What are fibroids?
Uterine fibroids are tumours or growths, made up of muscle cells and other tissues that grow within the wall of the uterus (or womb). Although fibroids are sometimes called tumours, they are almost always benign (not cancerous). The medical term for fibroids is uterine leiomyomata.
Fibroids can grow as a single growth or in clusters (or groups). Their size can vary from small, like an apple seed (or less than one inch), to even larger than a grapefruit, or eight inches across or more.
Why should women know about fibroids in the uterus?
Uterine fibroids are the most common, benign tumours in women of childbearing age, but no one knows exactly what causes them. They can be frustrating to live with when they cause symptoms. Not all women with fibroids have symptoms, but some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination.
Who gets fibroids in the uterus?
More research is being done to figure out who is at risk for fibroids. But it is known that:
• Most of the time, fibroids grow in women of childbearing age.
• African American women are more likely to get them than women of other racial groups.
• African American women tend to get fibroids at a younger age than do other women.
• Women who are overweight or obese also are at a slightly higher risk for fibroids than women who are not overweight.
• Women who have given birth appear to be at a lower risk for fibroids.
Where can fibroids grow?
Doctors put fibroids into three groups based on where they grow, such as just underneath the lining of the uterus, in between the muscles of the uterus, or on the outside of the uterus. Most fibroids grow within the wall of the uterus. Some fibroids grow on stalks (called peduncles) that grow out from the surface of the uterus, or into the cavity of the uterus.
What are the Different Types of Uterine Fibroids?
Fibroids are named depending upon where they lie. Those that are wholly within the muscle layer of the womb are called intramural fibroids. They typically give the uterus a globular feeling on examination (like early pregnancy). They increase overall blood flow to the uterus and if large can distort and enlargen the internal cavity, even if they don’t encroach onto it.
Subserosal fibroids are those that project out from the outer surface of the uterus. They can grow quite large, but do not typically affect the size of the womb cavity. They are more likely to produce pressure symptoms than heavy periods or infertility.
Submucosal fibroids are the least common (5% of all fibroids). They project into the womb cavity and greatly disrupt its shape. They are the type most likely to cause fertility problems. Sometimes they grow into the uterus, filling it and even growing out of the cervix.
What are the symptoms of fibroids in the uterus?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
• heavy bleeding or painful periods
• bleeding between periods
• feeling of fullness in the pelvic area (lower abdomen)
• urinating often
• pain during sex
• lower back pain
• reproductive problems, such as infertility, having more than one miscarriage, or having early onset of labor during pregnancy
What causes fibroids in the uterus?
No one knows for sure what causes fibroids in the uterus. Researchers have some theories, but most likely, fibroids are the result of many factors interacting with each other. These factors could be hormonal (affected by estrogen levels), genetic (running in families), environmental, or a combination of all three. Because no one knows for sure what causes fibroids, we also don’t know what causes them to grow or shrink. For the most part, fibroids stop growing or shrink after menopause. But, this is not true for all women with uterine fibroids.
Can fibroids turn into cancer?
Fibroids are almost always benign, or not cancerous, and they rarely turn into cancer (less than 0.1 percent of cases). Having fibroids does not increase a woman’s chances of getting cancer of the uterus.
How do I know for sure that I have fibroids?
Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 8 weeks pregnant.
Your doctor can do imaging tests, or tests that create a “picture” of the inside of your body without surgery, in order to confirm that you have fibroids. These tests might include:
• ultrasound – uses sounds waves to produce the picture.
• magnetic resonance imaging or MRI – uses magnets and radio waves to produce the picture.
• x-rays – use a form of radiation to see into the body and produce the picture.
• cat scan or CT – makes many pictures of the body from different angles to provide a more complete image.
Besides imaging tests, you also might need a surgery to know for sure if you have fibroids. These could include:
• laparoscopy – surgery with general anesthesia in which your doctor makes a small cut in the abdomen and places a small tube with a light inside to see any fibroids.
• hysteroscopy – surgery in which your doctor inserts a long tube with a camera into the vagina and directly into the uterus to see any fibroids. It also shows any growths or problems inside the uterus.
What is the treatment for fibroids?
Talk with your doctor about the best way to treat your fibroids. She or he will consider a number of things before helping you choose a treatment. Some of these things include:
• whether or not you are having symptoms from the fibroids
• if you might want to become pregnant
• the size of the fibroids
• the location of the fibroids
• your age
If you have fibroids, but do not have any symptoms, you may not need any treatment. But your doctor will check during your regular exams to see if they have grown.
Medications
If you have fibroids and have mild symptoms, your doctor might only suggest pain medication. Over-the-counter anti-inflammatory drugs, such as ibuprofen, or other painkillers such as acetaminophen can be used for mild pain. If pain becomes worse, your doctor can prescribe a stronger painkiller.
Other drugs used to treat fibroids are called gonadotropin releasing hormone agonists (GnRHa). These drugs can decrease the size of the fibroids. Sometimes they are used before surgery, to shrink the fibroids, making them easier to remove. Side effects can include hot flushes, depression, not being able to sleep, decreased sex drive, and joint pain. Anti-hormonal agents, such as a drug called mifepristone, also can stop or slow the growth of fibroids. These drugs only offer temporary relief from the symptoms of fibroids; once you stop the therapy, the fibroids often grow back.
Surgery
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
• Myomectomy – a surgery to remove fibroids without taking out the healthy tissue of the uterus. There are many ways a surgeon can perform this procedure. It can be major surgery (with an abdominal incision) or minor surgery. The type, size, and location of the fibroids will determine what type of procedure will be done. Talk with your doctor about the different types of this surgery.
• Hysterectomy – a surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. This surgery is used when a woman’s fibroids are large, or if she has heavy bleeding, and is either near or past menopause and does not want children. There are various types of hysterectomy that differ in how invasive they are. Sometimes, if the fibroids are large, a woman might need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the surgeon might be able to reach the uterus through the vagina, instead of making a cut in the abdomen.
• Endometrial ablation – the endometrial lining of the uterus is destroyed. This surgery controls very heavy bleeding, but afterwards a woman cannot have children.
• Myolysis – a procedure in which an electrical needle is inserted into the uterus through a small incision in the abdomen to destroy the blood vessels feeding the fibroids.
There is however a new non-surgical solution that has allowed thousands of women worldwide to successfully eliminate their fibroids pain and other related symptoms within 12 hours and their uterine fibroids permanently within 2 months!
