Uterine Fibroids

treat uterine fibroids diagnosed

Uterine fibroids are non-cancerous growths that are most common during the reproductive years and often shrink after menopause.

These benign tumors can vary widely in size, number, and location within the uterus.

What are uterine fibroids?

Uterine fibroids, also known as leiomyomas, are growths composed of muscle and fibrous tissue within the uterine walls.

They can be as small as a seed or grow large enough to distort the uterus. While many fibroids are asymptomatic, others may cause significant issues.

Types and Locations of Uterine Fibroids

Intramural Fibroids: Found within the muscular wall of the uterus, these are the most common type. Intramural fibroids may alter the shape of the uterus and lead to heavy menstrual bleeding or pelvic discomfort.
Submucosal Fibroids: These grow just beneath the inner uterine lining and can extend into the uterine cavity, often causing prolonged or heavy menstrual bleeding and fertility issues.
Subserosal Fibroids: Located on the outer uterine wall, subserosal fibroids can press on nearby organs like the bladder or rectum, resulting in symptoms such as pelvic pressure, constipation, or frequent urination.
Pedunculated Fibroids: Connected to the uterus by a thin stalk, these fibroids can develop inside or outside the uterus. When the stalk twists, it can cause intense pain.

Causes and Risk Factors

Hormonal Influence: Estrogen and progesterone stimulate fibroid growth during the reproductive years. Their size often decreases after menopause due to lower hormone levels.
Genetics: A family history of fibroids increases the likelihood of developing them, possibly due to inherited genetic traits.
Age: Fibroids occur most frequently in women aged 30 to 40 and tend to diminish after menopause.
Obesity: Excess body fat can elevate estrogen levels, thereby encouraging fibroid growth.
High Blood Pressure: Hypertension has been associated with an elevated risk of fibroids, though the exact link remains unclear.
Dietary Factors: Diets high in red meat and low in fruits and vegetables may increase fibroid risk. Meanwhile, certain vitamins and antioxidants may offer protective effects.

Symptoms of Uterine Fibroids

Heavy Menstrual Bleeding: Prolonged or heavy periods are a common symptom, potentially causing anemia over time.
Pelvic Pain or Pressure: Larger fibroids can create sensations of pressure or fullness in the lower abdomen.
Frequent Urination: Subserosal fibroids can press on the bladder, leading to increased or urgent urination.
Constipation or Rectal Pressure: Fibroids pressing on the rectum may cause discomfort and difficulty with bowel movements.
Backache or Leg Pain: Fibroids near the lower spine or pelvis can trigger pain in these areas.
Abdominal Enlargement: Larger fibroids might cause noticeable abdominal swelling, which can be mistaken for weight gain.

Do uterine fibroids bleed?

Yes, abnormal bleeding is a hallmark of fibroids, often taking the form of heavy periods or spotting between cycles.

Submucosal fibroids are particularly linked to bleeding problems as they affect the uterine lining.

Pain during intercourse and other symptoms may also occur depending on their location.

Diagnosis of Uterine Fibroids

Diagnosis begins with a thorough review of symptoms and medical history, followed by a physical pelvic exam.

If fibroids are suspected, additional diagnostic tools are employed:

Ultrasound: This noninvasive technique uses sound waves to create images of the uterus, revealing the size, location, and number of fibroids.
Magnetic Resonance Imaging (MRI): An MRI provides detailed, high-resolution images, often used for surgical planning or complex cases.
Hysteroscopy: A thin, lighted tube examines the uterine lining to detect submucosal fibroids contributing to heavy bleeding or infertility.
Sonohysterogram: Saline solution expands the uterus during an ultrasound, producing clearer images that help identify fibroids in challenging locations.

