Uterine Fibroids
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Uterine Fibroids
Uterine Fibroids, also known as Uterine Myoma are the growth of non-cancerous tumours that develop in a woman’s uterus. The fibroids are constructed out of the uterus muscles and connective tissues. Also known as ‘leiomyomas’, while these growths are not directly related to being cancerous, they can cause a variety of inconsistencies in the woman’s body depending upon their size.
In addition to the size, shape, and location in the uterus, even the number of fibroids has a direct impact on the prolonged effect on the body. The size ranges from being almost undetectable to being a stem-like weighted structure, extending till the ribcage. The fibroids can be located in a woman’s uterine wall, inside the uterus, or even on its outer surface.
Fibroids are a common phenomenon observed in the female body at any given age however are diagnosed mostly in the case of childbearing years.
Symptoms
Given that the fibroids don’t carry a strong impact on the female body i.e. they don’t show any immediate symptoms in the initial stages, it is almost impossible to diagnose the same individually. In fact, many women might contain these fibroids for their life spans but might not be aware of it till the very end. A pelvic examination or prenatal ultrasound is recommended to be aware of this condition.
Even so, in the case of an abnormal spread- of multiple branching nodules, a few symptoms commonly noticed, are as follows:
They are generally classified by their location with Intramural fibroids (the most common ones) appearing within the muscular wall, Subserosal fibroids forming outside the uterus (serosa), Pedunculated fibroids being an extension (stem-like) of subserosal ones, and Submucosal fibroids developing in the middle layer known as the myometrium of the uterus. Out of all these, Submucosal is the rarest kind. The growth patterns of these fibroids may also vary from a slow pattern to a plunged growth spurt. One can also expect a change (even a decrease) in the size of these fibroids.
Causes
Clinical research and experience point out the following directions to map the causes of the fibroids since there are no firm findings on the same-
- Family History and Genetics: Due to a pattern in genetic history, fibroids can be observed which are differing from the normal uterine muscle cells.
- Hormonal Factors: The two hormones, Oestrogen, and Progesterone which act as the stimulators in the regeneration of the uterine lining with each menstrual cycle might also be a stimulator in the growth of these fibroids. Comparatively, fibroids have more oestrogen and progesterone reception capacity than the uterine muscles. A shrinkage tendency is also observed in them after the menopausal stage due to a loss in hormone production by the body.
- Pregnancy: Fibroids may be developed during pregnancy since the body develops an enhanced level of hormonal secretion.
- Growth Related Factors: Any additional substances which might alter or be used to maintain the body's hormonal and chemical levels such as insulin can also be singularly responsible for fibroid growth.
- Extracellular matrix or the ECM: Similar to the brick and mortar arrangement, ECM is the compound that is responsible for the cells to stick together. It also facilitates a change in growth factors and thus can cause biological changes in the cells leading to the formation of fibroids.
Risk Factors
Other than the female body through reproductive age, some focused risk factors that are known to have an impact on fibroids are as follows:
Age
Older women are known to be at a higher risk than younger women in case of developing fibroids, say within the age group of 30-40 years. Additionally, experiencing menstruation at a younger age than what is normal can also suggest a hormonal impact which in turn can show up in the form of fibroids.
Race
A question of some genetic element that increases the tendency of developing severe fibroids is suggested for African-American women through a study.
Birth Control Measures
The birth control measures like pills or the like leading towards a change in the hormonal composition of the body might lead to a fibroid formation.
Environmental Factors
Factors such as diet and eating habits (pointing towards deficiencies or even conditions such as obesity i.e., which are not under the normal healthy body set), a history of abuse leading to overall psychological conditions like stress or anxiety can also lead to an increase in the risk of developing fibroids. Alcohol consumption too can be considered a contributing factor to the condition.
Family history
It has been observed in the case of traced family histories that if the female members say an individual’s mother or sister has had a history of fibroids, it is most likely that the body of the person in question might have a greater risk or tendency to bear the same. This can be attributed to the cell composition and body characteristics in the family.
Diagnosis
A consultation with your gynaecologist will help you identify the problem. The diagnosis process of uterine fibroids includes a pelvic exam through which your doctor will check your uterus for any abnormalities in the size, shape, or condition. After your pelvic exam, you can ask your doctor any questions or doubts you might have about uterine fibroids. You can discuss the number of fibroids, their size, where they are located if they are growing with time, and what are your treatment options.
Uterine fibroids may also be found during a routine pelvic checkup if your doctor finds any irregularities during the consultation. Once your doctor confirms the presence of uterine fibroids, they may ask for the following tests for getting a proper diagnosis of your condition –
- Ultrasound: An ultrasound will be the first diagnostic test that your doctor may order to confirm the presence of fibroids. An ultrasound uses sound waves to reflect an image of your uterus. This can help your doctor identify, map, and measure the size of the fibroids. The ultrasound can be done externally, where the device is placed over your abdomen or it can be a transvaginal ultrasound.
- Blood Tests: Along with an imaging test like the ultrasound, your doctor may also ask you to get some blood tests done to identify the cause for the formation of fibroids. Fibroids can also cause abnormal menstrual bleeding, which could be an indicator of anaemia due to blood loss, bleeding disorder, or thyroid issues.
- Magnetic Resonance Imaging (MRI): In case an ultrasound is not sufficient to get a good look at your uterus and the fibroids, your doctor may order an MRI scan that will help them take a better look at the issue. The test will show more details about the size, growth, and position of the fibroids.
- Hysterosonography: Hysterosonography is also known as a saline infusion sonogram that helps your doctor see the inner lining of the uterus. In this diagnostic procedure, sterile saline water is put in the uterus to allow better visibility of the inner walls of the organ. This test can indicate any serious problems that may be happening due to the fibroids such as infertility due to the fibroids blocking the fallopian tubes.
