What are uterine fibroids?
These are non-malignant tumours that grow in the uterus or womb. Uterina myoma is another name for the problem of the uterus.
Fast facts about uterine fibroids
- There is no clear explanation of why women are infected with fibroids in the uterus.
- Many uterine fibroid-infected women are asymptomatic (don’t show symptoms). But fibroids do come with symptoms based on where they are sited in the uterus, their size, and proximity to opposite pelvic organs. Common symptoms of fibroids include pressure, discomfort and unusual bleeding.
- A pelvic exam and an ultrasound are the diagnostic checks for uterine fibroids.
- There are many different ways to remove uterine fibroids if required, and these methods are via surgery: hysterectomy, cryosurgery, and myomectomy; uterine artery embolisation (UAE), and MRI-guided high-intensity focused ultrasound (MRgFUS or HIFU)
- Uterine fibroids can be treated with medicines like danazol (Danocrine), mifepristone (RU-486), oral contraceptive formula of low dose
Uterine fibroids description
These are mild fibroids that grow on the walls of the uterus. They are thicker than the normal muscle fibres of the uterine wall whose form they take. A round shape characterises a uterine fibroid. There are often no symptoms or pain associated with fibroids of the uterus. But fibroids of significantly large size can exert pressure on the bladder or other organs in the body. Consequently, this will result in particular symptoms.
A uterine fibroid is found in the uterus, which determines its description. Based on that, there are:
- Subserosal fibroids. There is a membrane that lines the outside of the uterus. It is called the serosa. Any fibroid found in this region is a subserosal fibroid. They usually are located on the outer part of the uterus or may adhere with the help of a pedicle to the external uterus surface.
- Submucosal fibroids. These ones are located under the uterine lining, right in the cavity.
- Intramural fibroids. Present in the walls of the uterine muscles.
- Pedunculated fibroids. The fibroid is called sobecause it forms on a pedicle (a stalk that bonds a tumour to normal tissue). These fibroids may stretch from the inner part of the uterine cavity or from the exterior surface outside the uterus
What symptoms do uterine fibroids have? Are they painful?
In many cases, uterine fibroids are silently present – devoid of symptoms and non-malignant. And women having fibroids do not always know they have these abnormal tumours.
Be that as it may, there is a very common sign that one has uterine fibroids, which is unusual bleeding from the uterus. Heavy menstruation may be experienced should the tumours be close to the lining of the uterus or when they cause disturbance to the flow of blood to the uterine lining. This position of the tumours may also lead to spotting between periods, extended periods, or pain during menstruation. If fibroids cause a woman to lose blood via bleeding, they may start experiencing iron deficiency anaemia. When uterine fibroids worsen, affected persons may feel serious pain in a particular area.
Several symptoms may arise from fibroids following how small or large a fibroid is, its location in the uterus and its proximity to the opposite pelvic organs. Those big size fibroids can bring about:
- Pain in the pelvis plus painful sex
- Pressure on the bladder with steady or difficulty in urination
- Rectal pressure accompanied by pains or inability to defecate
At the well woman clinic, symptoms of uterine fibroids can be better explained, and patients may get tested to know what type of fibroid they have and the possible treatment.
Moving forward, more details on the possible treatment of uterine fibroids will be discussed.
Pregnancy and uterine fibroids
Ovulation may not be stalled by the presence of fibroid – this means you may still be seeing your period monthly; however,studies are proposing it might not allow a woman to get pregnant. They could also cause less optimal results in pregnancy. It’s important to note that the submucosal fibroid, which is responsible for distorting the inside of the uterine cavity, is a prime culprit in lowering the chances of pregnancy. Sometimes, frequent miscarriages are linked to fibroids. Where this is evident, the fibroids have to be taken out; otherwise, a woman may be unable to carry a pregnancy to birth.
What is responsible for the growth of uterine fibroids? To what extent can they grow?
The reason behind developing these tumours called fibroids in women is not known. But research suggests that the following may be the likely causes of fibroids:
- Irregularities in the genes
- Changes in growth factor (body proteins that control how cells reproduce) expression
- Irregularities in the vascular system (the blood vessels)
- Tissue response to injury
One important factor to consider here is family history. It’s common for women to develop fibroids if the tumour is found in their lineage. There’s also the race factor. African women have twice or thrice more chances of having fibroids than women of other racial descent. Again, African women, while very young, can develop fibroids; even symptoms can show up in their 20s.
