Fibroids of the uterus Understand the causes, diagnosis and treatment options
Uterine fibroids (Fibroids of the uterus) are a common type of non-cancerous tumor that can grow in the uterus, but not all fibroids cause symptoms, and if they do occur, symptoms can include heavy menstrual bleeding, back pain, frequent urination, and pain during intercourse.
What are uterine fibroids
Uterine fibroids (also called muscular tumors) are tumors of muscle and tissue that form in the uterine wall.
These tumors are usually non-cancerous (benign) and are the most common non-cancerous tumor in women.
Uterine fibroids can cause a variety of symptoms such as pain and heavy and irregular vaginal bleeding. Sometimes, a woman has no symptoms and does not realize that she has fibroids. Treatment of fibroids usually depends on the symptoms you experience.
Where do fibroids grow
Fibroids can grow as a single node or a group of several nodes. The size of fibroid clusters can range from 1 millimeter to more than 20 centimeters (8 inches) in diameter or even larger.
For comparison, fibroids can be as small as seeds or become larger in size. These tumors can develop inside the uterine wall, inside the main cavity of the uterus, or on the outer surface of the uterus.
Types of uterine fibroids
There are different types of uterine fibroids depending on where they are located and how they are related. Specific types of uterine fibroids include:
- Intrauterine fibroids: These fibroids occur in the muscular wall of the womb. This type is most common among women and is in multiple sizes to have mild symptoms in case of small size to include back or pelvic pain and heavy menstrual cycle as well as irregular bleeding between periods.
- Sub-mucous fibroids: These fibroids grow under the inner layer of the womb, which is known as the mucous membrane, and are in small sizes, and include several symptoms, the most important of which are the bleeding of the boiler in the menstrual cycle.
- Sub-serological fibroids: This type of fibroids grows under the lining of the outer surface of the womb. It can become very large, but interesting in this type it causes less problems in the womb but its symptoms are more in the organs adjacent to the womb.
- Necked fibroids: This type is less common, these fibroids stick to the uterus with a marketplace and can grow inside or outside the womb. Symptoms may be mild but cause severe pain.
Are fibroids common
Fibroids are a very common type of tumor. Approximately 40% to 80% of women suffer from fibroids. It often occurs in persons aged between 30 and 50 years and is less common in women who have entered menopause.
Symptoms of uterine fibroids
Most small fibroids do not cause any symptoms and do not require treatment other than regular monitoring by the competent doctor, but large fibroids can cause you a variety of symptoms, including:
- Excessive or painful bleeding during the menstrual cycle.
- Bleeding between your period.
- Bloating in the lower abdomen.
- Frequent urination (this can happen when the fibroids pressure your bladder).
- Pain during the practice of intimacy.
- Lower back pain.
- Constipation or feeling pressure on the rectum.
- Chronic vaginal secretions.
- Inability to urinate or empty the bladder completely.
- Enlarged abdomen.
Symptoms of uterine fibroids usually stabilize or disappear after menopause because hormone levels decrease within your body.
The form of fibroids
Fibroids are usually round growths that look like soft bumps. In some cases, they can be tied to a thin leg, giving them a mushroom-like appearance.
Causes of uterine fibroids
The exact cause is unknown, but doctors believe that the hormones estrogen and progesterone play a role.
Most fibroids occur in women of childbearing age. Studies show that fibroids tend to grow when hormone levels are higher (such as during pregnancy) and shrink when hormone levels are low (such as during the transition to menopause).
Risk factors for uterine fibroids
There are several risk factors that can play a role in the chances of developing fibroids. They can include the following:
- Obesity and high body mass index (BMI).
- Family history of fibroids.
- Not having children.
- Early onset of menstruation (getting menstruation at an early age).
- The late age of menopause.
Complications of uterine fibroids
Most uterine fibroids do not cause serious complications. However, the most common complications of fibroids are:
- Swelling of the abdomen or pelvic area.
- Excessive bleeding.
- Anemia.
- Infertility (this is rare).
Diagnosis of uterine fibroids
In many cases, doctors detect uterine fibroids during a pelvic examination. It may also alert profuse bleeding and other related symptoms to consider fibroids as part of the diagnosis. There are several tests that can be done to confirm fibroids and determine their size and location. Such tests can include:
- Magnetic resonance imaging: this test creates detailed images of your internal organs using magnets and radio waves.
- Computed tomography: computed tomography uses X-ray images to make a detailed picture of your internal organs from several angles.
- Hysteroscopy: during a hysteroscopy, the doctor will use a device called an endoscope (a thin, flexible tube with a camera at the end) to look at the fibroids inside the uterus. The scope is passed through the vagina and cervix and then go to the uterus.
- Hysterography: this is a detailed X-ray in which a substance is injected and then an X-ray of the uterus is taken.
- Ultrasound hysterography: in this imaging test, the doctor places a small catheter in the vagina and then injects a saline solution into the uterus. This extra fluid helps to create a clearer picture of your uterus than you see during a standard ultrasound.
- Laparoscopy: during this test, the doctor will make a small cut (incision) in the lower abdomen. A thin, flexible tube with a camera will be inserted at the end to look closely at your internal organs.
Treatment of uterine fibroids
Treatment of uterine fibroids can vary depending on the size, number and location of the fibroids, as well as the symptoms they cause.
If you don’t experience any symptoms from fibroids, you may not need treatment. Some people do not experience any symptoms or have any problems associated with fibroids.
In these cases, the doctor may recommend monitoring fibroids through uterine examinations or ultrasound.
