The Office on Women’s Health, part of the U.S. Department of Health and Human Services, estimates that between 20%-80% of women will develop uterine fibroids by the time they are 50 years old. While not all women will have symptoms associated with fibroids, those who do often report a great deal of discomfort that can be very challenging to live with.
What are Uterine Fibroids?
To understand fibroids (also known as leiomyomas), it’s important to understand the structure of the uterus. The uterine cavity is surrounded by the multilayered uterine wall; this is composed of three layers known as the perimetrium, the myometrium, and the endometrium. The perimetrium is the outer covering, and the endometrium is the inner layer that is sloughed off during the menstrual cycle. It is in the myometrium, a uterine layer composed of smooth muscle tissue, where fibroids most frequently form.
These abnormal, fibrous growths can vary greatly in size and position. Some fibroids can be very small and aren’t even visible to the human eye. Large fibroids can become so large that they can actually distort the shape of the uterus or cause it to expand; some women end up having multiple fibroids that can grow large and push against their rib cage.
Since uterine fibroids are technically tumors, the initial diagnosis can be alarming. One piece of good news about these tumorous masses, however, is that they very rarely become cancerous. Most estimates put the chances of fibroids becoming cancerous at 1 in 1000.
What are the Different Types of Fibroids?
Though cancer is very rare, fibroids can still present a number of problems for the patient. The severity of the condition generally depends on their location within the uterus; this is also how doctors categorize the various types:
- Intramural: The most common variety, intramural fibroids, form inside the myometrium—the middle layer of the uterus composed of smooth muscle. Intramural fibroids can expand into the uterine cavity, yet they often are asymptomatic in most women unless they become particularly large. In such cases, the position in the myometrium can cause the uterine cavity to become distorted or elongated.
- Subserosal: This type forms on the surface of the perimetrium (the outer covering of the uterus) and grows outward into the pelvic cavity. Large subserosal fibroids can sometimes grow large enough to put pressure on other organs in the area.
- Pedunculated: Pedunculated fibroids usually start out as one of the other types of fibroid, but when they become separated from the uterine wall they remain attached by a thin piece of tissue.
- Submucosal: One of the least common types, submucosal fibroids, form underneath the endometrial lining of the uterus and push out into the uterine cavity. It is because of the location that this type can have the greatest negative impact on fertility.
- Cervical: Cervical fibroids form in the cervix and may negatively impact fertility or the urinary tract. This type is also fairly rare.
The number, size, and type of fibroids that can develop varies from person to person, but generally most women who are afflicted have more than one at a time. It is also possible to have multiple types occurring simultaneously.
Who Gets Fibroids?
Since many women who develop fibroids are asymptomatic, they may not even know that they have them. For this reason, the number of cases may be considerably larger than what is currently known. However, research has shown there are risk factors for some women:
- Family history: Some studies have indicated that there may be a genetic predisposition for fibroids; the daughter of a woman with fibroids is three times more likely to also develop fibroids.
- Age: The majority of cases develop in women who are between the ages of 35 and 50. After menopause, fibroids often calcify or shrink.
- Ethnicity: African-American women have the highest risk factor.
- Eating habits: Recent studies have pointed to the consumption of beef and pork as a factor in the chances to develop fibroids.
- Obesity: Overweight women have a higher than average risk of developing fibroids, and for extremely obese women the chance is two to three times as likely.
What Causes Fibroids?
Doctors still don’t really know what precisely causes fibroids. Most current research seems to indicate a genetic link, especially given how likely it is to be passed on from mother to daughter. It is possible that the genes involved in the growth of uterine muscle cells may play a part.
There have also been some indications that certain hormones are central to the development of fibroids. Since estrogen and progesterone, two hormones produced by the ovaries, are responsible for the regeneration of the wall of the uterus, it could be possible that they are linked to the formation of fibroids.
Fibroids hardly ever develop prior to the first menstrual period, so the increased estrogen and progesterone associated with pregnancy may lend credence to this theory; there has been significant evidence that pregnancy actually increases the growth of fibroids. Moreover, they tend to shrink after menopause.
What are the Symptoms of Uterine Fibroids?
As discussed earlier, many women don’t even have symptoms; this is usually because the fibroids are either small or few in number. For those who do experience symptoms, there are some common examples:
- Heavy bleeding during or in between menstrual cycle
- Heavy periods lasting longer than a week
- Swelling or pressure in the lower abdomen
- Severe menstrual cramping
- Difficult or frequent urination
- Aches and pains in the pelvis, lower back, or legs
How Are Fibroids Diagnosed?
Because some women are simply unaware of their presence, or because the symptoms can be mistaken for other conditions, fibroids are often detected incidentally by gynecologists or obstetricians during routine exams. If during a pelvic exam, the doctor detects irregularities in the shape of the uterus, she may order an ultrasound or magnetic resonance imaging test (MRI) to get a deeper look.
In some cases where heavy vaginal bleeding has been reported, the doctor may also order a blood test. The goal in these situations is to determine if anemia is a factor and what other conditions may be ruled out that also cause bleeding.
How Are Fibroids Treated?
For women with mild or no symptoms, the doctor may suggest no action for a time to observe the progression. Since the chance for fibroid tumors to become cancerous is exceedingly rare, doctors may recommend waiting to see if the condition worsens. Some women are able to live with the symptoms when they are very mild.
Since there isn’t a “cure” available, the doctor may use medication to shrink fibroids that have been detected. One option is the use of a gonadotropin-releasing hormone (GnRH) medication that works by inhibiting the production of estrogen and progesterone. This medication forces the body into a temporary menopause-like state that arrests the menstrual cycle and shrinks the fibroids. Another common approach is to use an intrauterine device (IUD) that is inserted into the uterus and which injects progestin, a hormone medication that can relieve the symptoms
For more severe cases of fibroids, there are a number of surgical options available:
- Myomectomy: traditional surgery performed via a large incision or through the use of laparoscopy
- Ultrasound surgery: this is a relatively new and noninvasive option that utilizes sound waves to destroy fibroid tissue
- Uterine Artery Embolization (UAE): minimally invasive option that works by injecting small particles into the arteries that supply the uterus with blood; the particles block blood flow, causing the fibroids to shrink (also sometimes referred to as Uterine Fibroid Embolization (UFE)
- Hysterectomy: very invasive option for extreme cases that involves the total removal of the uterus and sometimes the ovaries and fallopian tubes as well
For women with uterine fibroids, the experience can vary greatly from person to person. If you have been having any of the symptoms described here and think you might have fibroids, contact The Woman’s Clinic to make an appointment. Whatever your symptoms, the staff is available to diagnose and treat you with care and professionalism.