But in the case of Caucasian women, fibroid symptoms usually show up in their 30s and 40s. Getting pregnant early can lower the chances of getting fibroids. But for girls in pre-puberty age, fibroids have not been identified. Fibroids is uncommon among adolescent girls. There are other factors that research still suggest may be liable to cause fibroids, including seeing your first menstrual cycle before the age of 10, use of alcoholic beverages, especially beer, hypertension, and infections in the uterus.
More often, the hormone estrogen triggers the development of fibroids. In the first 3 months of pregnancy, one-third of fibroids will get bigger and become smaller post-childbirth. Generally, during postmenopause, fibroids reduce in size; however, symptoms may still linger due to postmenopausal hormone therapy.
In all, fibroids are quite common and are seen in around 70 to 80 percent of all women as they approach 50 years of age.
The size of uterine fibroids may vary in diameter between under 1 inch to as big or bigger than a grapefruit.
Is cancer linked to uterine fibroids?
Should I be worried about fibroids? Does it self-heal?
Largely, one can allow a fibroid – uterine fibroids that are non-problematic to a woman to remain without any treatment. Sometimes, asymptomatic fibroids need to be taken out or closely monitored. This is because fibroid can proliferate speedily, especially the type called leiomyosarcoma – an uncommon fibroid that is cancer-like. An ultrasound cannot distinguish between this fibroid form and the mild fibroids. Even an MRI and other technologies used in imaging the internals of the body can’t tell the difference. So fibroid must be watched. The good news, though, is that the occurrence of this form of fibroid is just a percent in all cases of uterine fibroids. Please remember that though cancerous in nature, a leiomyosarcoma may not develop from a mild fibroid.
A significant risk of not treating fibroids is that they can often form into sizes that bring about signs and symptoms, so they need to be taken out. For a large-size fibroid, the surgical procedure to take it out may have higher risks and is not easy.
What are the tests for uterine fibroids?
A common test to identify uterine fibroids is ultrasound. A pelvic exam can also detect these tumours. But the thing is that most times, one cannot rely only on a pelvic exam to spot fibroids; an ultrasound is needed mainly to separate it from other similar conditions like ovarian tumours and the like. The doctor can also use CT scans and MRI to check out fibroids. Still,the ultrasound test is a high-performance check that is even straightforward and very affordable. There is nothing about the pelvis with ultrasound that can be hidden – this is how effective this diagnostic test is.
There may be times when another diagnostic check can be done to see if there is a fibroid in the uterine cavity. This test is called hysterosonogram (HSG). It involves an ultrasound and passing a contrast fluid via the cervix to the uterus. This fluid pinpoints any abnormally thick lining (tumours) present in the uterine calvity. Submucosal fibroids can be detected in this way.
Any home-grown solution for uterine fibroids?
No. At the moment, we don’t know of any home-based treatment for fibroids. No issues or symptoms are arising from uterine fibroids. They can be allowed to stay with no particular treatment option. But where they become bigger and have signs such as pressure, pain, or bleeding start, there is a need for treatment with medication or surgery.
How can uterine fibroids be treated?
Several methods can be employed in the treatment of uterine fibroids. These are:
- Via surgery which could be cryosurgery, myomectomy, or hysterectomy
- MRI-guided high-intensity focused ultrasound (MRgFUS)
- Uterine artery embolisation (UAE)
Medicines can be used to treat uterine fibroids as well. On the list are medications like:
- Mifepristone (RU-486)
- Danazol (Danocrine)
- Raloxifene (Evista)
- GnRH analogs (Lupron and others)
- Oral contraceptives medically prepared in low doses
Later, more details about how these medications work for uterine fibroids will be discussed.
Removing fibroids surgically
Uterine fibroids can be kept under control in more ways than one. It’s usually through surgery that fibroids are removed as far as treatment is concerned. Many surgeries, including hysterectomy, can be done to kick out fibroids. In hysterectomy, both the tumours (fibroids) and the uterus (womb) are removed. Another surgery is myomectomy – where only the fibroids are removed. Methods for performing myomectomy range from the usual pattern of creating an incision on the abdomen to surgical devices like a laparoscope or hysteroscope.
