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About Uterine Fibroids
Types of Fibroids
These masses are the most common type of tumor found in the female genital tract. Roughly 1 in 3 women over age 35 will develop them in the uterine wall. The four types of fibroids are classified by their location:
Submucous (submucosal): These develop just under the endometrial lining of the uterus.
Intramural: These tumors appear in the muscular wall.
Subserosal: These fibroids develop under the outside covering of the uterus.
Pedunculated: These tumors grow on stalks. They either project from the uterine surface and can be confused with ovarian masses or they project from the uterine interior and extend through the cervix.
Fibroids develop from single uterine wall cells that transform. Although the cause for the transformation is unknown, we do know there is a genetic link. The female hormones estrogen and progesterone, as well as other growth factors, are related to fibroid growth.
Any woman of childbearing age can develop uterine fibroids. However, African American women have a higher incidence – up to 75 percent. Uterine fibroid risk also increases with obesity.
A lower incidence has been associated with women who:
- Exercise
- Have less body fat
- Smoke
- Have more children
- Have children later in life
Symptoms of Fibroids
Most uterine fibroid cases are asymptomatic. Between 60-90 percent of women don’t experience any symptoms at all.
If symptoms appear, they show up in the late 30s and 40s and worsen during perimenopause, the years immediately preceding menopause when your hormones and menstrual cycle begin to change. Some women may develop only one fibroid, but the average is six or seven. Most tumors are golf-ball size, but they can grow to the size of a melon.
Whether a woman experiences symptoms can depend on the number, location, and size of her fibroids.
If you have symptoms, they will commonly include:
- Periods lasting longer than a week
- Heavy menstrual bleeding (menorrhagia): Gushing, flooding, and passing large clots. Possible with submucous and intramural fibroids, this can lead to severe anemia.
Bulk symptoms:
- Frequent urination
- Difficulty fully emptying the bladder
- Pelvic pain or pressure: Associated with heavy menstrual bleeding and cramping.
- Back and leg aches
- Constipation
- Pain during sex
- Reproductive problems: Infertility, recurrent miscarriages, premature labor, and labor complications.
Diagnosis
Diagnosing uterine fibroids usually begins with an internal pelvic exam. During this exam, your doctor will determine if you have an enlarged or irregularly shaped uterus. The diagnosis can be confirmed in one of five ways:
Ultrasonography: Ultrasound images are captured either externally through a fluid-filled bladder or internally with a vaginal probe.
MRI: This non-radiation imaging test can confirm fibroids and rule out things similar to fibroids, including ovarian masses (adenomyosis).
Hysterosonography: A trans-vaginal ultrasound that involves passing a small tube through the cervix and injecting fluid that serves as a contrast agent for images into the uterine cavity.
Hysteroscopy: An office-based procedure where a small, lighted scope passes through the cervix for clear uterine lining visualization. You doctor might also do this to direct a biopsy.
Laparoscopy: This minimally invasive procedure is commonly used to evaluate pelvic pain and diagnose endometriosis. It occurs under general anesthesia and uses a lighted scope to visualize the outer surface of the uterus and surrounding pelvic structures.
Treatment Options
The best treatment option for you depends on what symptoms you have and how bad they are. Your doctor will also consider the size, number, and location of the fibroids, as well as whether you want to preserve your fertility.
TREATMENT OPTIONS INCLUDE:
Watchful waiting: Most fibroids don’t cause symptoms. They can be managed by checking their growth during an annual physical exam.
Medication: The first line of therapy for patients with symptoms, particularly abnormal bleeding.
- NSAIDS
- Iron supplements
- Birth Control Pills/Progestins
- GnRH agonists
Uterine Fibroid Embolization (UFE): An alternative to both medical and surgical therapy. Using imaging-guided angiographic techniques, an interventional radiologist blocks the fibroid’s blood supply, causing them to shrink. This resolves symptoms, preserves the uterus, and safeguards potential fertility.
Surgery: Includes hysterectomy and myomectomy and is available to patients who fail medical management or who aren’t UFE candidates.
