Uterine fibroids: Concerning or not?

One of the most common gynecological conditions affecting up to 70% of women are uterine fibroids.  Women who do develop uterine fibroids will do so by the age of 50 but most will not be aware of them.

Uterine fibroids are almost always benign, muscular tumors that grow in the wall of the uterus.  The medical term for them is leiomyoma or just “myoma.”  They can range in size from as small as an apple seed to as large as a grapefruit and can either grow as a single tumor or there can be many distributed within the uterus.  They are most common in women in their 40s and early 50s.

Risk factors for uterine fibroids

There are certain factors that can increase a woman’s chance of developing uterine fibroids:

·      Age – As a woman ages, they become more common. After menopause, fibroids usually shrink.

·      Family history – If a woman’s mother had fibroids, the risk for developing them is three times higher.

·      Ethnic background – African-American women have a higher risk than white women.

·      Obesity – Women who are overweight are at a higher risk. Obese women have a two to three times greater risk.

·      Food choices – Too much red meat and ham is linked with increasing fibroids.  Consuming more vegetables appears to protect against their development.

Symptoms of uterine fibroids

The majority of women do not have any symptoms but some women will which may include the following:

·      Heavy bleeding – heavy enough to cause anemia or painful periods

·      A feeling of fullness in the pelvic or lower stomach area

·      Enlargement of the lower abdomen

·      Frequent urination

·      Pain during sex

·      Lower back pain

·      Complication during pregnancy and labor – women with uterine fibroids have a six times greater risk of cesarean section

·      Reproductive problems such as infertility

The majority of fibroids grow in the wall of the uterus but they are categorized according to where they grow:

·      Submucosal fibroids grow into the uterine cavity

·      Intramural fibroids grown within the wall of the uterus

·      Subserosal fibroids grown on the outside of the uterus

Occasionally fibroids will grow out from the surface of the uterus or into the cavity of the uterus – these are called pedunculated fibroids. 

Causes of fibroids 

There is no known cause of fibroids but it is speculated that they are affected by the hormonal levels of estrogen and progesterone, and that genetics also plays a role.  If a woman has fibroids while she is pregnant, they can grow rapidly due to the high hormonal levels.  They can shrink if anti-hormone medications are given and will tend to stop growing or shrink when a woman goes through menopause.

If a woman has no symptoms, how does she know for sure if she has uterine fibroids?

The main way would be if a woman’s gynecologist discovers them when a woman has a pelvic exam. The doctor can feel the fibroid with their fingers during the pelvic exam as a lump or mass on the uterus. 

To confirm if a woman has fibroids, there are imaging tests that can be used to diagnosis them.  These tests might include an ultrasound, magnetic resonance imaging, x-rays, or a cat scan.  

Treatment of uterine fibroids

If a woman is having no symptoms, there is no need necessarily to treat them.  For women who are symptomatic, they should discuss with their doctor the best way to treat the fibroids.

·      Medications - If the fibroids are only causing mild symptoms, then a doctor may suggest over-the-counter medications of ibuprofen or acetaminophen for any mild pain.  Women experiencing heavy bleeding during her menstrual cycle may benefit from taking an iron supplement to prevent becoming anemic. 

Birth control pills can be another type of medicine to help control symptoms of fibroids.  Low-dose birth control pills do not make fibroids grow and they can also help with heavy menstrual bleeding. 

There are also drugs called gonadotropin releasing hormone agonists that can shrink fibroids.  The medication is given by injection, nasal spray, or implanted and they can cause side effects – hot flashes, depression, insomnia, reduced sex drive, and joint pain.  However, most women tolerate this medication well.  During the time a woman is using this drug they will not have a period which can allow women with anemia to recover to a normal blood count.  Other downsides of this drug is they can cause thinning bones, they are expensive and once a woman stops taking them, the fibroids can grow back rapidly.

·      Surgery - For women who have moderate to severe symptoms, surgery is another option for treatment.  Surgery could include a myomectomy, a hysterectomy, endometrial ablation, myolysis, or uterine fibroid embolization.