As many as 3 out of 4 women will develop uterine fibroids in their lifetime, so it is one of the most common gynecologic conditions seen in our practice. Fortunately, uterine fibroids, or leiomyomas, are noncancerous masses of muscle which develop from the uterine muscle cells. Although fibroids are often called tumors, they are not associated with an increased risk of uterine cancer and rarely develop into cancer.
Doctors are not sure what causes fibroids, but the following are considered possible factors:
- Genetic changes — many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
- Hormones — Estrogen and Progesterone, two ovarian hormones that stimulate development of the uterine lining during each menstrual cycle, appear to promote the growth of fibroids.
- Other growth factors — substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.
Any woman of reproductive age may develop uterine fibroids. Other risk factors include heredity and race. If a woman’s mother or sister had fibroids, she is at increased risk of developing them. African-American women are more likely to have fibroids than women of other racial groups. They are also more likely to have larger and more numerous fibroids which develop at a younger age.
Other risk factors include starting first period at an early age, having a diet high in red meat and low in green vegetables and fruit, and alcohol use.
Many women with fibroids have no symptoms, but those that do have symptoms most commonly complain of the following:
- Unusually heavy or painful periods
- Long periods lasting more than seven days
- Spotting or bleeding between periods
- Chronic pelvic pressure or pain
- Pain consistently with intercourse
- Difficulty emptying bladder
- Lower backache or upper leg pains
The absence or presence of symptoms may depend on the number, size and location of the fibroid tumors. Fibroids range in size from seedlings to large masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases enlarging the uterus so much that it reaches the rib cage. Fibroids can develop deep within the muscular uterine wall, on the surface of the uterine wall, or within the inner uterine cavity.
Uterine fibroids are frequently found on routine annual pelvic exams or incidentally during a prenatal ultrasound. The fibroid tumors that cause no symptoms may not require treatment. Those patients will be followed with regular pelvic exams and pelvic ultrasounds to assure the tumors are not growing or multiplying. If they are, then they are more likely to cause symptoms which warrant treatment.
Treatment may include medications to manage symptoms without removal of the fibroids, or a surgical procedure to remove the fibroids while leaving the uterus in place. This procedure is called a myomectomy, and depending on the size and location of the fibroids, may be performed hysteroscopically (vaginally) or laparoscopically (through small abdominal incisions), or through a single larger incision which is called a laparotomy.
Myomectomy is usually performed for a woman who desires future fertility, and she is advised that she may develop new fibroids in the future. The only proven permanent solution for uterine fibroids is removal of the uterus, or a hysterectomy. This procedure should be reserved for women who are done with childbearing because it ends their ability to bear children. Hysterectomy ends menstrual periods, but it does not cause menopause to occur unless the woman desires to have her ovaries removed at the same time.
Hysterectomies may be performed laparoscopically or with robotic assistance with rapid recovery times. Other cases may require a laparotomy. Radiologists offer uterine artery embolization where small particles are injected through the groin vessels to block the arteries supplying blood flow to the fibroids causing them to die.
Although uterine fibroids are not usually dangerous, they are very common so women should have their annual gynecologic exam done, and see their doctor sooner if they develop unusual persistent symptoms previously discussed. Iron deficiency anemia, infertility, and multiple miscarriages are possible complications associated with fibroids. The earlier a woman’s fibroids are diagnosed, the more treatment options she will have. At this time, very little is known on how to prevent fibroids. The good news is, the management and treatment of fibroids is well established.
Dr. Evangeline Ramos-Gonzalez
The Institute for Women’s Health