Uterine Fibroids | Causes, Symptoms, Diagnosis, & Effective Treatment Options

What are Uterine Fibroids?

Uterine Fibroids (also called myomas, fibromyomas, or fibromas) are benign (non-cancerous) growths that develop in or on the uterus. These fibroids can grow inside the uterus, on its outer surface, or within the uterine wall itself.

Uterine fibroids are the most common type of abnormal growth found in the female pelvis. Fibroids are found most often in women in their 30s and 40s, but they can occur in women of any age. About one in four or five women over the age of 35 has fibroids.

Fibroids are growths that develop from cells that make up the muscle of the uterine wall. The size, shape, and location of fibroids can vary greatly. They may be attached directly to the inside or outside of the uterus, or they may appear on a stem-like structure attached to the uterus. As they grow, fibroids can distort both the inside and outside surface of the uterus. Fibroids can range in size from small, pea-sized growths to large, round growths that may be more than 5-6 inches in diameter. In some cases, fibroids can grow large enough to fill the pelvis and be mistaken for pregnancy completely. While fibroids may occur singly, they are more commonly found in groups of varying sizes.

What are the Risk Factors of Uterine Fibroid?

Although fibroids are quite common, the cause of their development is still unknown. However, once fibroids appear, they may grow larger when the body produces higher amounts of oestrogen, such as during pregnancy or when using certain types of birth control pills. During menopause, when menstrual periods end and oestrogen production slows or stops, fibroids tend to become smaller and often disappear.

Hormonal changes also influence uterine fibroids, and as a woman approaches menopause, the levels of estrogen naturally decline, often causing fibroids to shrink and sometimes even disappear. Other factors such as genetic predisposition, age, and ethnicity may also increase the likelihood of developing fibroids.

What are the Symptoms of Uterine Fibroid?

Many uterine fibroids don’t produce any symptoms. However, some fibroid symptoms include:

• Changes related to menstruation such as:
  • Increased amount of menstrual bleeding
  • Increased frequency or length of menstrual periods
  • Increased menstrual pain
• Unexpected vaginal bleeding outside of the normal menstrual cycle
• Dull, heavy, aching pain in the abdomen or lower back
• More frequent urination, caused by pressure on the bladder

Although most fibroids do not cause significant problems, certain complications may occur. In fibroids attached to the uterus by a stemlike structure, twisting of the stem may cause acute pain, nausea, fever, and vaginal bleeding. Sometimes, a fibroid may become infected. In very rare cases, tissues in the fibroid may change and become cancerous. In rare instances, a very large fibroid may cause unusual swelling of the abdomen and infertility. See your doctor immediately if you experience any of these uterine fibroid symptoms.

How is Uterine Fibroid Diagnosed?

If your doctor suspects uterine fibroids, they will typically perform a pelvic exam to check for any obvious signs. Fibroids are often found during routine gynecological exams or when tests are done for other conditions, as they may not cause noticeable symptoms.

The main diagnostic tests for fibroids include:

• Ultrasound: A painless procedure that uses high-frequency sound waves to create images of the uterus. Two types of ultrasound scans can be used:
  • Abdominal Ultrasound: A probe is moved over the abdomen.
  • Transvaginal Ultrasound: A small probe is inserted into the vagina for more detailed images.
• Laparoscopy: A small camera is inserted into the abdomen to examine the organs and tissues. This is typically performed under general anesthesia.
• Hysteroscopy: A small telescope is inserted through the vagina and cervix to examine the inside of the womb. This procedure is most often used to identify submucosal fibroids.
• Hysterosalpingography: A special X-ray test where a dye is injected into the uterus and Fallopian tubes to detect abnormal changes in their size and shape.

As most fibroids don’t produce any symptoms, they are often first found during a routine pelvic exam. If fibroids are suspected, you may be referred to a gynecologist for further tests to confirm the diagnosis and rule out other potential causes.

What are the Treatment Options for Uterine Fibroid?

Treatment for uterine fibroids may not be necessary, if the fibroids: 

• Do not cause symptoms
• Are small
• Are in a woman nearing menopause, when the natural decline in oestrogen levels usually shrink fibroids

Treatment may be needed if a woman with fibroids experience has:

• Progressively heavy or painful menstrual periods
• Abnormal vaginal bleeding
• Fibroid that is suspected to be a potentially cancerous tumour
• Large fibroid
• Fast-growing fibroid

If treatment is needed, options typically include:

Medication for Uterine Fibroids

• Levonorgestrel intrauterine system (LNG-IUS): A device inserted into the uterus to release the hormone levonorgestrel, reducing menstrual bleeding.
• Tranexamic acid: Used to help reduce heavy bleeding by promoting blood clotting.
• Non-steroidal anti-inflammatory drugs (NSAIDs): These include ibuprofen to manage pain and heavy bleeding.
• GnRH analogues (GnRHas): This is a hormonal treatment that shrinks fibroids by reducing estrogen levels.
• Oral progestogen: Synthetic progesterone that helps reduce bleeding by preventing the rapid growth of the uterine lining.

Surgery for Uterine Fibroids

• Myomectomy: This operation involves the removal of the fibroids only, leaving the uterus in place, and it's suitable for women who wish to maintain fertility. Hysteroscopic myomectomy uses a hysteroscope, a telescope, and a thin tube inserted through the cervix to remove fibroids that protrude into the cavity of the uterus.
• Hysterectomy: This operation involves the removal of the entire uterus. It is the only certain “cure” for fibroids. Hysterectomy is usually recommended for women whose fibroids are causing symptoms, especially if no future pregnancy is planned.

Non-Surgical Procedures

• Uterine artery embolization (UAE): A minimally invasive procedure to block blood flow to the fibroids, causing them to shrink. This option is often used for larger fibroids.
• Endometrial ablation: Involves the removal of the uterine lining to reduce heavy bleeding. It is suitable for small fibroids located in the uterine lining.
• MRI-guided focused ultrasound: A non-invasive treatment that uses MRI to guide ultrasound energy to destroy fibroid tissue.

Surgery or non-surgical procedures may be recommended for large or rapidly growing fibroids or for fibroids causing significant discomfort. A gynecologist will discuss the best treatment option based on the fibroids size, type, and location, as well as the patient's symptoms and fertility desires.

Get Expert Care for Uterine Fibroids at Gleneagles Hospital Penang

If you are experiencing symptoms of uterine fibroids, it is essential to seek medical advice and explore the best treatment options for your condition. At Gleneagles Hospital Penang, our experienced gynaecologists offer comprehensive care and personalised treatment plans tailored to your unique needs. Whether you require medication, non-surgical procedures, or surgery, our team is here to provide expert guidance and support. Contact us today to schedule a consultation and take the first step towards effective fibroid management.