Uterine Fibroids: Symptoms, Causes and Treatment

While some women with fibroids have no symptoms, others may experience one or more of the following:

• Complications with pregnancy and Fertility: Fibroids can sometimes interfere with fertility, implantation, or pregnancy, increasing the risk of miscarriage and preterm birth.

Other symptoms are uncommon and include

• Heavy or Prolonged menstrual bleeding: This is one of the most common symptoms, and it can lead to anemia if left untreated.

   

• Pelvic pain and Pressure: Larger fibroids can cause a feeling of fullness or heaviness in the lower abdomen, along with pelvic pain.

   

• Constipation: Subserosal fibroids can press against the rectum, leading to constipation.

   

• Frequent urination: Fibroids pressing against the bladder can cause frequent urination or difficulty emptying the bladder.

   

• Backache or Leg pain: Some fibroids can press on nerves, causing pain in the lower back or legs.

   

• Pain during intercourse: Depending on their location, fibroids may cause pain during sexual intercourse.

   

Causes and Risk factors of uterine fibroids

While the exact cause of fibroids is still unknown, several factors may increase the likelihood of their development:

• Hormones: Estrogen and progesterone, two hormones that stimulate the uterine lining, also promote fibroid growth. This is why fibroids often shrink after menopause.

   

• Genetics: Women with a family history of fibroids are at a higher risk of developing them.

   

• Age and Ethnicity: Fibroids are more common in women in their 30s and 40s and are particularly prevalent among African American women.

   

• Obesity: Being overweight increases the risk of fibroids due to higher levels of estrogen.

   

• Lifestyle factors: Diet, lifestyle, and environmental factors may also play a role, though research is ongoing.

Diagnosis of uterine fibroids

Diagnosing fibroids usually involves a combination of the following:

• Pelvic exam: During a routine pelvic exam, a doctor may notice an irregularly shaped or enlarged uterus.

   

• Ultrasound: This imaging technique uses sound waves to create images of the uterus, helping identify fibroid size, location, and number.

   

• MRI (Magnetic Resonance Imaging): MRI provides detailed images of fibroids and is often used to assess larger or more complicated cases.

   

• Hysteroscopy: A thin, lighted tube is inserted through the cervix into the uterus, allowing the doctor to view and sometimes remove fibroids.

   

• Other imaging tests: X-rays, CT scans, or sonohysterography (an ultrasound after filling the uterus with saline) may also be used to evaluate fibroids.

Treatment options for uterine fibroids

Treatment depends on factors such as the size and location of the fibroids, the severity of symptoms, and a woman’s fertility goals. Here are the main treatment options:

1. Medication

• Hormonal therapy: Birth control pills, progesterone-releasing IUDs, and injections can help control heavy bleeding but do not eliminate fibroids.

   

• GnRH agonists: These medications temporarily reduce estrogen and progesterone levels, shrinking fibroids. However, they are typically used short-term due to potential side effects.

   

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can reduce fibroid-related pain but have no effect on fibroid size.

2. Non-Invasive procedures

• MRI-Guided Focused Ultrasound Surgery (FUS): This non-invasive treatment uses focused ultrasound waves to destroy fibroid tissue. It is suitable for some patients and avoids surgery.

3. Minimally invasive procedures

• Uterine Artery Embolization (UAE): In this procedure, particles are injected to cut off the blood supply to fibroids, causing them to shrink. UAE is typically used for women who are not planning future pregnancies.

   

• Laparoscopic or Robotic myomectomy: This surgical approach removes fibroids while leaving the uterus intact, making it an option for women who wish to retain fertility.

   

• Hysteroscopic myomectomy: A scope is inserted through the cervix to remove fibroids within the uterine cavity.

4. Traditional surgical procedures

• Abdominal myomectomy: For larger or numerous fibroids, an open surgery may be performed to remove fibroids from the uterus.

   

• Hysterectomy: The surgical removal of the uterus is the only permanent solution for fibroids. It is typically reserved for women with severe symptoms who do not wish to become pregnant in the future.

For woman planning to conceive who have fibroids that need treatment laparoscopic surgery may be the best suitable approach.

Natural and Lifestyle-based approaches