Uterine Fibroids

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Leiomyoma, or simply “myoma,” is another name for fibroids in a medical context. In your pelvis, the uterus is an organ with a pear-shaped shape on its side. The uterus’ typical size is comparable to a lemon. It is also known as the womb, and during pregnancy, it serves as the location where a baby develops and grows.

In the uterus, fibroids can develop into a single tumor or there may be several of them. Fibroid clusters can be as little as 1 mm or as large as 20 cm (8 inches) or even more. They can grow to be the size of a watermelon, for reference.

Uterine fibroids are a common condition in women. However, because uterine fibroids frequently don’t manifest any symptoms, you might not be aware that you have them. Inadvertent fibroids may be found by your doctor when performing a pelvic exam or prenatal ultrasound.

Symptoms of Uterine Fibroids

Location is the primary factor used to categorize fibroids. Intramural fibroids develop inside the uterine wall’s musculature. The uterine cavity is protruded into by submucosal fibroids. Subserosal fibroids protrude from the uterus’s wall.
Many women with fibroids have no symptoms at all. In those that do, symptoms can be influenced by the location, size, and the number of fibroids.
The most typical uterine fibroids symptoms and signs in women who experience them are as follows:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains
• Chronic vaginal discharge
• Increased abdominal distention (enlargement), causing your abdomen to look pregnant

As your hormone levels decrease after menopause, the symptoms of uterine fibroids typically stabilize or disappear.

Causes of Uterine Fibroids

Uterine fibroids have an unknown etiology, but studies and clinical experience indicate the following factors:

• Genetic changes. Numerous fibroids have gene alterations that are distinct from those found in ordinary uterine muscle cells.
• Hormones. The two hormones estrogen and progesterone, which encourage the uterine lining to form during each menstrual cycle in preparation for pregnancy, also appear to encourage the growth of fibroids.
• Compared to regular uterine muscle cells, fibroids have a higher concentration of estrogen and progesterone receptors. As hormone production declines after menopause, fibroids frequently get smaller.
• Additional growth factors. The development of fibroid tumors may be impacted by substances that aid in tissue maintenance, such as insulin-like growth factors.
• Extracellular matrix (ECM). ECM is the substance that binds cells together, just like a mortar holds bricks together. Increased ECM makes fibroids more fibrous. Additionally, the ECM stores growth substances and modifies the biology of the cells.

According to medical professionals, uterine fibroids originate from a stem cell in the uterus’ smooth muscle tissue (myometrium). Multiple divisions of a single cell result in the formation of a solid, rubbery mass that is different from the tissue around it.
Uterine fibroids can develop slowly, quickly, or stay the same size. Their growth patterns are variable. Some fibroids experience growth spikes, while others may naturally contract.

Risk factors of Uterine Fibroids

There are some things that can make a woman more likely to get fibroids. There are a number of variables that can affect fibroid development, such as:

• Race. Although fibroids are a possibility for all women of reproductive age, black women are more likely than women of other racial groups to have them. Additionally, black women are more likely to experience more severe symptoms, have more or larger fibroids, and experience their symptoms at a younger age.
• Heredity. You have a higher chance of getting fibroids if your mother or sister did.
• Higher body weight and obesity (a person is deemed obese if they are more than 20% over the healthy body weight).
• Age. As women get older, fibroids grow more prevalent, especially during the 30s, 40s, and menopause. Typically, fibroids reduce in size after menopause.
• Eating patterns. Consuming a lot of ham and red meat, such as beef, is associated with an increased chance of developing fibroids. Consuming a lot of green vegetables appears to shield females from getting fibroids.
• Alcohol
• Not having children.
• A lack of vitamin D
• Early menstrual cycle start (getting your period at a young age).

Pregnancy and fibroids

Usually, fibroids don’t prevent women from becoming pregnant. But it’s possible that fibroids, particularly submucosal ones, could lead to infertility or miscarriage.
Fibroid-positive women are more prone to experience complications during pregnancy and delivery. This does not imply that there will be issues. When you get pregnant and already know you have fibroids, your healthcare professional will collaborate with you to create a monitoring strategy for the fibroids.

Most fibroids-afflicted women experience routine pregnancies. Women with fibroids frequently have the following issues:

• Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
• The baby is breech. The baby is not positioned well for vaginal delivery.
• Labor fails to progress.
• Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
• Preterm delivery.

If you become pregnant while having fibroids, consult your physician. All obstetricians have dealt with fibroids during pregnancy in the past. The majority of women with fibroids who become pregnant do not require the services of an OB who specializes in high-risk pregnancies.

Prevention

There is little scientific data on how to prevent fibroid tumors, despite the fact that experts are still investigating their causes. Although it may not be possible to prevent uterine fibroids, only a tiny proportion of these tumors need to be treated.
By maintaining healthy body weight and obtaining frequent pelvic checks, you can lower your risk. Create a monitoring strategy with your healthcare professional if you have tiny fibroids.

