Uterine Fibroid – Causes, Symptoms and Treatment

What is a Uterine Fibroid?

A uterine fibroid is a benign (non-cancerous) growth that develops from the smooth muscle tissue of the uterus. Medically, fibroids are also referred to as leiomyomas or fibromyomas. They are the most common benign tumors in women of reproductive age. Fibroids can appear as a single growth or in multiples and vary widely in size – from a few millimeters to several centimeters in diameter.

Causes

The exact cause of fibroid development is not yet fully understood. The most important contributing factors include:

• Hormones: Estrogen and progesterone promote fibroid growth. This is why fibroids predominantly occur during the reproductive years and often shrink after menopause.
• Genetic predisposition: Women with a family history of fibroids (mother or sister) are at higher risk.
• Ethnicity: Women of African descent are more frequently and more severely affected.
• Obesity: Excess body weight may increase the risk of fibroid development.

Types of Fibroids

Fibroids are classified based on their location within the uterus:

• Intramural: The fibroid grows within the uterine muscle wall – the most common type.
• Subserosal: The fibroid grows outward toward the abdominal cavity.
• Submucosal: The fibroid grows into the uterine cavity and is most likely to cause heavy bleeding.
• Pedunculated: The fibroid is attached to the uterus by a stalk.

Symptoms

Many fibroids cause no symptoms and are discovered incidentally. When symptoms do occur, they may include:

• Heavy or prolonged menstrual bleeding (menorrhagia)
• Pelvic pain or pressure
• Frequent urination or difficulty emptying the bladder
• Lower back or leg pain
• Pain during sexual intercourse
• Bloating or constipation due to pressure on the intestines
• Difficulty conceiving (in some cases)

Diagnosis

Fibroids are typically diagnosed through:

• Gynecological examination: An enlarged or irregularly shaped uterus may be felt during a pelvic exam.
• Ultrasound (sonography): Transvaginal or abdominal ultrasound is the standard method for detecting fibroids.
• MRI (Magnetic Resonance Imaging): Provides detailed images and is used when surgical planning is needed.
• Hysteroscopy: Direct visualization of the uterine cavity, particularly useful for suspected submucosal fibroids.

Treatment

Treatment depends on the severity of symptoms, the size and location of the fibroid, and whether the patient wishes to preserve fertility:

Watchful Waiting

For small, asymptomatic fibroids, a watch-and-wait approach is often recommended, with regular monitoring.

Medication

• GnRH analogues: Reduce estrogen levels and can temporarily shrink fibroids before surgery.
• Ulipristal acetate: A selective progesterone receptor modulator used to manage fibroid symptoms.
• Hormonal contraceptives: Can help reduce menstrual bleeding associated with fibroids.
• Pain relief medication: Used to manage pelvic discomfort.

Minimally Invasive Procedures

• Uterine Artery Embolization (UAE): Blood vessels supplying the fibroid are blocked, causing it to shrink.
• MRI-guided Focused Ultrasound (MRgFUS): High-energy ultrasound waves destroy fibroid tissue.

Surgical Treatment

• Myomectomy: Surgical removal of the fibroid while preserving the uterus – suitable for women who wish to conceive.
• Hysterectomy: Complete removal of the uterus – a definitive solution for women who have completed their family planning.

Fibroids and Fertility

Most women with fibroids can conceive without difficulty. In some cases, particularly with submucosal fibroids, implantation of a fertilized egg may be impaired, or the risk of miscarriage may be increased. Individual medical consultation is essential in such cases.

References

1. Stewart EA. Uterine fibroids. N Engl J Med. 2015;372(17):1646-1655.
2. World Health Organization (WHO): Reproductive Health – Uterine Fibroids, 2023.
3. American College of Obstetricians and Gynecologists (ACOG): Practice Bulletin No. 228 – Management of Symptomatic Uterine Leiomyomas, 2021.