What Are Uterine Fibroids? Causes, Symptoms and Treatment

What Are Uterine Fibroids?

Uterine fibroids are a common gynaecological condition, particularly for those in their childbearing years. Referred to medically as leiomyomas, these are benign (non-cancerous) growths. They do not lead to cancer, nor is there a link between fibroids and other uterine malignancies. A person may develop a single fibroid or several, and their sizes may vary greatly. Some are so small they require imaging to see, while others grow large enough to impact the uterus and make the stomach appear enlarged.

Since fibroids are often present without symptoms, many people live with them unknowingly. They are usually detected during a routine pelvic check or a pregnancy scan. Understanding that these are benign is vital. While they can grow large enough to fill the pelvis, they are almost always non-malignant.

What are Symptoms of Uterine Fibroids?

Many individuals with uterine fibroids remain asymptomatic. When symptoms occur, they are directly linked to the fibroids' specific size, total number, and anatomical location.

The primary symptoms associated with uterine fibroids include:

• Heavy menstrual bleeding or painful cycles.
• Prolonged or more frequent menstruation.
• Pelvic pressure or general pain.
• Frequent urination or trouble emptying the bladder.
• An expanding or growing stomach area.
• Difficulties with regular bowel habits.
• Abdominal or lower back pain, or pain during intercourse.

In rare instances, a fibroid may cause sudden, intense pain if it outgrows its blood supply and begins to degenerate.

Commonly, fibroids are grouped by their uterine location. Intramural fibroids reside within the muscular wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids develop on the outer uterine wall.

What are the Causes of Uterine Fibroids?

While the exact cause of fibroids is unknown, several factors are identified as significant during clinical assessment.

Genetic Factors

Research confirms that fibroid cells often possess genetic differences that distinguish them from the healthy muscle cells of the uterine wall.

Hormonal Drivers

Oestrogen and progesterone, the primary hormones of the menstrual cycle, are associated with fibroid enlargement. These growths contain a higher density of hormone receptors, leading to regression after menopause when levels decrease.

Additional Growth Factors

Growth factors involved in tissue repair, including insulin-like growth factors, may likely influence growth.

Extracellular Matrix (ECM)

This material binds cells together, acting as a structural mortar within tissues. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biologic changes in the cells themselves. Doctors believe that uterine fibroids may develop from a stem cell in the smooth muscular tissue of the uterus. A single cell divides over and over. In time it turns into a firm, rubbery mass distinct from nearby tissue.

The growth patterns of uterine fibroids vary. They may grow slowly or rapidly. Or they might stay the same size. Some fibroids go through growth spurts, and some may shrink on their own. Fibroids that form during pregnancy can shrink or go away after pregnancy, as the uterus goes back to its usual size.

Risk Factors For Uterine Fibroids

Apart from being of reproductive age, there are several known risk factors for uterine fibroids:

Race

Although anyone of reproductive age born female can develop fibroids, Black people are more likely to be affected than other racial groups. Black individuals tend to develop fibroids earlier in life and are likely to have more numerous or larger growths, with more severe symptoms as compared to others.

Family History

Risk can be increased significantly if a mother or sister has previously been diagnosed with uterine fibroids.

Other Factors

Starting periods before age 10, obesity, and a deficiency in vitamin D are linked to increased risk. Dietary habits, including high red meat consumption and low intake of fruit, vegetables, and dairy, as well as drinking alcohol, also appear to raise the likelihood of developing these uterine growths.

Complications of Uterine fibroids

Uterine fibroids are usually not dangerous but can lead to anaemia if heavy bleeding occurs. This loss of red blood cells often results in feeling very tired. It is common for doctors to recommend iron supplements to manage these symptoms. In rare, extreme cases, a blood transfusion might be necessary. It is advised to undergo regular check-ups if you experience these issues. This allows for timely intervention and helps prevent the development of anaemia.

