Uterine fibroids are growths within the uterus that can result in pain and discomfort. Fibroids are also called leiomyomas and are made up of muscle and connective tissue; they may range in size from being microscopic to being larger than a grapefruit. One important fact about fibroids is that they are almost always noncancerous, but still may need to be removed surgically in order to treat symptoms. The rate at which they grow is unpredictable, and a woman may have more than one fibroid at a time. Fibroids are very common in women of childbearing age.
According to the Mayo Clinic, as many as 3 out of 4 women have uterine fibroids sometime during their lives. It is important to understand that having fibroids does not increase a woman's risk of developing uterine cancer.
Types of Fibroids
The following different types of fibroids exist:
- Submucosal fibroids grow in the uterine lining and may cause heavier than normal menstrual bleeding.
- Subserosal fibroids grow outwards from the outer covering of the uterus and may create pressure on the bladder resulting in incontinence and the constant urge to urinate.
- Intramural fibroids grow within the muscular wall of the uterus.
- Pedunculated fibroids have a stalk attaching them to the uterus and may grow either on the outside of the uterus or inside it.
Fibroid Risk Factors
Although all women can develop a uterine fibroid after puberty, there are a few factors that increase a woman’s risk, including the following:
- Family History: If a woman has a family history of uterine fibroids, it increases the chances she will develop a fibroid at some point in her life.
- Early Puberty: Women who have their first menstrual period before they are 10 years old are also at increased risk.
- Race: According to WebMD, African-American women get uterine fibroids more often than Caucasian women.
The cause of fibroids is unknown, but the hormone estrogen has been shown to have some connection. Fibroids are rare in women who are under the age of 20 and usually stop growing after a woman starts menopause. They are known to grow at points when a woman’s estrogen levels are high, as during pregnancy. Other factors in fibroid growth include genetics. Women of African-American descent are more likely to get uterine fibroids by a factor of three.
Although most uterine fibroids are asymptomatic and often discovered during regular gynecological checkups, fibroids can sometimes cause noticeable symptoms. Most symptoms are caused by the compression of organs, nerves and other structures surrounding the uterus. It's important to identify these symptoms early, as fibroids themselves are benign and can be effectively treated.
Uterine fibroid symptoms will depend in part on the nature of the fibroids. Size can vary greatly, ranging from microscopic to the size of a melon. Women may have many fibroids or just one. They may be located on any part of the uterus. A combination of these factors determines symptoms.
Uterine fibroid symptoms such as constipation, pelvic pain, painful intercourse, fertility and urination problems tend to be caused by a large fibroid(s) compressing nearby structures. In contrast, heavy menstrual bleeding symptoms are frequently caused by fibroids affecting the way the uterus develops and sheds its lining each month.
Pain and Pressure Fibroid Symptoms
- Chronic pelvic pressure or pain – Fibroids can cause a lingering feeling of pain and discomfort. Compression of nerves can exacerbate the pain and cause additional pain in the lower back and sides.
- Pain during sexual intercourse – While the cause is not limited to only fibroids, pain or discomfort during sexual intercourse can be caused by fibroids.
- Abdominal pain – Fibroids located in the upper part of the uterus can sometimes extend up into the abdomen, causing pain and pressure. Particularly large fibroids can also distend the abdomen, similar to the early stages of pregnancy.
- Difficult and painful bowel movements – If fibroids compress the rectum, they can cause pain during bowel movements and constipation. The constant pressure can also lead women to feel perpetually bloated.
Menstrual Fibroid Symptoms
- Abnormal bleeding – Fibroids often cause irregularities in menstrual bleeding. Heavy bleeding and bleeding for longer than normal are fairly common fibroid symptoms, and prolonged heavy bleeding can cause anemia. Fibroids can also sometimes lead to spotting or bleeding between periods.
- Painful periods – Fibroids may increase the likelihood of getting painful menstrual cramps.
Urinary Fibroid Symptoms
- Frequent urination – If fibroids compress the bladder, this will effectively decrease its capacity, leading to more frequent and sometimes painful urination. In some cases, this can also cause incontinence.
