What Are Uterine Fibroids?
Uterine fibroids, also known as myomas or leiomyomas, are benign (non-cancerous) tumors that develop within or around the uterus. These growths consist of muscle cells and fibrous connective tissue and can range in size from a pea to a small orange. It is estimated that between 30% and 77% of women will develop fibroids during their reproductive years, although many are asymptomatic and remain undiagnosed.
Causes of Uterine Fibroids
The exact cause of uterine fibroids remains unclear, but they are believed to originate from an abnormal muscle cell that grows rapidly in response to high levels of estrogen. Women approaching menopause are at greater risk due to hormonal changes. Additional risk factors include clinical obesity and being of African descent, although the reasons for these associations are not fully understood.
Symptoms of Uterine Fibroids
While fibroids may not always present symptoms, when they do, the severity can vary. Common symptoms include:
- Prolonged or Heavy Periods: Heavy menstrual bleeding or extended periods.
- Abnormal Bleeding: Bleeding between menstrual cycles.
- Abdominal Discomfort: Pain or pressure in the abdomen.
- Pelvic Pain: Pain caused by fibroids pressing on pelvic organs.
- Back Pain and Constipation: Pain in the lower back and difficulty with bowel movements.
- Frequent Urination: Increased urgency or difficulty in passing urine.
- Pain During Sex: Discomfort during or after intercourse.
- Firm Mass: A noticeable mass in the pelvic area, detectable by a healthcare provider.
Types of Fibroids
- Intramural Fibroids: These grow within the uterine muscle and can distort the uterus, leading to heavy bleeding and pain.
- Subserosal Fibroids: These protrude outside the uterus into the pelvic cavity, potentially causing pressure and discomfort.
- Submucosal Fibroids: These extend into the inner uterine cavity and can cause bleeding issues and difficulties with conception.
Impact on Pregnancy and Fertility
Fibroids can complicate pregnancy and fertility, particularly submucosal fibroids, which may interfere with implantation. Although fibroids do not typically prevent conception, they are linked to recurrent miscarriages and may require removal if fertility issues arise.
Detection and Diagnosis
Fibroids are usually detected during a pelvic exam, but further diagnostic tests may include:
- Transvaginal Ultrasound: Uses sound waves to assess the size and location of fibroids.
- MRI: Provides a detailed image of the uterus to evaluate fibroids.
- Hysterosonography: Injects saline to enhance ultrasound imaging, revealing submucosal fibroids.
- Hysteroscopy: A small camera examines the uterus and cervix, often used to diagnose and treat submucosal fibroids.
Treatment Options
Not all fibroids need treatment. For those that do, options include:
- Medications: To manage symptoms or shrink fibroids.
- Surgical Procedures: Such as myomectomy or hysterectomy, depending on the size and severity of the fibroids.
- Lifestyle Adjustments: Managing symptoms through diet and exercise, especially if the fibroids are causing significant discomfort.
In most cases, fibroids will shrink or disappear after menopause due to decreased estrogen levels.