Pregnancy and Fibroids

Fibroids often do not affect your ability to get pregnant. However, submucosal fibroids can lead to infertility or pregnancy loss. They also increase the risk of the following complications during pregnancy:

• Placental Abruption: When the placenta, which provides the baby with oxygen and nutrients, separates prematurely from the uterine wall.
• Fetal Growth Restriction: When the unborn baby does not grow at the expected rate.
• Preterm Delivery: When the baby is born early, specifically before the 37th week of pregnancy.

Prevention

Researchers are still investigating the causes of fibroid tumours, but more research work is needed regarding prevention. While it may not be possible to prevent them entirely, only a small percentage actually require medical treatment. You can lower your personal risk by adopting healthy habits, such as maintaining a healthy weight, exercising regularly, and eating plenty of fruit and vegetables. Some research indicates that birth control pills or long-acting progestogen-only contraceptives may reduce risk. However, starting the pill before age 16 may be linked to a higher risk of fibroids, so the timing of hormonal contraception is an important factor to consider.

Diagnosis of Uterine fibroids

Uterine fibroids are often detected incidentally during pelvic examinations. Structural uterine irregularities noted during the exam may necessitate further diagnostic investigation through the following methods:

• Ultrasound: This imaging uses sound waves to confirm, measure, and map fibroids. It is performed transabdominally, with a transducer moved across the abdomen, or transvaginally, with the device placed internally for detailed uterine images.
• Lab Tests: For those with irregular bleeding, blood tests are used to check for anaemia (via a full blood count), thyroid problems, or bleeding disorders.

Other imaging tests

If a primary ultrasound does not provide enough information, you may require further imaging studies:

• Magnetic Resonance Imaging (MRI): This scan shows the size and location of fibroids in greater detail. It helps identify different tumour types and determine suitable treatment options. It is most often used for patients with a larger uterus or those approaching menopause.
• Hysterosonography: Also called a saline infusion sonogram, this uses sterile saline to expand the uterine cavity. This allows for clearer images of the uterine lining and submucosal fibroids, which is essential if you are experiencing heavy bleeding or trying to conceive.
• Hysterosalpingography: This traditional X-ray examination uses a special contrast dye to reveal the interior of the uterus and the fallopian tubes. It is a reliable method for checking if the tubes are clear or if submucosal fibroids exist.
• Hysteroscopy: A doctor uses a small, lighted tube to look inside the uterus by passing it through the cervix. Saline is used to open up the uterine space, making it easy to see the walls and the entrances to the tubes. These tests are vital for identifying why you might be having difficulty conceiving or experiencing heavy periods.

When to see a doctor?

Consultation is advised for:

• Long-term pelvic pain.
• Heavy periods affecting your quality of life.
• Unexplained bleeding or spotting between periods.
• Problems with bladder evacuation.
• Persistent tiredness and weakness (potential symptoms of anaemia or low red blood cells).

Seek immediate emergency care if you have:

• Severe vaginal haemorrhage.
• Sudden, acute pelvic pain.

Treatment for Uterine Fibroids

A measured approach is often used for uterine fibroids. Because factors like size, number, and age may vary significantly, there is not one definitive treatment. Many individuals may not require immediate intervention if symptoms are absent. Doctors focus on symptom control and maintaining a high quality of life rather than aggressive removal. If your symptoms start to bother you, it is important to talk to your doctor. They will help you find the right plan.

Waiting

For many patients, uterine fibroids do not interfere with daily life or overall health. When symptoms are non-existent or mild, waiting is the standard recommended pathway. This means your healthcare provider will monitor you regularly without starting active treatment. Please note the following:

• Non-Malignant: Fibroids are benign growths and rarely undergo a cancerous transformation.
• Progress: They tend to grow slowly or remain completely stable.
• Hormones: Natural shrinkage often occurs after menopause as hormone levels fall.
• Care: Routine appointments ensure any new symptoms are addressed promptly.

By choosing this path, one can avoid the side effects of medications or the recovery time of procedures that may not be necessary.

Medications for Uterine Fibroids

When fibroids lead to heavy periods or pelvic pressure, healthcare professionals often suggest using medication to manage these issues. These medical options target the hormones governing the menstrual cycle. While they cannot permanently eliminate fibroids, they are effective for alleviating symptoms and inducing a temporary reduction in fibroid size.