Rare Fibroid Symptoms
- Decreased fertility and miscarriage – The presence of fibroids can sometimes make it more difficult to conceive.
- Kidney blockage – Very rarely, fibroids can compress the ureter leading from the kidney to the bladder.
Fibroid Treatment Options
In most cases, fibroids are only treated if they are causing symptoms with the most common procedure for removing them being hysterectomy. They are the most common reasons for hysterectomies. A hysterectomy eliminates the potential for recurrence of fibroids, but also eliminates the possibility of a woman getting pregnant in the future.
Women who want to retain the option of bearing children can choose to have a myomectomy done instead of a hysterectomy. A myomectomy involves the surgical removal of the individual fibroids, rather than the whole uterus.
For women who want to preserve their uterus and have completed child-bearing, there are the following options:
- Uterine artery embolism is a procedure that consists of a catheter delivering small particles that block the blood supply to the uterine body.
- In some cases, depending on the type and location of the fibroids, women may have the option of undergoing a non-surgical endometrial ablation procedure, which uses heat to destroy the lining of the uterus.
There is another option called the Acessa procedure. Acessa is a relatively new advance in the treatment of fibroids. The Acessa procedure utilizes a technology called radiofrequency ablation, and treats each fibroid by applying energy through a small needle array. The surrounding normal uterine tissue is not damaged or otherwise affected. Over time, the treated fibroid tissue shrinks and may become completely reabsorbed by the body. Acessa is a minimally invasive surgical treatment performed under general anesthesia, and only two very small (approximately ¼”) abdominal incisions are needed during the procedure – there is no cutting, suturing or removal of the uterus itself.
None of the drug therapies for uterine fibroids get rid of them entirely. Some of the drugs work by lowering estrogen and placing the woman in a state similar to menopause. The lowered estrogen may shrink the fibroids and relieve symptoms. Other methods of treatment, such as using contraceptive pills, have been shown to control excessive menstrual bleeding, but do not affect the size of the fibroid.
Fibroids are a common condition that while potentially painful, are treatable and are not likely to cause long-lasting harm. Women who exhibit symptoms of having fibroids should see their healthcare provider as soon as possible to get treatment.
When to Seek Help
Women who are asymptomatic do not need treatment; however, patients experiencing moderate or severe uterine fibroid symptoms should seek medical attention. Fibroids can be diagnosed either by pelvic exam or by ultrasound. If a patient presents with symptoms of uterine fibroids, one or both of these methods may be used.
While some discomfort during the menstrual cycle is normal, there are a number of factors which indicate that a woman should seek medical attention. If periods are consistently long (more than 7 days) or very painful, a physician should be consulted. A doctor should be informed if a woman experiences persistent pelvic pain, frequent pain with sexual intercourse, frequent difficulty urinating or moving the bowels, or consistent spotting between periods. Women who experience anemia related to their menstrual cycle should be tested for fibroids, as should women who experience fertility problems, multiple miscarriages or other problems during pregnancy.
Women who experience sharp, sudden pelvic pain or severe vaginal bleeding should seek immediate medical attention.
While uterine fibroids are generally benign, uterine fibroid symptoms are often indistinguishable from other disorders of the digestive, urinary or reproductive systems until further testing is performed. This is one reason that timely diagnosis is important. In addition, as with any condition, when uterine fibroid symptoms begin to impinge upon a patient's quality of life, it is time to seek medical treatment. Women who experience menstrual discomfort that is less severe may want to discuss their concerns with their physician during their annual exam, at which time the physician can decide if further testing is necessary.
National Institutes of health/National Library of Medicine
University of California, San Francisco Medical Center
The following websites were specifically developed for women who have been diagnosed with uterine fibroids or other diseases of the female reproductive system. We know that every woman is unique, and the information and perspectives provided on these websites are oftentimes that of the patient. They may provide you additional insight into the challenges thousands of women face when selecting the treatment that is right for them.