If you have symptoms of fibroids including anemia caused by excessive bleeding, moderate to severe pain, or urinary and intestinal problems, you will need treatment to help. Your treatment plan depends on some factors , including:
- The number of fibroids.
- The size of fibroids.
- The place of fibroids.
- The symptoms you experience related to fibroids.
- The desire to preserve the uterus.
The best treatment option for you also depends on your plans for future pregnancy, treatment options for uterine fibroids can include:
Medicines
Over-the-counter pain medications: these medications help manage the pain and discomfort caused by fibroids. Over-the-counter medications include Acetaminophen and ibuprofen.
Iron supplements: if you have anemia caused by excessive bleeding, you may also be suggested to take an iron supplement.
Birth control
Birth control can also help to specifically treat the symptoms of fibroids, heavy bleeding during and between menstrual cycles and menstrual cramps. There are a variety of birth control options that you can use, including oral birth control pills, rings, injections, and intrauterine devices (IUDs).
Gonadotropic hormone agonists
These drugs work to shrink fibroids. They are sometimes used to shrink the fibroid before surgery, making it easier to remove the fibroid. However, these drugs are temporary, and if you stop taking them, fibroids can grow again.
Oral treatments
Elagolix is a new oral treatment for the management of profuse uterine bleeding in women who have not experienced menopause with symptomatic uterine fibroids. It can be taken for up to 24 months.
Another oral remedy, tranexamic acid, treats profuse menstrual bleeding in people with uterine fibroids.
Fibroid surgery
There are many factors to consider when talking about different types of surgery to remove fibroids.
Not only the size, location and number of fibroids can affect the type of surgery, your wishes for a future pregnancy can also be an important factor when developing a treatment plan.
Some surgical options preserve your uterus and allow you to get pregnant in the future, while other options can damage the uterus or lead to its removal.
Muscular tumor removal is a procedure that allows your doctor to remove fibroids. There are several types of muscle tumor ablation.
The type of procedure that may work best for you depends on where you have fibroids, their size, and number. Types of muscle tumor removal procedures to remove fibroids can include:
- Hysteroscopy: the doctor inserts a binoculars (a thin and flexible tube-like instrument) through the vagina, cervix and into the uterus
- Laparoscopy: In this procedure, your doctor will use a speculum to remove fibroids. Unlike hysteroscopy, this procedure involves putting a few small cracks in your abdomen. This is how it will enter the range and come out of your body.
- Abdominal opening: During this procedure, the caregiver makes a larger incision in the abdomen and removes fibroids through this wound.
- If you are not planning a future pregnancy, there are additional options that doctors may recommend. These options can be very effective, but they prevent future pregnancy. These can include:
- Hysterectomy: The doctor removes the uterus during the hysterectomy. Hysterectomy is the only way to treat fibroids. By completely removing the uterus, fibroids cannot return and symptoms must disappear. If you leave the ovaries in place, you will not enter menopause after a hysterectomy. This procedure may be recommended if you have very severe bleeding from fibroids or if you have significant fibroids. Minimally invasive hysterectomies include vaginal, laparoscopic or robotic methods.
- Uterine fibrosis: This procedure is performed by an interventional radiologist with the help of your gynaecologist. They place a small catheter in the uterine artery or hepatotransference and inject small particles, which then prevent blood flow from the artery to fibroids. Loss of blood flow reduces fibroids and improves symptoms. But this procedure may not be appropriate for everyone.
- Radio frequency ablation: This is a safe and effective treatment that uses radio frequency energy to treat uterine fibroids. It is recommended for people who have not reached menopause. Treats small fibroids.
The size of uterine fibroids before their surgical removal
No specific size of the fibroid automatically means that it needs to be removed. The specialist will determine whether surgery is necessary based on the symptoms. For example, fibroids the size of a small marble may still cause excessive bleeding depending on their location. Your doctor can discuss symptoms that may require surgical intervention.
What happens if fibroids are not treated
If you have no symptoms, treatment for fibroids may not be necessary. If you have large fibroids or the symptoms are causing you pain and discomfort, getting treatment may be the best option. Only you and your doctor can determine the best course of treatment or if treatment is necessary.
Prevention
Can fibroids be prevented
In general, you cannot prevent fibroids. You can reduce the risk by maintaining a healthy body weight and having regular check-ups. If you have small fibroids, make a plan with your health care provider to monitor them.
Is it possible to get pregnant if there are uterine fibroids
Yes, pregnancy is possible if you have fibroids in the uterus. If you already knew you had fibroids when you became pregnant, your doctor will work with you to develop a fibroid monitoring plan. During pregnancy, your body releases elevated levels of hormones.
These hormones support pregnancy. However, they can also cause your fibroids to increase. Large fibroids can cause the following problems during pregnancy:
- The risk of cesarean section increases because the fetus cannot turn over in a head-down position.
- Placental abruption.
- Premature birth.
Can fibroids change over time
Fibroids can shrink or grow over time. Its size can change suddenly or steadily over a long period of time. This can happen for a variety of reasons, but in most cases, such a change in the size of fibroids is related to the amount of hormones in your body.
When you have high levels of hormones in your body, fibroids can get bigger. This can happen at specific times in your life, such as during pregnancy.
Fibroids can also shrink when hormone levels decrease. This is common after menopause. Often, the symptoms can also improve after menopause.
Do fibroids disappear on their own
Fibroids in some women can shrink after menopause. This happens due to a decrease in hormones. When fibroids shrink, the symptoms may disappear. Small fibroids may not need treatment if they do not cause any symptoms.
