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Summary

Uterine fibroids (also known as leiomyomas, uterine myomas, myomas, or fibromas) are non-cancerous (benign) growths that develop from the muscular tissue of the uterus (womb). A fibroid may be present anywhere in the uterus, such as in the, on the outer surface of the uterus, within the wall of the uterus, or attached to the uterine wall by a supporting structure resembling a stem (pedunculated fibroid). There may be a single fibroid or multiple fibroids of varying sizes. A fibroid may gradually grow over a number of years or may remain small for a long time and then suddenly grow rapidly. While the reason why fibroids develop is unknown, factors like heredity and hormones are thought to play a role in stimulating the development of fibroids. In some cases, fibroids may cause no symptoms at all, while in others, women may experience heavy periods and severe abdominal pain. There are certain medications that can relieve the symptoms of fibroids. However, these medicines may not prevent the fibroids from increasing in size. Usually, fibroids that are without any symptoms do not require any treatment. In symptomatic women, if the medications do not work as expected, surgery is the choice of treatment. The possible complications of fibroids mainly include severe pain, heavy bleeding, or twisting of the fibroid itself. Other complications that can occur include anaemia, urinary tract infections or in rare cases, infertility.

  1. What are Uterine fibroids
  2. Types of Uterine fibroids
  3. Uterine fibroids symptoms
  4. Uterine fibroids causes and risk factors
  5. Prevention of Uterine fibroids
  6. Diagnosis of Uterine fibroids
  7. Uterine fibroids treatment
  8. Uterine fibroids prognosis and complications
  9. Medicines for Uterine Fibroids

What are Uterine fibroids

Uterine fibroids are abnormal growths made up of smooth muscle cells and other surrounding tissue that develop within the wall of the uterus. The number of fibroids can vary from being a single growth to multiple fibroids. Even the size can range from being just about microscopic to eight inches or more. The size of most fibroids ranges from being the size of a large marble to being slightly smaller than a baseball.

Uterine fibroids are the most common pelvic tumours that occur in women who are in the reproductive age. According to a study, by the age of 50 years, up to 80% of women develop uterine fibroids. In the United States, uterine fibroids are the main reason for surgical removal of the uterus (hysterectomy). In a study conducted in the European population in 2014, an estimated 21.4% of women between 30 to 60 years of age were diagnosed with fibroids. In women who have no symptoms of fibroids, the diagnosis is usually established incidentally on an ultrasound scan during routine health check-up or during investigations performed for the diagnosis of some other health condition. 20% to 50% of women with uterine fibroids are symptomatic and may wish to undergo treatment.

Types of Uterine fibroids

Fibroids are of three types depending on their location within the uterus or on the outer surface of the uterus:

  • Intramural fibroids 
    These are the most common type of fibroids, developing within the muscular wall of the uterus. They may grow larger over time and may stretch the uterus.
  • Subserosal fibroids 
    These fibroids develop outside the wall (serosa) of the uterus and into the pelvis. They can become very large. In fact, if they become too big, they can make your belly look protruded and big from one side.
  • Submucosal fibroids
    These types of fibroids develop in the middle muscular layer (myometrium), beneath the innermost lining of the uterus and may protrude into the uterine cavity. They are uncommon as compared to the other types.

In some people, subserosal or submucosal fibroids can develop a narrow stem, which provides support to the fibroid. These are known as pedunculated fibroids.

