Uterine fibroids, clinically known as uterine leiomyomata, are the most common form of non-cancerous growth in the uterus for women of child-bearing age. These fibroids are made up of groups of muscle cells and other tissues and can range from the size of a pea to a large, round growth that may be more than 5 to 6 inches (12.7 to 15.24 centimeters) wide. Fibroids can be found inside the uterine cavity (submucosal), on the wall of the uterus (intramural) or the outside of the uterus (subserosal).
As many as 20 to 80 percent of women will develop fibroids by the time they reach age 50, according to the National Women’s Health Information Center. However, it’s hard to say exactly how many women have them because many women have no symptoms at all. Studies, including a randomized Scandinavian study of 335 asymptomatic women as well as another study conducted among 1,364 women between the ages of 35 and 49 in the Washington, D.C., area, have shown that the likelihood of getting fibroids increases with age. African American women also have three times the risk of developing fibroids compared to white women, according to statistics from the National Institutes of Health’s Nurses’ Health Study.
Signs & Symptoms
Many women don’t have any symptoms, but when they do they can include heavy or painful periods or unexpected bleeding between periods, according to the NIH. If the fibroid grows unchecked, it can cause acute or chronic pressure or pain against the bladder or the intestines. In such cases, the patient may experience lower back pain, frequent urination and pain during sex.
Diagnosis & Tests
Ultrasound is the most common way to detect uterine fibroids. There are two types of ultrasounds: transabdominal, where the transducer is placed over the abdomen to obtain an image (much like prenatal ultrasound), and transvaginal, where the transducer is placed inside the vagina. According to the Mayo Clinic, the former method can cover a larger area both inside and outside the uterus and the surrounding abdominal area, while the latter method provides more details since it is closer to the uterus.
Other imaging techniques include hysterosalpingography, which uses an injectable X-ray dye to highlight the uterine cavity and fallopian tube in order to provide better-detailed X-ray images, and hysteroscopy, where a long, thin scope with a light and a camera is inserted into the uterus through the cervix. Both of these imaging techniques can also be used detect other conditions and growths, such as polyps.
Fibroids are almost always benign and don’t increase the risk of developing a cancerous fibroid, nor do they increase the chances of developing other cancers in the uterus, according to the National Women’s Health Information Center.
In rare cases, fibroids can distort and block the fallopian tubes, making it more difficult for the sperm to move from the cervix into the fallopian tubes. Occasionally, submucosal fibroids that grow in the uterine cavity may prevent implantation and growth of an embryo. In some cases, multiple fibroids or a single large fibroid can distort the uterine cavity and cause complications. But overall, fibroids usually don’t interfere with conception and pregnancy.
Some pregnant women will experience localized pain during the first and second trimester, according to the Mayo Clinic. However, this can be treated with over-the-counter painkillers.
Treatments & Medication
Fibroids can be controlled through medication, surgery or other nonsurgical procedures. Gonadotropin releasing hormone agonists (GnRHa), such as those under the tradename Lupron and Synarel, can provide temporary relief by shrinking the fibroids and controlling heavy bleeding. However, this is not a permanent solution, as GnRHas can cause bone thinning and their use is generally limited to six months or less, according to the National Women’s Health Information Center. In addition, fibroids often grow back quickly once the patient stops taking the drug.
Certain symptoms, such as excessive bleeding, can be treated with endometrial ablation, which uses heat, microwave energy, hot water or an electric current to slough off the endometrial lining of the uterus. However, the procedure will not alleviate symptoms caused by fibroids growing on the outside of the uterus and it will affect child bearing.
Hysterectomy — the complete removal of the uterus — is, so far, the only proven permanent solution for uterine fibroids. In fact, uterine fibroid is one of the three most common reasons why hysterectomy is performed, according to the Centers of Disease Control and Prevention. The procedure eliminates the ability to bear children and, if the ovaries are also removed, initiates menopause immediately.
Myomectomy removes the fibroids without removing the healthy part of the uterus. While this surgical option is preferable for women who still wish to bear children, there will be a risk of fibroid reoccurrence. The surgery can be minimally invasive and performed through a small incision using a laparoscope. However, if there are multiple fibroids, a single large fibroid or fibroids that are deeply embedded in the uterus, the surgeon may have to create a larger incision to remove all the fibroids.
Another minimally invasive option is uterine artery embolization. During the procedure, a thin catheter the size of a spaghetti strand is inserted into the arteries that feed into the uterus. Small plastic or gel particles are then injected into the catheter to block the blood supply to the fibroid, causing it to shrink. The procedure is most suitable for women with fibroids that cause chronic pain or compression of the bladder or rectum, or women who experience significant bleeding, according to the University of Maryland.
Another treatment option is myolysis, which uses an electric current, laser or liquid nitrogen to destroy the fibroids and shrink the blood vessels around them. However, the safety, effectiveness and risk of recurrence of these procedures are still unclear, according the Mayo Clinic.