Additionally, some data points to a possible link between utilizing hormonal contraceptives and a lower risk of fibroids.

Diagnosis

Oftentimes, uterine fibroids are discovered by chance during a normal pelvic check. When you see your doctor for a routine pelvic exam to check your uterus, ovaries, and vagina, your doctor may discover that you have fibroids. Quite frequently, your description of severe bleeding and other relevant symptoms may prompt your doctor to think about including fibroids in the diagnosis.

The following tests may be prescribed by your doctor if you exhibit uterine fibroids symptoms:

•  Ultrasound. Your doctor might request an ultrasound if further confirmation is required. In order to map and quantify fibroids as well as confirm the diagnosis, it uses sound waves to create a picture of your uterus.

To obtain photos of your uterus, a doctor or technician will either place the ultrasound transducer into your vagina or move it over your abdomen (transabdominal).

• Lab tests Your doctor can prescribe additional testing if you experience unusual menstrual bleeding to look into possible causes. A complete blood count (CBC) can help identify whether you have anemia from ongoing blood loss, and additional blood tests can help rule out thyroid issues or bleeding disorders.

Other imaging tests

Your doctor may request additional imaging tests if regular ultrasound is insufficient for gathering information, such as:

•   (MRI). By using imaging technology, it is possible to identify different tumor kinds, see in greater detail the size and location of fibroids, and choose the best course of therapy. Women with larger uteruses or those who are close to menopause are the ones most likely to undergo an MRI (perimenopause).
• Hysterosonography. In women who are trying to get pregnant or who are experiencing heavy monthly flow, hysterosonography, also known as a saline infusion sonogram, uses sterile salt water (saline) to expand the uterine cavity to make it easier to see submucosal fibroids and the lining of the uterus.
• Hysterosalpingography. In hysterosalpingography, the uterine cavity and fallopian tubes are highlighted on X-ray pictures using a dye. If there is a concern about infertility, your doctor might advise it. This test may reveal certain submucosal fibroids and assist your doctor in determining whether your fallopian tubes are blocked or open.
• Hysteroscopy. Your doctor will pass a tiny, illuminated telescope called a hysteroscope through your cervix and into your uterus for this examination. Then, after injecting saline into your uterus to expand the uterine cavity, your doctor can inspect your uterus’s walls and the apertures of your fallopian tubes.
• Laparoscopy. A small incision made in or close to the navel is used by the doctor to insert a long, thin scope. The scope features a camera and a bright light. During the surgery, the doctor can use a monitor to see the uterus and other organs. Pictures may also be produced.

Treatment

Depending on the size, number, and location of the fibroids as well as the symptoms they’re producing, there are many approaches to treating uterine fibroids. You might not need treatment if your fibroids aren’t giving you any symptoms. Small fibroids can frequently be ignored.

Medications

The symptoms of uterine fibroids, such as excessive monthly flow and pelvic pressure, are treated with medications that target the hormones that control your menstrual cycle. They may cause fibroids to shrink, but they do not remove them. Medications consist of:

• Gonadotropin-releasing hormone (GnRH) agonists. GnRH agonist medications work to treat fibroids by preventing the production of estrogen and progesterone, which temporarily mimics menopause. Menstruation ceases, as a result, fibroids decrease, and anemia frequently gets better.
  Leuprolide (Lupron Depot, Eligard, among others), goserelin (Zoladex), and triptorelin are GnRH agonists (Trelstar, Triptodur Kit).
  When utilizing GnRH agonists, a lot of women get severe hot flashes. GnRH agonists are normally used for no longer than three to six months since long-term use might result in bone loss and symptoms returning after the medicine is stopped.
  Before a planned operation or to help you enter menopause, your doctor may prescribe a GnRH agonist to reduce the size of your fibroids.
• Progestin-releasing intrauterine device (IUD). An IUD that releases progesterone can stop excessive bleeding brought on by fibroids. A progestin-releasing IUD merely relieves symptoms; it does not reduce or eliminate fibroids. It also avoids getting pregnant.
  Before a planned operation or to help you enter menopause, your doctor may prescribe a GnRH agonist to reduce the size of your fibroids.
• Tranexamic acid (Lysteda, Cyklokapron). To reduce painful menstrual cycles, people take this nonhormonal medicine. Only days with significant bleeding are taken.
• Other medications. Other medications may be suggested by your doctor. For instance, while oral contraceptives can help regulate menstrual bleeding, they have little effect on fibroid size.
  Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal pharmaceuticals, may be useful in reducing fibroids-related pain, but they have no effect on fibroids’ tendency to hemorrhage. If you have excessive menstrual bleeding and anemia, your doctor can also advise you to take vitamins and iron.

