Fibroids

Fibroids are muscular growths that develop in the walls of the uterus (womb). They are almost always non-cancerous (benign) and can grow as a single tumor or multiple ones. These growths vary in size, from as small as a seed to as large as a grapefruit, and in rare cases, they can get much bigger.

Prevalence

Fibroids are common; between 20% to 80% of women will develop them by the time they turn 50. They usually appear in women in their 40s and 50s. Many women with this muscular growths don’t experience symptoms, but for those who do, the symptoms can be challenging. Some experience pain or heavy menstrual bleeding. Large fibroids can press on the bladder, leading to frequent urination, or on the rectum, causing discomfort. In extreme cases, they may cause the abdomen to swell, giving the appearance of pregnancy.

Causes

The exact cause of fibroid isn’t clear. However, certain factors are believed to play a role:

Hormonal Influence: Estrogen and progesterone, two key female hormones, seem to control fibroid growth. Fibroids grow quickly during pregnancy when hormone levels are high and often shrink after menopause or with hormone-suppressing medication.
Genetics: A family history of fibroid increases the likelihood of developing them.

Where Can Fibroids Grow?

Fibroids generally grow within the uterine wall, and their location determines how they are classified:

Submucosal: Grow into the uterine cavity.
Intramural: Develop within the wall of the uterus.
Subserosal: Grow on the outer surface of the uterus.

Some fibroids grow on stalks attached to the uterus, resembling mushrooms. These are called pedunculated fibroids.

Symptoms

Many women don’t experience symptoms, but those who do may have:

Heavy or painful menstrual bleeding
A feeling of fullness or swelling in the lower abdomen
Enlarged lower stomach area
Frequent urination
Pain during sexual intercourse
Lower back pain
Complications during pregnancy, like a higher risk of cesarean delivery
Infertility, though rare

Risk Factors

Several factors can increase a woman’s chances of developing his muscular growths:

Age: Fibroids are more likely to appear as women get older, particularly in their 30s and 40s.
Family History: If a close relative, like a mother, had fibroids, the chances of developing them are higher.
Ethnic Background: African-American women are more prone to fibroids than white women.
Obesity: Being overweight raises the risk, with very heavy women being 2-3 times more likely to get fibroids.
Diet: Consuming a lot of red meat is linked to a higher risk, while a diet rich in green vegetables may lower it.

Diagnosis

Your doctor may detect fibroid during a routine pelvic exam, where they feel for lumps or masses in the uterus. They may also use imaging tests to confirm the diagnosis, including:

Ultrasound: Uses sound waves to create images of the uterus.
MRI: A more detailed imaging test using magnets and radio waves.
X-ray or CT scan: Can offer clearer views of fibroids from different angles.
Hysterosalpingogram or Sonohysterogram: Both involve inserting a liquid (dye or water) into the uterus to capture clearer images.

In some cases, minor surgery, like laparoscopy or hysteroscopy, may be needed for diagnosis.

Treatment for Fibroids

Treatment depends on symptoms, the size and location of the fibroids, your age, and whether you plan to have children. If you don’t have symptoms, no treatment may be necessary, but your doctor will monitor your condition over time.

Medications

For mild symptoms, over-the-counter pain relievers like ibuprofen can help. If heavy bleeding is an issue, iron supplements can prevent or treat anemia. Hormonal treatments like low-dose birth control pills, injections like Depo-Provera, or a hormonal IUD like Mirena® can also help manage symptoms. More advanced drugs like GnRHa (e.g., Lupron®) can shrink fibroids but come with side effects and are usually only a temporary solution.

Surgical Options

For moderate to severe symptoms, surgery may be recommended:

Myomectomy: Removes fibroid while preserving the uterus, ideal for women who want to have children.
Hysterectomy: Complete removal of the uterus, which is a permanent solution but is major surgery.
Endometrial Ablation: Destroys the lining of the uterus to stop heavy bleeding.
Myolysis: Uses electric current or freezing to destroy fibroids.
Uterine Fibroid Embolization (UFE): Blocks blood flow to fibroids, causing them to shrink.

New and Emerging Treatments

Some new treatments for fibroids include:

Radiofrequency ablation: Uses heat to shrink fibroids while leaving the uterus intact.
Anti-hormonal medications: May provide relief without the side effects of traditional hormonal treatments.

Complications of Uterine Fibroids

Anemia: Heavy menstrual bleeding can lead to anemia, which is a reduction in red blood cells. Symptoms of anemia include fatigue, dizziness, and weakness. In severe cases, blood transfusions may be necessary.

Fibroid Size and Danger

Small Fibroids (2-6 cm): These typically do not cause symptoms and may not require treatment. Monitoring through regular medical check-ups is recommended.
Large Fibroids (>6 cm): These can cause significant issues like heavy bleeding, pelvic pain, and pressure on nearby organs (bladder or rectum). Larger fibroids may also be more challenging to treat or remove.

Can Fibroids Become Cancerous?

Fibroids are almost always benign. In rare cases (less than 1 in 1,000), a cancerous type of fibroid called leiomyosarcoma can develop. However, having fibroids doesn’t increase the risk of developing uterine cancer.

Fibroids and Pregnancy

Women with fibroids are more likely to face pregnancy complications, but many still have healthy pregnancies. Possible issues include:

A higher chance of needing a cesarean section (C-section)
Breech positioning of the baby
Delayed labor progress
Premature delivery
Placental abruption, where the placenta separates from the uterus before birth

If you are pregnant and have fibroid, talk to your obstetrician, who can help manage any potential risks.

Prevention of Uterine Fibroids

While fibroid cannot be completely prevented, certain lifestyle factors may help reduce the risk:

Diet: Eating a diet rich in fruits, cruciferous vegetables (broccoli, cabbage, etc.), and fiber may lower the risk of developing fibroids. Conversely, high-sugar diets have been linked to an increased risk.
Exercise: Regular physical activity may also reduce the chances of fibroid development.

Fibroids After Menopause

Symptom Improvement: Most fibroids shrink after menopause due to the drop in hormone levels, leading to symptom relief.
Post-Menopausal Fibroid Growth: While rare, fibroid growth after menopause could indicate a need for further medical evaluation, as it may signal other health concerns.

Key Takeaway

Uterine fibroids, while common and noncancerous, can vary significantly in their impact. They are influenced by hormones and genetics, and their symptoms range from mild to severe. Treatments depend on the fibroid size, location, and the severity of symptoms, with options from medication to surgery. A healthy diet and regular exercise may help lower the risk of developing fibroids.

Sources

Health System – University of Michigan
Webmd
MedlinePlus: “Relugolix, Estradiol, and Norethindrone,” Elagolix, Estradiol, and Norethindrone.”
UCLA Health
American Journal of Clinical Nutrition: “Dietary glycemic index and load in relation to risk of uterine leiomyomata in the Black Women’s Health Study”
Surgical Science: “Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy – A Case Report and Review of Literature
WomensHealth.gov
Mayo Clinic:
American College of Obstetricians and Gynecologists: “Hysterosalpingography”
Fibroid Specialists of University Vascular: “Fibroid vs Cyst vs Polyp Differences”
Cleveland Clinic
Magnolia Regional Health Center
Journal of Obstetrics and Gynaecology Research

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