Uterine fibroids symptoms

Many women do not experience any symptoms even though they do have fibroids in the uterus. However, in other women, uterine fibroids can cause uncomfortable or sometimes painful symptoms, like:

  • Bleeding between periods (known as metrorrhagia, spotting or intermenstrual bleeding).
  • Heavy bleeding or painful periods.
  • Anaemia i.e., a decrease in the haemoglobin or the red blood cells of the blood due to heavy bleeding during periods.
  • Increased frequency of urination due to pressure caused by the fibroid pressing onto the bladder.
  • A lower back pain of the dull aching type.
  • Difficult bowel movements or constipation.
  • A feeling of “fullness” in the belly (lower abdomen). Sometimes, this is also called “pelvic pressure.”
  • Pain during sex (dyspareunia).
  • Problems of the reproductive system like multiple miscarriages, early onset of labour pains during pregnancy, and infertility.
  • Problems related to childbirth and pregnancy, like increased chances of requiring a caesarean section during delivery. (Read more - Pros and Cons of natural birth and C-section)

Differential diagnosis

Other health conditions that may present with symptoms similar to those of uterine fibroids are:

  • Adenomyosis: an abnormal encroachment of the muscular layer of the uterus (myometrium) by the inner lining of the uterus (endometrium).
  • Pregnancy
  • Ectopic pregnancy: a pregnancy that occurs outside the uterine cavity, mostly in the fallopian tubes.
  • Endometrial polyp: a small growth protruding from the inner lining of the uterus.
  • Endometrial hyperplasia: an abnormal growth of the inner lining (endometrium) of the uterus.
  • Endometriosis: tissues from the inner lining of the uterus grows at places outside the uterus.
  • Endometrial cancer: cancer arising from the inner lining of the uterus.
  • Ovarian cancer: a type of cancer that originates in the ovaries.
  • Uterine sarcoma: cancer of the muscles of the uterus or of the tissues that support the uterus.
  • Uterine carcinosarcoma: a rare type of uterine cancer.

Uterine fibroids causes and risk factors

Causes

The exact cause of fibroids is unknown. However, there are certain factors that are believed to play a role in the development of fibroids. These include:

  • Hormones
    The female sex hormones can stimulate the growth of fibroids, but they do not cause fibroids. After menopause, fibroids tend to shrink.
  • Heredity
    Women who have a family history of uterine fibroids are prone to develop fibroids themselves.

Risk Factors

While there are a few factors that increase the risk of developing uterine fibroids, there are also some factors that decrease the risk of developing uterine fibroids

  • Factors which increase the risk of fibroids:
    • Early occurrence of first menses (before 10 years of age).
    • A family history of uterine fibroids.
    • Women more than 40 years of age.
    • A woman who has never conceived or has never given birth to a viable baby.
    • Obesity.
    • Women of African descent.
  • Factors that decrease the risk of fibroids:
    • Use of oral contraceptive pills.
    • Higher the number of children a woman gives birth to, the lower is the risk.
    • Late occurrence of first menses (after 16 years of age).

Prevention of Uterine fibroids

There are no proven measures to prevent fibroids from developing in the uterus, as the cause is unknown. However, studies have shown that athletic women are less likely to develop fibroids than women who are not physically fit or are obese.

Diagnosis of Uterine fibroids

If your gynaecologist/health provider suspects fibroids, usually a pelvic examination will be performed to look for any obvious abnormalities. He/she may also advise further investigations to confirm the diagnosis or rule out any other possible causes. Sometimes fibroids are only discovered incidentally during routine gynaecological examinations, as they are often asymptomatic. Investigations include:

  • Ultrasound scan 
    This is one of the main tests for diagnosing uterine fibroids. An ultrasound scan is a painless diagnostic procedure in which a probe is used to generate sound waves. These sound waves are then captured back and an image is created that shows the details of the inside of the body. It is of two types:
    • Abdominal scan 
      In this type, the probe is placed over your abdomen and moved gradually over it to study the uterus for the presence of fibroids.
    • Transvaginal scan
      In this type, the probe is gently inserted through your vagina into the vaginal canal and the uterus is
  • Hysteroscopy
    This is a procedure wherein a small telescope (hysteroscope) is inserted into your uterus through the vagina. Hysteroscopy takes about 5 minutes only. Most women do not need anaesthesia, but if you experience pain, a local anaesthetic may be used. Hysteroscopy is mostly carried out to look for submucosal fibroids.
  • Laparoscopy
    During a laparoscopy, a small incision is made on the abdominal skin and a laparoscope is inserted through that. A laparoscope is a device in which a small telescope with a camera and light source are attached at one end. Once the camera is inserted through the incision, the monitor converts the signal into a series of images that give a detailed view of the uterus. A laparoscope not only helps in looking for fibroids that develop outside the uterus but also those that grow in the muscular layer. As the procedure is performed under general anaesthesia, the person undergoing it will be asleep during the entire procedure.
  • Biopsy
    Some women require biopsy, which means a small sample of the fibroid tissue will be removed by using a hysteroscope or laparoscope to be examined under a microscope.
  • Hysterosalpingogram
    This is an X-ray procedure wherein a dye is injected into the uterus and the fallopian tubes so that any irregularities, as noticed by the way the dye moves in the uterine cavity, are outlined.

