Definition and Treatment for Uterine Fibroids
Fibroids, also called uterine myoma, are abnormal, non-cancerous growths that develop in or on a woman’s uterus (womb). They are typically present during a woman’s reproductive years and affect up to 80% of women by the age of 50. Fibroids are, however, more common in the 40s and early 50s. Not all women have symptoms, and those who have symptoms (about 20-50% of women with fibroids) have a challenging time living with fibroids.
Fibroids can grow as single or multiple tumors of varying sizes in the uterus. Fibroids are also known as fibromas and leiomyomas. Although fibroids are non-cancerous, in rare cases, a fibroid might be cancerous. However, cancerous fibroids do not arise from already existing fibroids, so having fibroids does not increase the risk of cancers of the uterus.
Causes of Fibroids
The cause of fibroids is unknown, but different factors have been linked to the development of fibroids. Hormonal changes, such as estrogen and progesterone, have been shown to affect the formation of fibroids. Fibroids also have a genetic component and can run in families.
A fibroid can be as small as an apple seed, as huge as a grapefruit, or even bigger in rare cases. Since fibroids are under hormonal control, they tend to grow during pregnancy when hormone levels are rising and shrink or stop growing at menopause.
Symptoms of Fibroids
- Pain during intercourse
- Lower back pain
- Heavy bleeding that can lead to anemia
- Feeling of fullness in lower abdomen
- Painful periods
- Enlargement of lower abdomen, making a woman look pregnant
- Rectal pressure from pressure on the bladder
- Frequent urination from pressure on the bladder
- Difficulty getting pregnant
Different Types of Fibroids
Fibroids can grow in different parts of the wall of the uterus and are categorized based on where they reside. A fibroid in the uterine cavity is a sub-mucosal fibroid; a fibroid within the wall of the uterus is an intra-mural fibroid; and, a fibroid on the outside of the uterus is a sub-serosal fibroid. Occasionally, some fibroids can grow as stalks that resemble mushrooms. These are called pedunculated fibroids.
Diagnosis of Fibroids
Fibroids can be detected during a routine pelvic examination where the ovaries, vagina, and uterus are checked. The doctor may proceed with an imaging test for a definite diagnosis of fibroids. Examples of tests done to diagnose fibroids include X-ray, magnetic resonance imaging (MRI), cat scan (CT), and ultrasound. The doctor can also order a hysterosalpingogram (HSG) or a sonohysterogram, both of which involve either injecting a dye or water into the uterus and taking x-ray or ultrasound images to see the fibroids.
Risk Factors for Fibroids
Fibroids can occur in any woman of reproductive age; however, certain factors can increase the risk of fibroids, including:
- Obesity – women who are overweight have a two to three times more risk of developing fibroids compared to women within a healthy weight range
- Age – having fibroids is more common for women in their 30s and 40s and into menopause. However, since fibroids have a hormonal component, they tend to shrink as a woman approaches menopause
- Diet – a diet of meat, especially red meat and ham, can predispose a woman to fibroids. Green vegetables and fruits, on the other hand, can reduce the risk of developing fibroids
- Genetics – family history is a contributing factor to fibroids. A woman with a first-degree relative with fibroids, like her mother, is two to three times more likely end up with fibroids than a woman without a family history of fibroids
Treatment for Fibroids
If you have fibroids but do not have symptoms, chances are you may not need treatment. However, your doctor will keep an eye on the fibroids during your regular exams to track their growth. For those who need treatment due to symptoms, the choice of treatment will depend on many factors, like the location and size of the fibroids, but also your age, desire for pregnancy in the future, and proximity to menopause.
When treatment is an option, various medications like over-the-counter pain killers can help control pain. Certain hormonal medications like birth control can also help minimize symptoms.
Fibroids can also be treated with surgery for women with moderate to severe symptoms. Surgical procedures include:
- Myomectomy – removing the fibroids without taking out any healthy tissue
- Myolysis – using electric current or freezing to destroy the fibroid
- Endometrial Ablation – removing the lining of the uterus to control heavy bleeding
- Uterine Fibroid Embolization/Uterine Artery Embolization – blocking blood supply to the fibroid, which shrinks it
- Hysterectomy – surgically removing the uterus
- Antihormonal drugs – for symptomatic relief
- Radiofrequency Ablation – using heat to destroy fibroid tissue
Prevention of Fibroids
Although fibroids are usually not life-threatening, they are an inconvenience and can cause serious medical complications and health problems. A few changes you can make to reduce the risk of fibroids include:
- Eat a balanced diet with plenty of fruits, green vegetables, and fish. Avoid beef, ham, lamb, and other red meat when possible. Also eat foods rich in potassium (like avocado, bananas, dates, and citrus), fiber (like beans, lentils, oats, and raw vegetables), dairy (like yogurt and cheese), and tea (especially green tea with antioxidants)
- Get enough vitamin D, which has been shown to reduce the risk of fibroids by about 32%. Vitamin D can be found in foods like milk, eggs, fish, and fortified cereals. It is also naturally available when your skin is exposed to sunlight. Vitamin D supplements can also provide additional vitamin D
- Reduce alcohol intake since alcohol can increase the hormones that trigger fibroid growth. Alcohol can increase the risk of fibroids by up to 50%
- Maintain a healthy body weight as obesity increases the risk of fibroids. Excess fat cells make estrogen, which can increase growth of fibroids
- Control blood pressure since women with severe fibroids tend to have higher blood pressure than women without severe fibroids. By lowering your blood pressure, you can reduce the risk of fibroids as well as eliminate some symptoms of fibroids
- Quit smoking as smoking can increase the risk of fibroids
Complications of Fibroids
Although fibroids do not cause serious problems in the long run, when untreated, they can continue to grow and could lead to worsening bleeding and anemia. Anemia can be exhausting and can affect the quality of life of a woman. With pregnancy, enlarged fibroids can complicate labor and delivery. A pregnant woman with fibroids is six times more likely to deliver by cesarean section compared to a pregnant woman without fibroids. In rare cases, fibroids can lead to infertility as well as other reproductive problems. Fibroids, especially the larger ones, can also cause bladder and bowel dysfunction. And in acute cases, fibroids can be more complicated and potentially lead to severe disruption of the woman’s quality of life.