Fibroids are non-cancerous tumours that appears in the tissues around the uterus.
They are also known as uterine fibroids, leiomyomas, or myomas.
These growths of smooth muscle can vary from the size of a bean to being as large as a melon.
Fibroids affect around 30 percent of all women by the age of 35 years, and from 20 to 80 percent by the age of 50 years.
They usually develop between the ages of 16 to 50 years, the reproductive years during which estrogen levels are higher.
Being overweight or obese significantly increases the risk.
Here are some key points about fibroids. More information is in the main article.
- Fibroids are most common during the reproductive years.
- Exactly why they form is unclear, but they appear to develop when estrogen levels are higher.
- Most people experience no symptoms, but they can include backache, constipation, and excessive vaginal bleeding leading to anemia.
- Complications are rare, but they can be serious.
Types of fibroid
There are four types of fibroids:
- Intramural: Located in the muscle wall of the uterus, this is the most common type.
- Subserosal fibroids: Located outside the wall of the uterus but under the surrounding tissue layer. They can develop into pedunculated fibroids, with stalks, and can become quite large.
- Submucosal fibroids: This type can protrude into the cavity of the uterus and is located in the muscle beneath the lining of the uterus wall.
- Cervical fibroids: This is located in the neck of the womb, or the cervix.
The classification of a fibroid depends on its location in the uterus.
Around 1 in 3 women with fibroids will experience symptoms.
These may include:
- anemia, as a result of heavy periods
- backache or leg pain
- discomfort in the lower abdomen, especially in the case of large fibroids
- frequent urination
- heavy, painful periods
- pain during intercourse
Other possible symptoms include:
- labor problems
- pregnancy problems
- fertility problems
- repeated miscarriages
If fibroids are large, there may be weight gain and swelling in the lower abdomen.
It remains unclear exactly what causes fibroids, but it may be related to estrogen levels.
During the reproductive years, estrogen and progesterone levels are high.
When estrogen levels are low, fibroids may shrink, for example during menopause.
Heredity may play a role. Having a close relative with fibroids increases the chance of developing them.
There is also some evidence that red meats, alcohol, and caffeine could increase the risk of fibroids, and that an increased intake of fruit and vegetables might reduce it.
As fibroids are often asymptomatic, they are usually discovered during a routine vaginal examination.
It is possible to detect fibroids and rule out other conditions through:
- an ultrasound scan used over the abdomen, or by inserting a small probe into the vagina. This can help visualize cervical and submucosal fibroids.
- an MRI, which can determine the size and quantity of fibroids.
- a hysteroscopy, in which a small telescope with a camera on the end is used to examine the inside of the uterus. If necessary, a biopsy can be taken at the same time.
- a laparoscopy, in which a small, flexible tube is inserted into the abdomen and used to examine the outside of the uterus.
During this procedure, if necessary, a biopsy can be taken from the outer layer of the uterus. This would require cutting through the skin
If there are no symptoms and the fibroids are not affecting an individual's quality of life, treatment may not be necessary.
If fibroids lead to heavy periods, but these do not cause major problems, the woman may choose not to have treatment.
During menopause, fibroids often shrink, and symptoms often become less apparent or even disappear completely.
When treatment is necessary, it may be in the form of medication or surgery.
The location of the fibroids, the severity of symptoms, and childbearing plans can all affect the decision.
Treating fibroids with medication
Birth control medication an be used to shrink fibroids.
Gonadotropin-releasing hormone agonist (GnRHA) causes the body to produce less estrogen, which shrinks the fibroids. GnRHA stops the menstrual cycle, but it does not affect fertility once treatment stops.
GNRHAs can cause menopause-like symptoms, including hot flashes, a tendency to sweat more, vaginal dryness, and, in some cases, a higher risk of osteoporosis.
They may be given before surgery to shrink the fibroids. GNRHAs are for short-term use only.
Other drugs may be used, but they are less effective when treating larger fibroids.
Anti-inflammatory drugs: These include mefenamic and ibuprofen. Anti-inflammatory medications reduce the production of prostaglandins, which are normally associated with heavy periods. Anti-inflammatory drugs are also painkillers. They do not affect fertility.
Birth control pills: Oral contraceptives help regulate the ovulation cycle, and they may help reduce menorrhagia.
Levonorgestrel intrauterine system (LNG-IUS): A plastic device, placed inside the uterus, releases a progestogen hormone called levonorgestrel.
The hormone stops the lining of the uterus from growing too fast, which reduces bleeding. Adverse effects include irregular bleeding for up to 6 months, headaches, breast tenderness, and acne. It can, in some cases, stop periods.
If symptoms are severe and medical therapy has failed, surgery may be necessary.
The following procedures may be considered:
- Hysterectomy: Removing the uterus is considered if the fibroids are very large, or if the patient is bleeding excessively. A hysterectomy can prevent fibroids returning. If a surgeon removes the ovaries and fallopian tubes, side effects can include reduced libido and early menopause.
- Myomectomy: Fibroids are surgically removed from the wall of the uterus. It can help women who still want to have children. Women with large fibroids, or fibroids located in particular parts of the uterus, may not benefit from this surgery.
- Endometrial ablation: Removing the lining of the uterus may help if fibroids are near the inner surface of the uterus. It can be an effective alternative to a hysterectomy.
- Uterine artery embolization (UAE) or uterine fibroid embolization (UFE): The cutting off of the blood supply to the area shrinks the fibroid. A chemical is injected through a catheter into a blood vessel in the leg, guided by X-ray scans. It reduces or removes symptoms in up to 90 percent of fibroid patients, but it is not suitable for women who still wish to have children.
- MRI-guided percutaneous laser ablation: An MRI scan is used to locate the fibroids. Then, fine needles are inserted through the patient's skin and pushed until they reach the targeted fibroids. A fiber-optic cable is inserted through the needles. A laser light goes through the cable and shrinks the fibroids.
- MRI-guided focused ultrasound surgery: An MRI scan locates the fibroids, and sound waves are used to shrink them.
In severe cases, fibroids can lead to infertility
Fibroids do not normally result in complications, but they can be serious and even life-threatening if they occur.
Complications may include:
- Menorrhagia, or heavy periods: This can sometimes prevent a woman from functioning normally during menstruation, leading to depression, anemia, and fatigue.
- Abdominal pains: If fibroids are large, swelling and discomfort may occur in the lower abdomen. There may also be constipation and painful bowel movements.
- Pregnancy problems: Preterm birth, labor problems, and miscarriages may occur as estrogen levels rise significantly during pregnancy.
- Infertility: In some cases, fibroids can make it harder for the fertilized egg to attach itself to the lining of the uterus. A submucosal fibroid, which grows outside the uterus, may change the uterus' shape, making conception more difficult.
- Leiomyosarcoma: This is an extremely rare form of cancer that can develop inside the fibroids.
Other serious complications include acute thromboembolism, deep vein thrombosis (DVT), renal failure, and internal bleeding.
If a woman with fibroids suddenly develops severe abdominal pain, she should contact her doctor.
Natural treatments for fibroids
There is no proven natural treatment for fibroids, but keeping weight down through exercise and a healthful diet may help to moderate estrogen levels.