Uterine fibroids treatment

Treatment of uterine fibroids depends on whether the woman is symptomatic or asymptomatic:

For women without symptoms

In women without symptoms, treatment is generally not required. A regular clinical monitoring is carried out to ensure that the fibroid does not grow suddenly or increase in number.

For women with symptoms

​In women who experience symptoms, treatment depends on whether the woman is premenopausal or postmenopausal.

  • Premenopausal woman
    • If the woman wishes to preserve her fertility or her uterus then she can be managed medically or surgically. Medical therapy includes drugs that temporarily make the ovaries to stop the production of estrogen, the female sex hormone.
      So, oral contraceptives (birth control pills), NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), drugs containing tranexamic acid (to reduce the amount of blood flow during menstruation) or Gonadotropin-releasing hormone (GnRH) agonists (medicines that reduce the production of sex hormones), and selective progesterone receptor modulators (SPRMs) that reduce the growth of the fibroids are usually prescribed. Surgical therapy involves removing the fibroids (myomectomy).
    • If the woman does not wish to preserve her fertility or her uterus, then the choice of procedure will be between surgically removing just the fibroids (myomectomy), cutting off the blood supply to the fibroids (uterine artery embolization) or removal of the uterus with or without removal of the fallopian tubes and the ovaries (hysterectomy with or without bilateral salpingo-oophorectomy).
  • Postmenopausal woman
    In these women, either only the fibroids are removed or the uterus is removed with or without removal of the fallopian tubes and the ovaries.

Treatment for fibroids may also include:

  • Iron supplements that may be needed to treat or prevent anaemia, which can occur due to heavy bleeding during periods.
  • Pain relief medications like ibuprofen or naproxen for pain or cramps.
  • You may have to undergo pelvic examinations and ultrasounds, once in a year, just so your doctor can keep a check on the size and the number of fibroids.

Lifestyle management

A study conducted by researchers in China reported that pre-menopausal women with a high BMI (Body Mass Index) had a higher risk of developing uterine fibroids. So, aim to maintain an ideal weight for your height by eating healthy food and by exercising regularly. 

Uterine fibroids prognosis and complications

Prognosis

Almost 75% of all fibroids are non-cancerous (benign). They usually shrink after menopause as menopause results in a drop in hormone levels. that are required for the fibroids to grow. Many women have small to medium sized uterine fibroids throughout their reproductive years that cause them little or no problems.

If you are pregnant and have fibroids or you become pregnant and have fibroids, then your doctor will carefully monitor you throughout your pregnancy until delivery. After the baby is born, a fibroid usually goes back to its original size. In most women, fibroids generally do not cause any problems. 

Complications

Complications of fibroids include:

  • Extreme pain or very heavy bleeding which might need an emergency surgical treatment.
  • Twisting of the uterine fibroid may also occur. When a fibroid twists, the blood vessels that feed the fibroid can be blocked. If this happens, surgery may be required.
  • Anaemia (reduced number of red blood cells in the blood) can occur due to heavy bleeding.
  • Urinary tract infections may also occur if the fibroid presses onto the urinary bladder. Thus, it can be difficult to empty your bladder completely and this may predispose you to develop urinary tract infections.
  • In rare cases, infertility may occur.

