Uterine Fibroids diagnosis and treatment

What are uterine fibroids?

Uterine fibroids are noncancerous growths made of muscle tissue that develop on or in the uterus. They rarely become cancerous and, if present, don't increase the risk of uterine cancer. They vary significantly in terms of shape, location and size. They can develop within the walls of the uterus and its surface or attach via a stem-like structure. Some may be too small to be seen by the naked eye, while others may grow large enough to alter the shape and size of the uterus.

Fibroids are commonly diagnosed in middle-aged women during their childbearing years, typically between the ages of thirty and forty. They are more common in Black individuals than in White individuals and tend to develop earlier and grow more rapidly in Black women. However, the underlying reasons for this disparity remain unclear.

Uterine Fibroids vs. Polyps

Although both uterine fibroids and polyps can share similar symptoms, they are distinct conditions. While fibroids are bigger and made up of muscle tissue (muscular in nature), polyps are smaller in size and comprise tissue that lines the uterus (endometrium). Uterine polyps can block the fallopian tube openings, making conception difficult. Unlike fibroids, a small percentage of polyps (around 5%) may turn cancerous or contain abnormal cells with a higher potential to become cancerous, so most gynaecologists recommend their removal. Treatment for polyps can include medication, surgery, or simply monitoring their development to see if they resolve naturally.

Types of fibroids

Fibroids are categorised based on their location:

• Intramural Fibroids – These fibroids grow within the walls of the uterus
• Submucosal Fibroids – These extend into the uterine cavity
• Subserosal Fibroids – These form on the outer surface of the uterus
• Pedunculated Fibroids – These form when submucosal or subserosal fibroids grow on a stalk, which makes them more mobile inside or outside the uterus

How common are uterine fibroids?

Fibroids are a common type of growth, affecting an estimated 40% to 80% of individuals with a uterus. They are most prevalent between the ages of 30 and 50. Fibroids rarely develop before the onset of menstruation and become less common after menopause.

Symptoms of uterine fibroids

Most small fibroids do not cause symptoms and typically require no treatment beyond regular monitoring by a healthcare provider. However, larger fibroids can lead to various symptoms, including:

• Heavy or painful menstrual bleeding
• Bleeding between periods
• A sensation of fullness or bloating in the lower abdomen
• Frequent urination due to pressure on the bladder
• Pain during intercourse
• Lower back pain
• Constipation or pressure on the rectum
• Chronic vaginal discharge
• Difficulty urinating or fully emptying the bladder
• Abdominal enlargement, sometimes giving the appearance of pregnancy

Fibroid symptoms often stabilise or subside after menopause, as hormone levels naturally decline.

Causes of uterine fibroids

The precise cause of uterine fibroids remains unclear, but several factors may play a role:

• Hormones: Oestrogen and progesterone, the hormones that stimulate uterine lining thickening during the menstrual cycle, appear to foster fibroid growth. Usually, fibroids shrink when hormone levels decrease, as in menopause
• Genetics: Studies have shown that fibroids possess genetic differences from normal uterine cells
• Other growth factors: These are substances such as insulin-like growth factors. They help in the maintenance of tissue health and may contribute to fibroid development
• Extracellular Matrix (ECM): The ECM plays a role in cell adhesion and is more abundant in fibroids, making them tougher and more fibrous. It is also a storage for growth factors that influence cell development

Uterine fibroid risk factors

Certain factors may increase the likelihood of developing uterine fibroids, including:

• Age: Middle-aged women (30s and 40s) are at higher risk
• Race: They are more frequently diagnosed in Black women
• Early Onset of Menstruation: Beginning periods at a younger age increases the risk
• Use of Birth Control Pills Before Age 16
• Vitamin D Deficiency
• Diet: A diet high in red meat and low in green vegetables, fruits, or dairy products may contribute to the risk
• Alcohol Consumption
• Family History: If a close relative, such as a mother or sister, has had fibroids, you may be at higher risk

Uterine Fibroid Diagnosis

Fibroids may be identified through a pelvic exam. If they detect an enlarged or irregular uterus, they may use additional tests to confirm the diagnosis:

