Understanding Uterine Fibroids

Uterine fibroids (leiomyomas) are non-cancerous growths within or on a woman's uterus. Fibroids typically form during a woman's reproductive years, from approximately age 16 to 50, when oestrogen (female reproductive hormone) levels peak.

Types of uterine fibroids

Fibroids can appear anywhere within the uterus and can vary significantly in size, ranging from being minuscule (the size of a pea) or occasionally as large as a grapefruit.

Firbroids can be categorised into three main types. Intramural fibroids are the most common type of uterine fibroid that forms within the muscular wall of the uterus. Subserosal fibroids develop on the outer wall of the uterus, extending into the pelvic area. They can sometimes grow quite large. Submucosal fibroids originate in the muscle layer beneath the inner lining of the uterus and can protrude into the uterine cavity.

Additionally, some subserosal and submucosal fibroids are connected to the uterus by a slender stalk of tissue, and these are referred to as pedunculated fibroids.

Risk factors for uterine fibroids

The exact cause of uterine fibroids is not fully understood. However, several risk factors may increase the risk of developing uterine fibroids: early menarche below the age of 10 years old, previous exposure to diethylstilbestrol during pregnancy, and being overweight or obese.

Excessive consumption of beef and other red meat and the consumption of beer seems to be linked to a higher likelihood of developing fibroids.

There is evidence suggesting the existence of specific susceptibility genes that may play a role in the development of fibroids.

Symptoms of uterine fibroids

Many women with uterine fibroids are asymptomatic (have no symptoms), although certain symptoms may be experienced, for example heavy or prolonged menstrual bleeding, painful periods, painful sexual intercourse, frequent urination, and constipation.

Fibroids are more likely to cause symptoms when they are large, when multiple fibroids are present, or when located in specific areas within the uterus.

Fibroids tend to diminish in size when estrogen levels decrease and the symptoms associated with fibroids often improve when a person reaches menopause, when a woman's menstrual cycles cease.

While most uterine fibroids do not cause significant health problems, it is crucial to seek medical attention if you suspect you have uterine fibroids or are experiencing symptoms.

The probability of complications depends on various factors, including the location and size of the fibroids. Large fibroids may be a cause for infertility. Fibroids may cause complications during pregnancy, such as premature labour, preterm birth, and foetal malpresentation. They may also increase the risk of miscarriage.

Diagnosis of uterine fibroids

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Ultrasound is the most common test used to diagnose uterine fibroids. This is a non-invasive imaging procedure that utilises a probe emitting high-frequency sound waves to generate a visual representation of the inside of your body.

Hysteroscopy is a procedure involves inserting a small camera into the uterus through the cervix to look for fibroids.

Magnetic resonance imaging (MRI) is the most effective imaging technique for accurately visualising the size and location of all uterine myomas. It also can differentiate between various uterine conditions, such as leiomyomas, adenomyosis, and adenomyomas, providing valuable diagnostic information.

Treatment options for uterine fibroids

Treatment for fibroids may not be required if you are asymptomatic (do not experience any symptoms) or if you only have mild symptoms that do not significantly disrupt your daily activities.

Antifibrinolytic medication such as Tranexamic acid tablet

• This medication helps blood to clot in order to reduce blood loss. It is not advisable to take antifibrinolytic medications concurrently with hormonal birth control without the approval of your doctor or nurse. Combining these medications may heighten the risk of blood clots, stroke, and heart attack.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Ibuprofen may also be taken from the first day of one's period until the bleeding stops or reduces to manageable levels. These work by lowering one's body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

Hormonal birth control (birth control pill, skin patch, vaginal ring, contraceptive shot, hormonal intrauterine device (IUD), implant)

• These methods are effective in reducing menstrual bleeding, alleviating cramps, and mitigating menstrual pain. Additionally, they can help correct anaemia associated with heavy periods.
• It is worth noting that it may take up to three months after initiating hormonal birth control for menstrual bleeding to improve.

Levonorgestrel intrauterine system (LNG-IUS)

• A small device that is placed in your womb to slowly release the progestogen hormone levonorgestrel, which stops the womb lining from growing quickly.

Gonadotropin-releasing hormone analogues

• It can cause the ovaries to temporarily stop producing estrogen and progesterone. This reduction in hormonal production can help reduce heavy menstrual bleeding.

If your symptoms are severe and medication has been ineffective, surgery may be suggested. Hysterectomy is a surgical procedure to remove the uterus that may be recommended if one has large fibroids or severe bleeding and does not wish to have any more children.

Another option is myomectomy, a surgical procedure to remove fibroids from the uterine wall. It is often considered an alternative to a hysterectomy, especially if you desire to preserve your fertility and have children in the future.

Non-surgical procedures that are available to treat fibroids include uterine artery embolisation (UAE), a procedure done to block blood supply to the fibroids. Endometrial ablation is a procedure done to destroy the lining of the uterus, but it does not shrink the fibroids. It may help to reduce heavy menstrual bleeding due to fibroids.

Read more: Fibroids vs Cysts

Make an appointment at Gleneagles Hospitals

If you suspect that you are experiencing symptoms of uterine fibroids, get in touch with us to find out more about our Obstetrics & Gynaecology Services at your nearest Gleneagles Hospital.

You may also contact the Health Screening Centre at your nearest Gleneagles Hospital for health screening appointments