If you are pregnant, there is a minor risk that your fibroids may cause complications:

  • If the fibroid causes a blockage in the birth canal or positions the baby dangerously, a  surgery (a caesarean section) may be required.
  • If the fibroid occupies too much space in the uterus, the woman may have a premature delivery. 
  • Heavy bleeding may occur after the delivery.

Medicines for Uterine Fibroids

Medicines listed below are available for Uterine Fibroids. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
ADEL 78 Dercut OintmentADEL 78 Dercut Ointment340
AgoprideAgopride 1 Mg Injection200
EligardELIGARD 45MG INJECTION29085
EurolideEurolide 1 Mg Injection141
LeuprogonLeuprogon Injection3056
Lucrin DepotLucrin Depot 11.25 Mg Injection12500
LuprideLupride 0.5 Mg Injection239
LuprodexLuprodex 11.25 Mg Injection8820
LuprolideLuprolide 3.75 Mg Injection4200
LuprorinLUPRORIN DEPOT INJ 3.75MG INJECTION 1S4634
Corlide DepotCorlide Depot 3.75 Mg Injection3520
GynactGynact 1 Mg Injection96
Gynact M.DGynact M.D 4 Mg Injection420
LeuprostaLeuprosta Depot 22.5 Mg Injection15984
LugonistLugonist Depot 3.75 Mg Injection0
LuprofactLuprofact 1 Mg Injection170
NadogonNadogon 3.75 Mg Injection2784
Prolide (Celon)Prolide 11.25 Mg Injection3110
Leuprolide Acetate(Lup)Leuprolide Acetate Injection2610
LuprotasLuprotas 22.5 Mg Vial16163
ADEL Vinca Minor Mother Tincture QADEL Vinca Minor Mother Tincture Q 208
SBL Vinca minor Mother Tincture QSBL Vinca minor Mother Tincture Q 145
SBL Viola odorata Mother Tincture QSBL Viola odorata Mother Tincture Q 76

Do you or anyone in your family have this disease? Please do a survey and help others

References

  1. American College of Obstetricians and Gynecologists [Internet] Washington, DC; Uterine Fibroids
  2. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Uterine fibroids
  3. F O Okogbo, OC Ezechi, OM Loto, PM Ezeobi. Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome. Afr Health Sci. 2011 Jun; 11(2): 271–278. PMID: 21857861
  4. MARIA SYL D. DE LA CRUZ, EDWARD M. BUCHANAN. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017 Jan 15;95(2):100-107. [Internet]
  5. Agency for Healthcare Research and Quality. Management of Uterine Fibroids: An Update of the Evidence . U.S. Department of Health and Human Services, Rockville [Internet]
  6. National Health Service [Internet] NHS inform; Scottish Government; Fibroids
  7. Eunice Kennedy Shriver National Institute of Child Health and Human; Monday, July 21, 2014; What are the symptoms of uterine fibroids?. National Health Service [Internet]. UK.
  8. Fleischer AC, James AE Jr, Millis JB, et al. Differential diagnosis of pelvic masses by gray scale sonography. AJR Am J Roentgenol. 1978;131(3):469–476. PMID: 98992
  9. AC Fleischer, AE James, Jr, JB Millis and C Julian. Differential diagnosis of pelvic masses by gray scale sonography Read More: https://www.ajronline.org/doi/abs/10.2214/ajr.131.3.469?src=recsys. American Journal of Roentgenology. 1978;131: 469-476. 10.2214/ajr.131.3.469
  10. National Health Service [Internet]. UK; Fibroids.
  11. He Y, Zeng Q, Dong S, Qin L, Li G, Wang P. Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China. Asia Pac J Clin Nutr. 2013;22(1):109-17. doi: 10.6133/apjcn.2013.22.1.07. PMID: 23353618
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