• Ultrasound: A technician uses sound waves to create images of the uterus, allowing the doctor to locate and determine the size of the fibroids
• Blood Tests: A complete blood count (CBC) may help diagnose anaemia or other blood disorders that could be causing heavy bleeding
• MRI: Magnetic Resonance Imaging can offer more detailed images of fibroids, assisting doctors in determining the best treatment plan, especially in cases of large fibroids or if menopause is near
• Hysterosonography: This test involves injecting saline solution into the uterine cavity to enlarge it, helping detect submucosal fibroids. This is especially useful when considering fertility issues or if heavy bleeding is present
• Hysterosalpingography: Used to check for fallopian tube blockages. This involves injecting dye into the uterus and fallopian tubes and using X-rays to observe the areas
• Hysteroscopy: A small telescope with a light is inserted into the cervix to provide a detailed view of the uterine walls and fallopian tube openings after expanding the cavity with saline

Uterine Fibroid Treatment

Treatment for uterine fibroids varies depending on your symptoms, fertility goals, age, and fibroid location.

Below are the common treatment options available for uterine fibroids:

Close monitoring

Doctors might recommend simply monitoring the condition if symptoms are mild or absent. Fibroids are noncancerous; in some cases, they grow very slowly, stay the same size, or even shrink after menopause.

Medications

Medications aim to manage symptoms rather than eliminate fibroids. They may reduce size temporarily or ease specific symptoms like pain or bleeding. These medications can also help with pain and bleeding relief. Birth control pills will reduce heavy bleeding during periods. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): E.g., ibuprofen and naproxen alleviate pain. Vitamins and iron supplements help combat anaemia caused by heavy bleeding.

Other Medications:

• Gonadotropin-Releasing Hormone (GnRH) Agonists: Temporary menopause is induced by blocking oestrogen and progesterone, causing fibroids to shrink. Often used before surgery and taken as injections
• GnRH Antagonists: Work differently from agonists but also reduce bleeding and shrink fibroids. Options like Oriahnn and Myfembree combine GnRH antagonists with oestrogen and progestin, taken orally
• Progestin-Releasing IUDs: Help control heavy bleeding and prevent pregnancy but may not be suitable for fibroids in the uterine cavity
• Tranexamic Acid: Non-hormonal, taken during heavy bleeding to reduce flow

Surgical Treatments

For moderate to severe symptoms, surgery may be required:

• Myomectomy: Removes fibroids while preserving the uterus, making it an option for those planning to conceive. It can be done via open surgery, aka minimally invasive laparoscopic techniques
• Endometrial Ablation: Destroys the uterine lining using methods such as lasers, heat, freezing, or electric currents. While periods often stop after this procedure, it also prevents pregnancy
• Uterine Fibroid Embolisation (UFE): Blocks the blood supply to fibroids using gel or plastic particles, causing them to shrink
• Hysterectomy: Complete removal of the uterus, eliminating fibroids permanently. This is a major surgery with varying techniques like abdominal or laparoscopic procedures

Uterine Fibroid Complications

Although uterine fibroids are generally not dangerous, they may cause complications like anaemia, resulting from heavy bleeding and reduced red blood cell levels. For severe anaemia, treatments such as iron supplements or blood transfusions may be required.

What are the sizes of fibroids and their risks?

• Small fibroids (2–6 cm): Often symptomless and manageable without treatment
• Larger fibroids: Associated with severe pain, heavy bleeding, and complications in treatment or removal

Uterine Fibroid Prevention

While fibroids cannot be entirely prevented, adopting certain lifestyle habits may reduce the risk:

Healthy Diet

Limit high sugar intake, which may increase fibroid risk. Consume more fresh fruits and cruciferous vegetables (e.g., broccoli, cabbage, cauliflower). These vegetables contain beta carotene, vitamins C and E, and fibre, all of which lower risk.

Exercise

Regular physical activity may help reduce your chances of developing fibroids.

Uterine Fibroids and Pregnancy

Fibroids don't always affect fertility, but some may interfere with conception or pregnancy by causing complications such as:

• Infertility or miscarriage
• Preterm birth
• Restricted foetal growth

Discuss treatment options with your doctor if you're trying to conceive or are already pregnant.

Uterine fibroids after menopause

Fibroids usually shrink due to reduced oestrogen levels after menopause, leading to improved symptoms. However, if they continue to grow post-menopause, consult a doctor, as this may indicate a more serious underlying condition.

Key Takeaways

Uterine fibroids are benign tumours made of muscle tissue that vary in size, shape, and location. The cause of this uterine fibroid is not fully understood but may involve hormones, genetics, and growth factors. Eating a balanced diet and exercising regularly may lower your risk.

For more information or treatment options for uterine fibroids, kindly reach out to us to book an appointment.