But there are methods of treating fibroids that simply destroy the harmful tissues in the uterus rather than remove them. Some of them include cryosurgery – freezing of tumours, the use of laser tech to bore holes in the fibroid and other related options. Should there be an indication that the fibroids may likely be harmful, it is necessary to have them surgically removed.
Fibroids can also be treated with another option called uterine artery embolisation (UAE). This method works by passing polyvinyl alcohol (in bead form) via a catheter into the artery supplying the fibroids with blood. Once there, the beads of alcohol restrict blood flow to the fibroids; thus, their source of survival is breached. They begin to die. This treatment option is quite a new method, but when compared to surgery, those who receive UAE don’t spend much time on hospital beds.However, complications are possibly high, and patients may return to hospital beds. UAE is still being studied to confirm it has had long-term results like surgery offers. Interestingly, there is an alternative to UAE: uterine artery occlusion (UAO). Here the artery releasing blood to the fibroid is shut off; beads of polyvinyl alcohol are not used. But UAO is still being evaluated.
To treat fibroids plus other tumours, another treatment option called High-intensity Focused Ultrasound (HIFU) can be used. This option is quite new. Another name for it is Focused Ultrasound Surgery (FUS). It is also called MRI-guided Focused Ultrasound (MRgFUS). An advanced ultrasound transducer that performs better than other options utilised for diagnosis is used in the HIFU treatment for fibroids. With this device, sound waves are concentrated, and heat is released to eliminate fibroids.
MRI imaging can come in handy for organising and keeping an eye on the treatment of fibroids.
Treating fibroids medically
Aside from surgeries, fibroids can be treated with medications that are typically hormone-related which obstruct the ovaries in estrogen production (GnRH analogues). Women take this med for 3 to 6 months and experience a low-level estrogen production. If everything goes well, the size of fibroid can be reduced by half (50 percent). These meds have side effects similar to menopausal symptoms: changes in mood, dry vagina, inability to sleep, and hot flashes. When the use of these drugs is prolonged for 6 to 12 months, and beyond, a complication like osteoporosis caused by loss of bone is imminent. But this issue returns to normal immediately after the treatment reaches completion. Most importantly, these drugs can be administered before the surgery to remove malignant fibroids to make them smaller,so the surgical procedure has minimal risks and is not so difficult.
An antiprogestin med like Mifepristone (RU-486) can reduce fibroids to a size similar to what GnRH analogs does. Early pregnancy can also be lost with the help of this medication. Bleeding that comes with fibroids can be stopped with this drug. However, there is a harmful side effect of this med – it’s capable of causing endometrial hyperplasia – excessive growth of the uterine lining. In places like the US, Mifepristone does not have the approval of the Food and Drug Administration (FDA) for use in treating harmful uterine fibroids. And the dosage of this drug is yet to be definitely ascertained though that for early pregnancy loss has been set.
With the help of danazol, menses can be stopped, and so it finds use in reducing blood loss in women infected with fibroids. It is an androgenic steroid hormone. But as per reducing fibroid size, danazol doesn’t do this. This medication comes with different side effects, including:
- Breast size-reduction
- Cramps in the muscles
- Abnormal hair growth (hirsutism)
- Mood swings
- Gain in weight
- Oily skin
- Reduction in high-density lipoproteins (HDL)
- A rise in liver enzyme levels
Raloxifene (Evista) is medication women who have passed the age of menopause take to stop the occurrence and as a treatment for osteoporosis. Studies show that this med can lower fibroid size in women done with menopause. When its use was evaluated in women yet to reach menopause, the outcome was inconclusive.
Oral contraceptives medically prepared to low doses are often administered to cure fibroid-induced bleeding; however, they don’t reduce fibroid size.
What risks do uterine fibroids pose to pregnancy?
According to some research, complications may be on a high during pregnancy with fibroids present. This includes bleeding during the first three months, abruption of the placenta, labour difficulties, and breech presentation. More children are borne via CS (Caesarean Section) due to the presence of fibroids. To determine whether fibroids can complicate pregnancy, the size and exact location of the fibroids in the uterus must be known. Visit the well woman clinic in London to learn more and get fibroid out of your uterus. There are specialist doctors here that are friendly and experienced, ready to help you regain a healthy reproductive system free from fibroids and other issues. Schedule a visit for consultation or treatment today.