Common medical treatments include:

1. Gonadotropin-Releasing Hormone (GnRH) Agonists

GnRH agonists are essential for managing fibroids by temporarily lowering hormone levels. This temporary menopausal state ensures that periods stop and fibroids shrink. Most importantly, the cessation of period leads to a positive recovery from anemia.

These medications can cause side effects, such as bone loss and hot flushes, they are typically used for a limited time. Doctors often prescribe them for several months before surgery to make the fibroids smaller, or to help individuals transition into menopause safely and comfortably.

2. Gonadotropin-Releasing Hormone (GnRH) Antagonists

GnRH antagonists are medicines used to treat heavy menstrual bleeding in premenopausal patients with fibroids.

Key features include:

• Reliable reduction of blood loss.
• No effect on the actual size of fibroids.
• Safe for extended use up to two years.

Usually combined with low-dose hormones to minimize adverse effects, such as hot flushes and bone density loss, during the course of the long-term treatment plan.

3. Progestin-Releasing Intrauterine Device (IUD)

A progestin-releasing IUD is recommended for controlling heavy menstrual bleeding caused by fibroids.

Key benefits:

• Reduced menstrual flow.
• Secure, long-term birth control.
• Consistent, long-acting relief.

Please note that it does not shrink or remove fibroids.

4. Tranexamic Acid

Tranexamic acid is a non-hormonal treatment used to reduce heavy menstrual bleeding. Taken only during heavy flow days, it offers a flexible alternative for those seeking symptom-specific relief without the use of daily hormonal medications or invasive procedures.

5. Other Supportive Medications

Various medications manage fibroid symptoms effectively. Low-dose contraceptives regulate bleeding, while NSAIDs reduce pelvic pain. If heavy bleeding leads to anaemia, iron supplements or vitamins are typically recommended. Medication is often an effective initial step for patients preferring non-surgical routes or those nearing menopause. Regular medical consultation is required to ensure that these treatments continue to meet the patient’s health needs safely and effectively

Noninvasive Procedure

MRI-Guided Focused Ultrasound Surgery (FUS):

MRI-guided focused ultrasound surgery (FUS) is a non-invasive, uterus-preserving treatment option for uterine fibroids. It is important to understand that non-invasive procedures do not require surgical incisions or the insertion of instruments. They mostly rely on imaging and energy-based technologies.

The procedure is usually conducted as an outpatient service, with patients usually returning home the same day. During the session, the patient is placed in an MRI scanner to provide the detailed imagery needed to identify fibroid tissue precisely. A specialised ultrasound device then directs high-energy sound waves to create heat, destroying the fibroid in small, controlled zones. This ensures that the fibroid is damaged while healthy tissue is preserved.

FUS is a newer technology, but current evidence shows it is safe and effective for many individuals. While research into long-term results is still happening, many individuals see a meaningful improvement in their symptoms. Many have also reported that relief is less significant than with other treatments. However, many patients still choose Focused Ultrasound Surgery because it avoids the need for surgery and offers a fast recovery period afterwards.

Minimally Invasive Procedures

Minimally invasive procedures use small or no incisions, which usually means a quicker recovery and fewer problems compared to open surgery. These options aim to shrink or remove fibroids while keeping your uterus intact.

Uterine Artery Embolisation (UAE):

UAE is a procedure that shrinks fibroids by blocking their blood supply. A physician inserts a thin catheter into an artery and guides it to the uterine arteries. Tiny embolic particles are then injected to stop the flow of blood.

These particles block blood flow, causing the fibroids to shrink and die. As they reduce in size, symptoms, such as heavy bleeding and pelvic pressure, usually improve. Although complications can occur if blood flow to the ovaries is affected, research indicates that the risk levels are comparable to those with surgical treatments.

Importantly, UAE usually involves a lower risk of needing a blood transfusion as compared to some surgeries. For many, it provides effective and lasting relief while avoiding the need for open surgery. This formal treatment offers you a sophisticated way to manage your fibroid health.

