Uterine Fibroids

What are Uterine Fibroids?

Uterine fibroids, also known as leiomyomas or myomas, are noncancerous growths that develop in the muscular wall of the uterus. These growths vary in size, ranging from small, undetectable nodules to large masses that can distort the shape of the uterus. While fibroids are typically benign, they can cause symptoms and complications that affect a woman’s reproductive health and quality of life.

Types of Uterine Fibroids

• Intramural Fibroids: These fibroids grow within the muscular wall of the uterus and are the most common type.
• Subserosal Fibroids: Located on the outer surface of the uterus, these fibroids can grow to a significant size and may cause pressure or pain.
• Submucosal Fibroids: These fibroids develop just beneath the inner lining of the uterus and can protrude into the uterine cavity, potentially causing heavy menstrual bleeding and fertility issues.

Causes and Risk Factors

While the exact cause of uterine fibroids is unknown, several factors may contribute to their development:

• Hormonal Influence: Estrogen and progesterone, hormones that stimulate the uterine lining’s growth during menstrual cycles, may promote the growth of fibroids.
• Genetic Predisposition: A family history of fibroids increases the likelihood of developing them.
• Race: African American women are at higher risk of developing fibroids and experiencing more severe symptoms.
• Age: Fibroids are most common in women of reproductive age and tend to shrink after menopause.

Symptoms of Uterine Fibroids

The symptoms of uterine fibroids can vary depending on their size, number, and location. Common symptoms include:

• Heavy Menstrual Bleeding: Prolonged or heavy menstrual periods, often requiring frequent changes of sanitary products.
• Pelvic Pain: Dull, aching pain in the pelvis or lower back, especially during menstruation.
• Pelvic Pressure: A sensation of fullness or pressure in the lower abdomen or pelvis.
• Urinary Symptoms: Frequent urination, difficulty emptying the bladder, or urinary urgency.
• Reproductive Symptoms: Infertility, recurrent miscarriages, or complications during pregnancy and labor.

Diagnosis and Treatment

Diagnosing uterine fibroids typically involves a combination of:

• Pelvic Examination: A physical examination to check for the presence of fibroids and assess their size and location.
• Imaging Tests: Ultrasound, MRI, or hysteroscopy may be used to visualize the uterus and confirm the presence of fibroids.
• Biopsy: A tissue sample may be taken to rule out other conditions or confirm the diagnosis.

Treatment options for uterine fibroids depend on the severity of symptoms, the patient’s age, and their desire for future fertility. Treatment modalities include:

• Watchful Waiting: Monitoring fibroids for changes in size or symptoms, particularly in asymptomatic cases.
• Medications: Hormonal medications, such as birth control pills or GnRH agonists, may help alleviate symptoms by reducing estrogen levels.
• Minimally Invasive Procedures: Procedures such as uterine artery embolization (UAE) or MRI-guided focused ultrasound surgery (MRgFUS) can shrink fibroids or alleviate symptoms without surgery.
• Surgical Removal: Myomectomy involves surgically removing fibroids while preserving the uterus, making it an option for women who wish to retain fertility. In severe cases or for women who have completed childbearing, hysterectomy may be recommended to remove the uterus entirely.