About Fibroids

Uterine fibroids are non-cancerous growths that form within the uterus, most frequently during the reproductive years when a person is capable of becoming pregnant. These fibroids are not linked to uterine cancer and rarely become malignant. They’re also referred to as myomas or leiomyomas. Fibroids can range significantly in size and number—from tiny, undetectable nodules to large masses that reshape the uterus. In extreme cases, they can expand enough to fill the abdomen and resemble pregnancy. Most individuals with fibroids don’t have symptoms, and many discover them incidentally during a pelvic check or prenatal scan.

What Are Fibroids?

Uterine fibroids are non-cancerous (benign) growths that develop from the smooth muscle tissue of the uterus, also known as the myometrium. Despite being tumors, they are not associated with cancer and do not increase the risk of uterine cancer.

Fibroids are highly variable—they can occur as a single growth or multiple clusters, and they can range in size from a pinhead (1 mm) to more than 20 cm in diameter, sometimes large enough to distort the shape of the uterus or resemble pregnancy.

Types of Uterine Fibroids

Fibroids are classified based on their location within or around the uterus, which also influences the symptoms they may cause:

1. Intramural Fibroids

• Grow within the muscular wall of the uterus.
• The most common type.
• May cause heavy bleeding, pelvic pain, or an enlarged uterus.

2. Submucosal Fibroids

• Develop just beneath the endometrium, the inner lining of the uterus.
• Can protrude into the uterine cavity.
• Often associated with excessive bleeding, infertility, and recurrent miscarriages.

3. Subserosal Fibroids

• Form on the outer surface of the uterus, just under the outer lining (serosa).
• Can grow outward into the pelvis, potentially compressing nearby organs like the bladder or bowel.

4. Pedunculated Fibroids

• Grow on a thin stalk (peduncle), extending from the uterus either inside or outside.
• Often described as mushroom-shaped.
• If the stalk twists, it can cause acute pain and may require emergency treatment.

Common Signs and Symptoms of Fibroid

Not all women with fibroids experience symptoms. When symptoms do appear, they depend on the size, number, and position of the fibroids:

• Heavy or prolonged menstrual bleeding
• Painful periods (dysmenorrhea)
• Irregular menstrual cycles
• Pelvic pressure or bloating
• Lower back or abdominal pain
• Pain during sexual intercourse
• Frequent urination or urinary urgency
• Constipation
• Visible or palpable abdominal swelling
• Sudden sharp pain if a fibroid outgrows its blood supply and degenerates

Fibroid Causes and Contributing Factors

The exact cause of fibroid formation is not fully understood, but several biological and genetic factors have been identified:

1. Hormonal Influence

• Estrogen and progesterone, two key reproductive hormones, promote the growth of uterine fibroids.
• Fibroids contain higher concentrations of hormone receptors than normal uterine tissue.
• After menopause, when hormone levels drop, fibroids often shrink naturally.

2. Genetic Mutations

• Many fibroids show changes in specific genes such as MED12 and HMGA2, both associated with cell growth and proliferation.
• A family history of fibroids significantly increases the risk, indicating a possible hereditary component.

3. Extracellular Matrix (ECM) Imbalance

• Fibroids produce an excessive amount of ECM, the supportive tissue around cells.
• This makes them firm and fibrous, contributing to their size and stiffness.
• ECM also influences cell signaling and hormone response, encouraging fibroid growth.

4. Growth Factors

• Proteins such as Insulin-like Growth Factor (IGF) and Transforming Growth Factor-beta (TGF-β) can stimulate the growth of fibroid tissue by promoting cell multiplication and ECM production.

Risk Factors for Developing Fibroids

Certain factors may increase a woman's likelihood of developing uterine fibroids:

• African-American ethnicity (higher incidence, earlier onset, and more severe symptoms)
• Age 30 to 50 (most common in reproductive years)
• Family history of fibroids (especially first-degree relatives)
• Obesity and hypertension
• Early onset of menstruation (before age 10)
• Never having been pregnant (nulliparity)
• Diet low in fruits and vegetables and high in red meat

Possible Complications of Untreated Fibroids

Without timely treatment, fibroids can lead to:

• Iron-deficiency anemia due to chronic heavy bleeding
• Infertility or repeated pregnancy loss, especially with submucosal fibroids
• Pregnancy complications such as preterm labor or the need for C-section
• Urinary or bowel obstruction from pressure exerted by large fibroids
• Sudden severe pain if a fibroid undergoes degeneration or torsion (twisting)
   

Diagnosis of Uterine Fibroids

Timely and accurate diagnosis is crucial for appropriate management. Diagnostic methods include:

1. Pelvic Examination

• May reveal an enlarged or irregular uterus.
• Often the first step in identifying possible fibroids.

2. Ultrasound (Sonography)

• A non-invasive, first-line test using abdominal or transvaginal probes.
• Provides information about fibroid size, number, and location.

3. MRI (Magnetic Resonance Imaging)

• Offers detailed images of uterine tissue.
• Helpful in planning surgery or distinguishing fibroids from other conditions.

4. Hysteroscopy

• Involves inserting a thin telescope-like device through the cervix into the uterus.
• Allows direct visualization and sometimes simultaneous removal of submucosal fibroids.

Treatment Options for Uterine Fibroids

Treatment depends on symptoms, size and location of fibroids, age, and fertility goals. Options include:

Medications

• NSAIDs (e.g., ibuprofen) – for pain relief.
• GnRH agonists – to shrink fibroids by lowering hormone levels temporarily.
• Hormonal therapy – such as birth control pills to manage bleeding.
• Tranexamic acid – to reduce menstrual blood loss.

Note: Medications do not eliminate fibroids but help manage symptoms. Always consult your doctor before starting any treatment.

Minimally Invasive Surgical Procedures

1. Advanced Laparoscopic Myomectomy

• Removes fibroids through keyhole incisions while preserving the uterus.
• Ideal for women wishing to maintain fertility.
• Less pain, faster recovery, and minimal scarring.

2. Advanced Laparoscopic Hysterectomy

• Involves complete removal of the uterus using laparoscopy.
• Permanent solution for fibroids with no chance of recurrence.
• Benefits include smaller incisions, less blood loss, and quicker healing.

3. Advanced Laparoscopic Excision or Ablation

• Excision physically removes fibroid tissue.
• Ablation destroys fibroids using energy sources (laser, radiofrequency).
• Both aim to relieve symptoms while sparing the uterus.

4. Hysteroscopic Myomectomy

• Used to remove submucosal fibroids via a scope inserted through the vagina and cervix.
• No external incisions, minimal downtime, and can improve reproductive outcomes.

Surgery Options

• Myomectomy: Preserves fertility by removing fibroids only
• Hysterectomy: Removes the uterus completely—considered a permanent solution