Uterine fibroids or leiomyomata are areas of smooth muscle cells and fibrous connective tissue that develop in or on the uterine wall. You can develop one fibroid or many of them. Fibroids are the most frequently diagnosed tumor of the female pelvis and the most common reason for a woman to have a hysterectomy. They are benign, not associated with cancer, and rarely become cancerous.
Symptoms
Uterine fibroids range in size and location. It is their size and location that determine the possible symptoms you may have. Fibroids can be found during a routine gynecologic examination. Many women do not know they have fibroids because they do not experience any symptoms.
Types
- Intramural fibroids are located in the wall of the uterus and are the most common. They can cause the uterus to bulge
- Submucous or Submucosal fibroids are found within the uterine lining and can protrude into the uterine cavity. Generally these are ones that can cause the most problems. Since they are located in the uterine endometrium, they can cause heavy or prolonged bleeding during menstruation
- Subserous or Subserosal fibroids develop on the outside of the uterus and usually have the least symptoms. Subserous fibroids can become pedunculated as they grow, meaning they can develop a stalk. These fibroids can reach out to other organs to gain additional blood supply
The cause of fibroids has not been determined but most fibroids develop in women during their reproductive years. Fibroids need a rich blood supply and estrogen stimulates their growth. Once menopause has begun, fibroids generally stop growing and can begin to shrink due to the loss of estrogen. It is estimated that at least 20 to 30% of women have fibroids. Many women do have symptoms and may not know that they have fibroids. Some women only discover that they have fibroids when they become pregnant. Fibroids may cause infertility, miscarriage and early labor. However, many women have carried to term with fibroids. If your doctor recommends getting pregnant while you have fibroids, you may wish to consider getting a second opinion.
Treatment
Sometimes it is recommended that you “wait and see” what will happen. This approach is most practical when menopause is not far away and when symptoms are limited. Fibroids generally continue to grow until menopause.
Signs, symptoms & indicators of Fibroids
Slight/intermittant/constant abdominal fullness
Painful deep penetration during sex
Conditions that suggest Fibroids
Anemia (Iron deficiency)
Submucous fibroids are the type that most commonly cause significant problems; even small tumors located in or bulging into the uterine cavity may cause heavy bleeding, anemia, pain, infertility or miscarriage.
Constipation
Mural fibroids (located in the uterine wall) and subserous fibroids (protrude outside the uterine wall) may reach a large size before causing symptoms. These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy bleeding.
Low Back Pain / Problems
See link between Constipation and Fibroids.
Uterine fibroids
Counter Indicators
Absence of uterine fibroids
Menorrhagia (Heavy Periods)
See links from Constipation and Anemia to Fibroids.
Increased Urinary Frequency
Mural fibroids (located in the uterine wall) and subserous fibroids (protruding outside the uterine wall) may reach a large size before causing symptoms. These symptoms may include pressure on the bladder with difficulty voiding or urinary frequency and urgency, pressure on the rectum with constipation, lower back and abdominal pain, as well as heavy bleeding.
Female Infertility
See link between Anemia and Fibroids.
Susceptibility To Miscarriages
See link between Anemia and Fibroids.
Nocturia
See link between Constipation and Fibroids.
Risk factors for Fibroids
Low Progesterone or Estrogen Dominance
Estrogen levels have persistently been shown to be elevated in patients with uterine fibroids.
Total/radical/partial hysterectomy or hysterectomy with one ovary or hysterectomy with both ovaries
History of uterine fibroids resolved
Recommendations for Fibroids
Vitex
Vitex is used as a way to prevent repeat uterine fibroids.
Conventional Drugs / Information
Doctors may prescribe / recommend drugs of various types.
GnRH agonists. Gonadotropin-releasing hormone agonists can be used to treat fibroids. Most fibroids shrink by one-third to one-half of their original size after two to three months of treatment with these drugs. Smaller fibroids may cause fewer problems and they are often easier to remove surgically. Women should not take GnRH agonists for more than six months. After that, the drugs can cause rapid bone loss, leading to osteoporosis. Fibroids generally start to grow again once drug treatment stops. Most women stop having menstrual periods while they are taking GnRH agonists.
OCs. Oral contraceptives are sometimes used to control the heavy menstrual bleeding associated with fibroids, but they do not help prevent fibroid growth. Newer types of continuous-dosing OCs reduce or eliminate the number of periods a woman has per year.
IUDs Intrauterine devices that release progestin can be very beneficial for reducing heavy bleeding. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), has shown excellent results. Many doctors now recommend the LNG-IUS as a first-line treatment for heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus).
NSAIDS. For fibroid pain relief only, women can use nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil) or naproxen (Aleve).
Estrogen-balancing Medications
Uterine fibroids are often associated with elevated levels of estrogens.
Progesterone
Though systemic progesterone use is often indicated, intravaginal application of progesterone cream may provide higher doses to the area needing it, and counter an estrogen dominance at the site.
Estrogen Replacement
Supplemental estrogens should generally be avoided when fibroids are present, as estrogen stimulates fibroid growth.
Lycopene
A study from Firat University in Turkey (in association with the University of Maryland and Detroit’s Karmanos Cancer institute) indicates that lycopene intake may provide another preventive benefit for women.
The Firat researchers used Japanese quails to assess the effects of lycopene on the development of benign tumors of the uterus called fibroid tumors. The quails were used in the trial because fibroid tumors occur naturally in this species.
For 10 months, half the quails received feed with lycopene added, while half received normal feed. In the lycopene group, half the quails received twice the amount of lycopene as the other half. At the end of the trial period, the lycopene group had half as many tumors as the normal-feed group. And among the lycopene quails, those receiving the double dose of lycopene had significantly fewer tumors than the birds that received less of the supplement. Further study is needed to determine if this benefit is seen in humans.
Surgery
A new procedure called Uterine Artery Embolization is considered to be less invasive than other procedures and enjoys a high success rate. It involves cutting off the blood supply to the fibroid by placing a catheter into the uterine arteries and injecting small particles. This blocks the blood flow and causes the fibroid to degenerate, leaving the remainder of the organ intact. Often this is a better approach than a hysterectomy.
Neural Therapy
Injections into a nerve plexus near the uterus is said to stabilize and sometimes shrink fibroids.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Reasonably likely to cause problems |
Glossary
Uterine Fibroids
Fibroids are the most frequently seen tumors of the female reproductive system. Also known as uterine myomas, leiomyomas, or fibromas, they are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. In more than 99% of cases they are benign (non-cancerous). They may range in size from the size of a pea to the size of a softball or small grapefruit. Some women never have symptoms, the most common of which are: heavy or prolonged menstrual periods; abnormal bleeding between menstrual periods; pelvic pain; frequent urination; low back pain; pain during intercourse; a firm mass, often located near the middle of the pelvis, which can be felt by a physician.
Hysterectomy
Surgical removal of the uterus, by way of either an abdominal or vaginal incision. Removal might include removal of the cervix (total hysterectomy) or not (subtotal / partial hysterectomy). A radical hysterectomy involves surgical removal of the uterus, upper vagina, tissues adjacent to the uterus and possibly the ovaries; usually undertaken for carcinoma of the uterus. A hysterectomy with oophorectomy involves the removal of the uterus and one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Estrogen
One of the female sex hormones produced by the ovaries.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Constipation
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.