Radiofrequency Ablation:

Radiofrequency ablation is a minimally invasive treatment for uterine fibroids that uses controlled heat to destroy tissue and its blood supply. This process results in the gradual shrinkage of the fibroid over several months.

There are three ways to perform this:

• Laparoscopic: Small incisions are used to guide needles into the fibroid.
• Transvaginal: Access is through the vagina.
• Transcervical: Access is through the cervix.

Once the heat is applied, the fibroid softens instantly. Over the following three to twelve months, the body’s natural processes absorb the treated tissue, resulting in a steady reduction of symptoms. As radiofrequency ablation is minimally invasive, it involves less physical trauma than traditional surgery. Consequently, patients usually benefit from reduced pain and a significantly faster recovery period. This methodical approach ensures the fibroid is effectively treated with minimal disruption to the surrounding healthy tissue.

Laparoscopic Radiofrequency Ablation (Lap-RFA)

This procedure is an effective laparoscopic method for fibroid treatment. It avoids uterine incisions, resulting in faster recovery as compared to traditional surgery. Most individuals return to normal activities within days.

Transcervical Radiofrequency Ablation (Sonata Procedure)

The Sonata procedure is a transcervical approach that uses ultrasound to treat fibroids through the cervix. This allows your doctor to find fibroids easily and apply heat directly. Notably, this method requires no incisions on your abdomen.

Hysteroscopic Myomectomy

Hysteroscopic myomectomy treats fibroids that grow inside the uterus. The methodical process involves inserting instruments through the vagina and cervix to reach the uterine cavity. As there are no external incisions, recovery is typically faster. This approach explains why symptoms like heavy bleeding and fertility struggles improve significantly. The cause of the problem is removed directly from the source within the uterus.

Endometrial Ablation

Endometrial ablation is a procedure designed to stop heavy bleeding by disrupting the lining of the uterus. A medical device delivers energy through heat, microwaves, hot water, cold, or electricity. While this reduces the flow, it is important to understand that pregnancy afterward can be dangerous. If pregnancy occurs, there can be a serious risk of an ectopic pregnancy. Therefore, you are advised to use effective birth control following this procedure.

Furthermore, it is important to recognise that because the uterus remains, new fibroids could develop later in life. This authoritative approach ensures you achieve the best health outcomes while remaining fully informed of the necessary safety precautions regarding future pregnancy and uterine health.

Surgical Procedures

Surgery treats large, numerous, or deeply embedded fibroids. Such procedures require larger incisions and result in longer recovery times for the patient.

Laparoscopic or Robotic Myomectomy

A myomectomy removes fibroids while leaving the uterus intact, making it an objective choice for fertility preservation. Laparoscopic procedures use small abdominal incisions. Robotic systems are often used to provide a magnified 3D view, which objectively improves surgical precision.

Large fibroids may require morcellation, which breaks the tissue into smaller pieces for removal through small openings. For safety, this process is usually conducted inside a surgical containment bag. Alternatively, an incision may be slightly enlarged to remove the fibroid whole. These professional methods allow physicians to treat various fibroid sizes while maintaining a minimally invasive approach to surgical care.

Abdominal Myomectomy

Abdominal myomectomy is a procedure used to remove fibroids through a major abdominal incision. This method is typically advised for patients presenting with:

• Multiple fibroids
• Very large fibroids
• Deeply embedded fibroids

While the treatment is effective, open surgery can cause uterine scarring. Consequently, this scar tissue may decrease the likelihood of a successful future pregnancy.

Hysterectomy

A hysterectomy is the surgical removal of the uterus and is considered as the most effective treatment for fibroids. It is important to understand that pregnancy is impossible after this procedure.

Some patients may choose to have their ovaries removed during the operation. This results in immediate menopause and symptoms such as hot flashes, which can be managed with hormone replacement therapy. However, the majority of individuals treated for fibroids can keep their ovaries. This allows them to avoid early menopause while still achieving a permanent cure.

Morcellation and Safety Considerations

Morcellation is used during fibroid surgery to divide large masses into smaller pieces. It is important to be aware that this technique carries a risk: if a tumour is cancerous, breaking it up can spread cancer cells.