Treatment Options for Uterine Fibroids

Non-Surgical Treatment Options:

Medications: Managing uterine fibroid symptoms with medications is a common choice for women seeking non-surgical options. Common medications include:
- NSAIDs: Pain relief for symptoms like pelvic discomfort or menstrual cramps is often achieved using drugs such as ibuprofen.
- Hormonal Therapy: Hormonal treatments regulate or reduce bleeding and may treat fibroids. Options include:
- Birth Control Pills: These help manage menstrual cycles and alleviate heavy bleeding.
- Progestin-Only Therapies: Injectables or devices like the IUD release progestin to reduce pain and bleeding, also serving as contraception.
- GnRH Agonists: Medications like leuprolide (Lupron) suppress estrogen and progesterone production, inducing a temporary menopause-like state to shrink fibroids. However, they are typically limited to short-term use due to side effects like hot flashes.
- Tranexamic Acid: This helps control heavy periods by reducing the amount of blood flow and slowing the breakdown of blood clots.
Uterine Artery Embolisation (UAE): A minimally invasive procedure into the blood vessels, the blood supply to fibroids is blocked, causing them to shrink and reduce symptoms. UAE is particularly suitable for women not planning future pregnancies due to potential effects on fertility.

MRI-Guided Focused Ultrasound (FUS): This non-invasive procedure uses high-frequency ultrasound waves, guided by MRI, to destroy fibroid tissue. While effective for some, it may not be ideal for all fibroid types or cases.

Surgical Treatment Options:

If symptoms persist despite non-surgical methods, surgery may be an option based on fibroid size, location, and fertility plans.

Myomectomy: This surgery removes fibroids while preserving the uterus, making it suitable for women wanting to maintain fertility. Approaches include abdominal, laparoscopic, or hysteroscopic surgery, depending on the fibroid's characteristics. Recurrence of fibroids, however, is possible.
Laparoscopic Myomectomy: This minimally invasive surgery employs small incisions and specialised tools for fibroid removal, offering benefits like faster recovery and less scarring compared to open surgery.
Hysterectomy: For severe symptoms that resist other treatments, a hysterectomy offers a permanent solution by removing the uterus. It is a definitive choice for women who no longer wish to maintain fertility. Methods include:
Abdominal Hysterectomy: Removal via an abdominal incision.
Vaginal Hysterectomy: Uterus removed through the vaginal canal.
Laparoscopic Hysterectomy: A minimally invasive option with small incisions.
Endometrial Ablation: By destroying the uterine lining, this procedure reduces menstrual bleeding but does not remove fibroids. It is recommended for women with small fibroids who are not preserving fertility.

How to prevent uterine fibroids?

Maintain a Healthy Weight: Excess body fat elevates estrogen levels, a key hormone linked to fibroid growth. Maintaining a healthy weight through diet and exercise not only balances hormones but also supports overall reproductive health.
Eat a Balanced Diet: A diet rich in fruits, vegetables, whole grains, and lean proteins helps balance hormones. High-antioxidant foods like leafy greens and berries reduce inflammation, while limiting red meats and processed foods may further lower fibroid risks.
Exercise Regularly: Regular physical activity can help manage weight, regulate hormones, and improve circulation, which may reduce the risk of uterine fibroids. Studies suggest that physically active women have a lower risk of developing fibroids, possibly due to exercise’s impact on reducing body fat and regulating estrogen levels. Additionally, regular exercise can help regulate female hormones, such as oestrogen and progesterone, which play a significant role in fibroid development. Aim for at least 30 minutes of moderate exercise most days of the week to reap these benefits.
Manage Stress: Physical activity aids weight management and hormone regulation. Studies suggest active women have a lower risk of fibroids due to reduced body fat and stabilised estrogen levels. Aim for 30 minutes of moderate exercise most days.
Limit Alcohol Consumption: Excess alcohol intake is linked to higher estrogen levels and increased fibroid risk. Reducing or avoiding alcohol supports hormonal balance and reproductive health.
Consider Birth Control Options: Hormonal contraceptives, such as birth control pills, can manage estrogen levels and fibroid symptoms. Consult a healthcare provider to determine the most appropriate option.