week
Other symptoms soon develop as the fibroid/s grows larger in size and impinge upon other organs within the pelvic cavity. These symptoms include…
- Pelvic pressure or pain
- Abdominal bloating
- Frequent urination
- Difficulty in emptying the bladder
- Constipation
- Backache or leg pains
In rare cases, fibroids can cause acute pain when it grows so big that it cannot be supplied with blood, and thus starts to die.
Diagnosis of Uterine Fibroids
Asymptomatic uterine fibroids usually go undetected. For those fibroids that do present with symptoms and are large in size, they are easily identified on physical examination through palpation of the pelvis and uterus.
For smaller masses and those that are located within the uterine cavity, the definitive diagnosis is with a pelvic ultrasound, wherein a probe is inserted through the abdomen or via the vagina. For better ultrasound visualization of the fibroid, saline is infused into the cavity (saline sonohysterography).
If there are many fibroids inside the uterus or the mass has grown to a huge size that the uterus moves up into the upper abdomen, Magnetic Resource Imaging (MRI) is the diagnostic procedure of choice in order for the doctor how best to treat the condition. Endoscopy is also utilised to better visualise the fibroid inside the uterine cavity and determine if hysteroscopic removal can be performed. This procedure is best used in intra-cavitary and submucous fibroids.
Treatment of Uterine Fibroids
Most uterine fibroids are asymptomatic and do not require treatment. However, they must be checked out by a doctor regularly to see if they have grown in size. If not, they are left untouched until a woman reaches menopause, when the fibroid shrinks on its own.
If the uterine fibroid is big and presenting with symptoms, doctors may prescribe Gonadotropin Releasing Hormone (GnRH) for six months or less to shrink the mass and provide symptomatic relief. It should be mentioned though that GnRH may produce side effects in the form of decreased bone density, making a woman prone to osteoporosis and bone fractures, and hot flashes.
Surgery is the definitive treatment of uterine fibroids. The type of surgery depends upon a woman’s desire to have a baby. If she wants to maintain her fertility, the procedure of choice is a myomectomy, wherein the fibroids are removed through one or more incisions and then closing the uterus again.
Even with a myomectomy, it is impossible to remove all the fibroids, especially since smaller sized ones cannot be detected easily. There is also the risk of recurrence of fibroids by as much as 15 to 30 percent, in addition to the possibility of severe blood loss during the procedure. The best procedure is still a hysterectomy because, by removing the uterus, you are assured that all fibroids are removed. But, with this procedure, fertility is ultimately sacrificed.