To minimise this risk, surgeons must:

• Assess the patient’s cancer risk factors before the procedure.
• Use a specialised containment bag during morcellation.
• Enlarge the incision to remove the fibroid intact if required.

The risk of accidentally cutting into cancer is usually lower in younger people who haven't reached menopause. However, for those over 50, the chance of undiagnosed cancer is higher. For this reason, individuals are advised to be cautious and generally recommend avoiding this method for those near or past menopause. Before the surgery, it is important to have a formal discussion with the doctor about these risks and other options to ensure the safest care for any situation.

If you're trying to get pregnant or might want to have children

Hysterectomy and endometrial ablation permanently prevent pregnancy. Uterine artery embolisation and radiofrequency ablation are also generally not the best options for those seeking to keep their fertility. It is important to methodically review the risks and benefits of these treatments with your doctor if you hope to conceive later. This direct approach ensures you make a safe and informed medical choice.

If you are actively trying to become pregnant, a complete fertility assessment is recommended before choosing a treatment. When fibroid removal is necessary and fertility must be preserved, myomectomy is usually the preferred method. However, since all medical treatments have specific risks and benefits, you must discuss them thoroughly with your physician. This methodical approach ensures your treatment plan is safe and helps you achieve your health goals without compromising the future fertility.

Risk of new fibroids

Aside from a hysterectomy, most fibroid procedures involve a recurrence rate. This means undetected "seedlings" or new fibroids could grow and require future treatment.

Methods such as radiofrequency ablation, FUS, and laparoscopic or robotic myomectomy may only treat some of the fibroids present. Consequently, if other fibroids are left or new ones appear, symptoms may return, potentially leading to the necessity of further medical or surgical intervention.

Can individuals with fibroids expect to become pregnant?

It is possible to achieve pregnancy with uterine fibroids. Upon confirmation of pregnancy, your healthcare provider will implement a specific monitoring strategy. Hormonal increases necessary for pregnancy can unfortunately cause fibroids to enlarge.

Large fibroids may cause certain challenges, such as:

• An increased need for a C-section if the baby cannot turn head-down.
• Labour not progressing as expected.
• Placental abruption (the placenta separating early).
• Preterm delivery.

Close medical supervision is essential to manage these potential outcomes effectively and safely.

Can fibroids grow or shrink over time?

You should know that fibroids can grow or shrink over time, either rapidly or gradually. This change is directly related to the hormone levels in your body. When hormones are high, such as during pregnancy, fibroids are likely to enlarge. However, they can also shrink when hormone levels fall. This is a common occurrence after menopause. You will often find that the symptoms improve once you reach menopause and the hormone levels drop. It is important to have regular check-ups so that your doctor can monitor these changes and provide instruction on managing any evolving symptoms.

Can uterine fibroids regress without medical intervention?

Fibroids may shrink post-menopause as hormones decline, potentially reducing symptoms. Small, asymptomatic fibroids often require no active treatment or medical therapy.

Can uterine fibroids cause chronic fatigue?

Tiredness is not a standard symptom of fibroids themselves. It is, however, a frequent sign of anaemia caused by excessive blood loss. Seek medical advice for extreme fatigue to identify the cause.

Do fibroids lead to abdominal enlargement?

Yes, large uterine fibroids may cause the stomach to appear enlarged or feel bloated.

Conclusion

Uterine fibroids are a common condition during the reproductive years, consisting of non-malignant growths in the uterine tissue. They vary in size and location. While some women feel no different, others may experience heavy periods, pelvic pain, or a feeling of pressure in the abdomen.

While the exact cause is not known, hormones, genetics, and lifestyle factors play a role. Medical professionals identify fibroids through physical examinations and imaging tests like MRI or ultrasound. Their effect on fertility is generally linked to their physical position and size. Treatment options are diverse, including simple monitoring, medication, and various surgical procedures. The choice of treatment depends on symptom severity and the patient's future health goals. Proper medical care ensures that symptoms are managed and that you can continue your normal life. Early diagnosis and treatment are the most effective ways to handle fibroids and ensure that your reproductive health is protected for the future.