FIBROIDS: Causes, Treatment and Symptoms

FIBROIDS

Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Fibroids are also known by the following names:

• leiomyomas
• myomas
• uterine myomas
• fibromas

What are the different types of fibroids?

The type of fibroid a woman develops depends on its location in or on the uterus.

Intramural fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.

Pedunculated fibroids

Subserosal tumors can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of tumors develop in the middle muscle layer, or myometrium, of your uterus. Submucosal tumors aren’t as common as the other types.

What causes fibroids?

It’s unclear why fibroids develop, but several factors may influence their formation.

Hormones

Estrogen and Progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.

Family history

Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

Pregnancy

Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you're pregnant.

Who is at risk for fibroids?

Women are at greater risk for developing fibroids if they have one or more of the following risk factors:

• pregnancy
• a family history of fibroids
• age of 30 or older
• Africans
• a high body weight

What are the symptoms of fibroids?

Your symptoms will depend on the number of tumors you have as well as their location and size. For instance, submucosal fibroids may cause heavy menstrual bleeding and trouble conceiving. 

If your tumor is very small or you’re going through menopause, you may not have any symptoms. Fibroids may shrink during and after menopause. This is because women undergoing menopause are experiencing a drop in their levels of estrogen and progesterone, hormones that stimulate fibroid growth.

Symptoms of fibroids may include:

• heavy bleeding between or during your periods that includes blood clots
• pain in the pelvis or lower back
• increased urination
• pain during intercourse
• pressure or fullness in your lower abdomen
• swelling or enlargement of the abdomen
• increased menstrual cramping
• menstruation that lasts longer than usual 

How are fibroids diagnosed?

For a proper diagnosis, you’ll need to see a gynecologist to get a pelvic exam. This exam is used to check the condition, size, and shape of your uterus. You may also need other tests, which include:

Ultrasound

An ultrasound uses high-frequency sound waves to produce images of your uterus on a screen. This will allow your doctor to see its internal structures and any fibroids present. A transvaginal ultrasound, in which the ultrasound wand is inserted into the vagina, may provide clearer pictures since its closer to the uterus during this procedure.

Pelvic MRI

This in-depth imaging test produces pictures of your uterus, ovaries, and other pelvic organs.

How are fibroids treated?

Your doctor will develop a treatment plan based on your age, the size of your fibroids, and your overall health. You may receive a combination of treatments.

Home remedies and natural treatments

Certain home remedies and natural treatments can have a positive effect on fibroids, including:

• acupuncture
• yoga
• massage
• applying heat for cramps (avoid heat if you experience heavy bleeding)

Dietary changes can help as well. Avoid meats and high-calorie foods. Instead, opt for foods high in flavonoids, green vegetables, green tea, and cold-water fish such as tuna or salmon.

Managing your stress levels and losing weight if you're overweight can also benefit women with fibroids

Medications

Medications to regulate your hormone levels may be prescribed to shrink fibroids.

Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.

Zoladex also help to shrink fibroids. They work by stopping your body from producing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Examples include:

• ganirelix acetate, an injectable drug
• cetrorelix acetate (Cetrotide), an injectable drug
• elagolix, which is present in the oral drug elagolix/estradiol/norethindrone acetate (Oriahnn)

Other options that can help control bleeding and pain, but won’t shrink or eliminate fibroids, include:

• an intrauterine device (IUD) that releases the hormone progestin
• over the counter anti-inflammatory pain reliever, such as ibuprofen
• birth control pills

Surgery

Surgery to remove very large or multiple growths may be performed. This is known as a myomectomy. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopic, using a few small incisions into which surgical tools and a camera are inserted. Fibroids might grow back after surgery.

If your condition worsens, or if no other treatments work, your physician may perform a hysteroscopy. However, this means that you won’t be able to bear children in the future.

Noninvasive or minimally invasive procedures

A newer and completely noninvasive surgical procedure is forced ultrasound surgery (FUS). You lie down inside a special MRI machine that allows doctors to visualize the inside of your uterus. High-energy, high-frequency sound waves are directed at the fibroids to ablate, or destroy, them.

Myolysis procedures (such as Acessa) shrink fibroids using heat sources like an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial Ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, hot water, or extreme cold.

Another nonsurgical option is uterine artery embolization. In this procedure, small particles are injected into the uterus in order to cut off the fibroids’ blood supply.

 What can be expected in the long term?

Your prognosis will depend on the size and location of your fibroids. Fibroids may not need treatment if they’re small or don’t produce symptoms.

If you’re pregnant and have fibroids, or become pregnant and have fibroids, your doctor will carefully monitor your condition. In most cases, fibroids don’t cause problems during pregnancy. Speak with your doctor if you expect to become pregnant and have fibroids.