- Hysteroscopy: This diagnostic procedure includes the insertion of a telescope-like device in the cervix that allows a doctor to examine the cervical opening and the uterus lining.
Treatment
There are various treatment options available for uterine fibroids. Your course of treatment may depend on factors like the number, size, and position of the fibroid, your age, any additional issues you may have, etc. You can consult your gynaecologist regarding the available treatment options and discuss them in detail before making any decision. Some of the common treatments are –
Medications
This course of treatment is best if fibroids are causing issues such as heavy menstrual bleeding, irregular menstrual cycles, pelvic pressure, etc. The medicines that your doctor prescribes can help regulate your hormones and get your menstrual cycle back on track. Some medicines work by shrinking the fibroids. Your gynaecologist may prescribe Gonadotropin-releasing hormone (GnRH) agonists that work by blocking the production of oestrogen and progesterone in the body and putting a temporary stop to your menstrual cycle. As a result, the uterine fibroids may shrink. Another treatment that your doctor may prescribe is a progestin-intrauterine device, which can help reduce the heavy bleeding caused due to uterine fibroids. Other medicines to regulate your menstrual cycle may also be used. You may also be asked to take pain relievers, vitamins, and iron supplements to help you with the symptoms.
Non-invasive Treatment
A non-invasive procedure to shrink the fibroid size could be a treatment option for you. In an MRI-guided focused ultrasound surgery, an ultrasound transducer is used while the patient is in the MRI scanner to see the exact position of the fibroids, and sound waves are focused on that area to heat the fibroids and shrink them. This technique is non-invasive, requires no incision, preserves your uterus, and can be done as an outpatient procedure.
Minimally Invasive Procedures
Multiple minimally invasive procedure options can be considered for removing or shrinking uterine fibroids. The uterine artery embolization procedure is effective in shrinking fibroids. The blood flow to the fibroids is stopped by injecting small embolic agent particles into the arteries that supply blood to the uterus. This causes them to shrink and die and will help in managing other symptoms as well. Another procedure is radiofrequency ablation, where radiofrequency energy is used to shrink the blood vessels to the fibroids, effectively destroying them. Laparoscopic or robotic myomectomy is a procedure where a small incision is made in the abdominal area to remove the fibroids. Hysteroscopic myomectomy may be done if you have submucosal fibroids. In this procedure, instruments are inserted through the vagina and cervix to reach the uterus and remove the fibroids. You may also have the option of endometrial ablation wherein an instrument is inserted in the uterus and heat, current, hot water, or microwaves may be used to destroy the lining of the uterus. Most women who get this procedure done may not be able to get pregnant.
Surgical Procedure
Surgical procedures like abdominal myomectomy and hysterectomy may also be considered if you have large and multiple fibroids that keep returning despite getting other procedures. Abdominal Myomectomy refers to a traditional surgical procedure where doctors remove the fibroids from the uterus. This surgical procedure could cause scarring in the uterus and may affect your chances of getting pregnant. On the other hand, Hysterectomy refers to the complete removal of the uterus and is the only permanent solution for treating uterine fibroids. Consult your doctor before making the decision to go ahead with a hysterectomy as this procedure is permanent.
Prevention
Not a lot of scientific evidence is available that sheds light on the reasons why women of child-bearing age develop uterine fibroids. This makes it difficult for women to know what could potentially lead to the development of these non-cancerous growths in the uterus. Your doctor may share some common steps that you could take to help avoid getting the fibroids, however, with little scientific evidence available, prevention may not be possible.
The bright side is that these are non-cancerous growths and often, do not require any form of medical treatment. The risk of getting fibroids can be decreased by following a healthy lifestyle, eating healthy food like vegetables and fruits, exercising regularly, and getting regular gynaecology checkups. Some research has also suggested that the risk of getting uterine fibroids may decrease if you take hormonal contraceptives. However, this is not a permanent or viable solution for everyone. Therefore, taking care of your body from a young age and following a healthy lifestyle is the best way to prevent getting fibroids.
FAQs
Yes, it is possible to get pregnant even if you have fibroids in the uterus. When you get pregnant even if there are fibroids in the uterus, the doctor will make a plan to monitor the fibroids. During pregnancy, there is a surge in the level of progesterone and oestrogen which help in the growth of your baby but these hormones will also support the growth of fibroids. Large fibroids can prevent the movement of your baby in the womb and it may result in the wrong position of the baby during delivery. You are also at a high risk of pre-term delivery or a caesarean section.
Taking medications for fibroid treatment can produce side effects. You must talk to the doctor about any medications that you are taking or other medical health problems before taking any new medicines. If you experience any side effects, you must talk to your doctor. Risks are also associated with the surgical treatment of fibroids. Surgery puts you at risk of infection.
If there are small fibroids in the uterus, there is no need for any treatment if you are not experiencing any symptoms. Some fibroids may go away after menopause because the level of hormones decreases after menopause. Women should maintain a healthy lifestyle and should try to do pelvic floor exercises to strengthen the muscles of the pelvic region.
Fibroids can be prevented by maintaining healthy body weight. A woman should visit a gynaecologist after 40 years of age for a regular health check-up. A pelvic examination can help in the early diagnosis of the problem. If you have small fibroids, your doctor will make a regular plan to monitor the growth of fibroids. Women should eat a healthy diet for balancing their hormones and for maintaining a healthy body weight.
Yes, being overweight increases the risk of developing fibroids. Women who are overweight are at a greater risk because hormones become imbalanced which may cause fibroids. Other risk factors for fibroids include family history, age above 40 years, menarche at an early age, late onset of menopause, other health problems such as sexually transmitted diseases.