Noninvasive procedure

MRI-guided focused ultrasound surgery (FUS) is:

• A non-invasive, outpatient procedure for the treatment of uterine fibroids that keeps your uterus intact.
• Performed while you’re inside an MRI scanner equipped for therapy with a high-energy ultrasound transducer. Your doctor can precisely locate the uterine fibroids thanks to the photos. The ultrasonic transducer concentrates sound waves (sonications) into the fibroid at the chosen site, where they cause small patches of fibroid tissue to heat up and be destroyed.
• Newer technology, Therefore, scientists are discovering more about the effectiveness and safety over the long term. But the evidence thus far gathered indicates that FUS for uterine fibroids is both secure and efficient.

Minimally invasive procedures

Uterine fibroids can be eliminated using specific methods without having to be surgically removed. They consist of:

• Uterine artery embolization. Small particles (embolic agents) are injected into the uterine arteries, blocking the flow of blood to the fibroids, which causes them to contract and eventually die.
  This method has the potential to reduce fibroids and relieve the problems they bring on. If your ovaries or other organs’ blood flow is disturbed, complications could result. Research reveals that transfusion risk is significantly decreased, and consequences are comparable to those seen with surgical fibroid therapies.
• Radiofrequency ablation. Radiofrequency energy is used in this therapy to eliminate uterine fibroids and constrict the blood arteries that feed them. This can be carried out laparoscopically or transcervical. The fibroids are frozen using a similar method called cryomyolysis.
  Your doctor creates two tiny abdominal incisions for laparoscopic radiofrequency ablation (Acessa), also known as Lap-RFA, in order to implant a thin viewing device (laparoscope) with a camera at the tip. Your doctor finds the fibroids that need to be treated using a laparoscopic camera and a laparoscopic ultrasound instrument.
  Your doctor locates a fibroid and inserts many tiny needles into it using a specialist tool. The fibroid tissue is heated by the needles and is therefore destroyed. Immediately after being destroyed, a fibroid undergoes a consistency change, going from being hard like a golf ball to being soft like a marshmallow. The fibroid continues to diminish over the following three to twelve months, alleviating discomfort.
  Lap-RFA is viewed by clinicians as a less invasive option than hysterectomy and myomectomy because no uterine tissue is cut. After recovering for 5 to 7 days, the majority of women who undergo the surgery resume their normal activities.
  Ultrasound guidance is also used in the transcervical (through the cervix) method of radiofrequency ablation (Sonata) to identify fibroids.
• Laparoscopic or robotic myomectomy. In a myomectomy, the uterus is left in place while the surgeon removes the fibroids.
  You and your doctor may decide on a laparoscopic or robotic operation if there are only a few fibroids, which employs thin devices inserted through tiny incisions in your belly to remove the fibroids from your uterus.
  Morcellation, which can be performed inside a surgical bag, or extending one incision to remove the fibroids are two methods for removing larger fibroids through fewer incisions.
  A tool with a tiny camera on it allows your doctor to see your abdomen on a monitor. Robotic myomectomy allows for greater precision, adaptability, and agility than is feasible with some conventional treatments since it gives your surgeon a magnified, 3D picture of your uterus.
• Hysteroscopic myomectomy. If the fibroids are only present inside the uterus, this procedure can be an option (submucosal). Instruments are put into your uterus through your vagina and cervix by your surgeon to access and remove fibroids.
• Endometrial ablation. This procedure, carried out with a specialized tool put into your uterus, damages the lining of your uterus with heat, microwave energy, hot water, or electric current, either terminating menstruation or lessening the flow.
  Abnormal bleeding can typically be stopped with endometrial ablation. While submucosal fibroids can be removed during hysteroscopy for endometrial ablation, this does not apply to fibroids that are beyond the uterus’ internal lining.
  After endometrial ablation, women are unlikely to become pregnant, but birth control is necessary to stop a pregnancy from growing in a fallopian tube (ectopic pregnancy).

Any operation that doesn’t remove the uterus carries the possibility of additional fibroids developing and manifesting symptoms.

Traditional surgical procedures

Traditional surgical treatments have the following alternatives:

• Abdominal myomectomy. Your doctor may do an open abdominal surgical treatment to remove the fibroids if you have numerous, very large, or very deep fibroids.
  An abdominal myomectomy can often be performed in place of a hysterectomy for many women. However, scarring from surgery may impair fertility in the future.
• Hysterectomy. This procedure eliminates the uterus. The only lasting treatment for uterine fibroids is still this one.
  Having a hysterectomy makes it impossible to get pregnant. Menopause and the decision to undergo hormone replacement therapy are brought on by surgery if you also choose to have your ovaries removed. The majority of uterine fibroid sufferers may opt to maintain their ovaries.