Uterine Fibroids: Symptoms, Causes, and Treatment – includes a free patient information PDF!

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What Are Uterine Fibroids?

Uterine fibroids are swellings in the uterus. They are formed by excess normal uterine muscle tissue and hence are not cancers. Although they are not cancers, they can be symptomatic, depending on the location of the fibroid. They are classified according to location. The symptoms and treatment depend on the location of the fibroid. The following diagram describes its location and name.

Uterine_fibroids

Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=intraligamental fibroid

What Causes Uterine Fibroids?

No one definitely knows the cause of the fibroid formation. However, people have observed the following (1,2):

  1. It occurs in families. If a mother or sister has fibroids, then the chances of having it are high
  2. It is more common in some races, especially those who start having periods before the age of ten
  3. High alcohol intake, high blood pressure and pelvic infections increase the incidence
  4. On the other hand, pregnancy and taking oral contraceptive pills can decrease the incidence

Female hormones tend to make the fibroids grow in size, especially during the first trimester, while they decrease in size after menopause.

Although half of all women can be found to have fibroids if an ultrasound examination is done, most of them do not cause any symptoms.

What Are the Symptoms of Uterine Fibroids?

Most women who have uterine fibroids do not have any symptoms. For those who do, the most common symptom is abnormal uterine bleeding. Fibroids that occur near the uterine lining can cause heavy or painful periods, longer periods, or spotting at other times. Iron deficiency anemia can also occur when there is excessive bleeding. Large fibroids may cause pelvic pain, pressure, pressure on the bladder (causing frequent urination or blocking urination), or pressure on the rectum along with pain. Deteriorating fibroids can also cause severe pain in a small area.

Although fibroids do not interfere with ovulation, they may impair fertility and lead to poorer pregnancy outcomes. This is true especially of submucosal fibroids that deform the inner uterine cavity. They often cause miscarriage too.

How Are Uterine Fibroids Diagnosed?

Uterine fibroids could be diagnosed by pelvic examination. However, they are commonly diagnosed by ultrasound. Often, the ultrasound is very helpful in differentiating the fibroid from other conditions, such as ovarian tumors. Diagnosis may also include MRI or CT scans, but they are more expensive and complex than ultrasound.

What Are the Risks of Untreated Fibroids?

In most cases, uterine fibroids do not cause any problems, even if they are not treated. Some fibroids that are not causing symptoms may still be removed or observed, especially if they are growing rapidly, since there is a rare, cancerous type of fibroid.

How Are Uterine Fibroids Treated?

Medical treatment

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Medicines used for fibroids are typically used to affect hormones, including causing a decrease of estrogen production. They are usually prescribed for 3 to 6 months, and can shrink fibroids by as much as half of the original size. Sometimes the drugs may be used to decrease the size before surgery (3). Side effects may include hot flashes, vaginal dryness, sleep disturbance, and mood change, generally similar to the effects of menopause. If they are used for over a year, they can also lead to osteoporosis, or loss of bone.

Other drugs can be used as well. Mifepristone, sometimes known as the "morning-after pill," can shrink the fibroid and reduce the bleeding (3). Danazole is another medicine, however it has many side-effects, including weight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, depression, decreased HDL (or “good cholesterol”), and increased liver enzyme levels (3).

Oral contraceptives can be used in low doses to decrease the abnormal bleeding caused by fibroids, but they do not treat the fibroids themselves. It has been found that these drugs decrease the risk of new fibroids, as well.

Surgical treatments

Surgery is usually the preferred method of treatment, when treatment is deemed necessary. One type of surgery is hysterectomy, which removes the whole uterus and the fibroids altogether. Another type is myomectomy, which involves only removing the fibroids, through either open surgery or by using a laparoscope. The recent development is the use of single incision surgeries with a gasless lift laparoscope (4).

If the doctor suspects there may be malignancy or cancer, then surgery is necessary. Some of the fibroids could be removed endoscopically or through the uterine opening, either by cutting them into small pieces and removing them, which is called resection, or by vaporizing them in place.

uterus with multiple fibroids - dr g

Uterus with Multiple Fibroids

Fibroid during surgery - dr g

Fibroid during Surgery

During endoscopic treatment of fibroids - dr g

During Endoscopic Treatment of Fibroids

At SEESHA Medical Services

A variety of treatment options are available at the SEESHA Karunya community hospital at Karunya Nagar Coimbatore, and at the SEESHA surgical camps at Bethesda Hospital Aizawl, Sielmat Christian Hospital at Churachandpur at Manipur, Family Health Hospital at Dimapur and the other places.

Endoscopic resection and vaporization of submucosal fibroids have been carried out, and several women have conceived after this procedure, which is carried out through the vagina and cervix (5,9). Large fibroids have been removed, both laparoscopically and by open surgeries.

The new procedure that is available now is the use of gasless laparoscopic surgery, or lift laparoscopic surgery, which was started after training at EndoGyn in Germany.

More details could be seen at the following sites:
http://www.youtube.com/watch?v=3n2XX1zlxKQ
http://endogyn.com/
http://www.youtube.com/watch?v=xOOcYk_i-v0

gnanaraj Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

Image: Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=intraligamental fibroid. Source/Author: Hic et nunc. 2012. Access the original Image information here: https://commons.wikimedia.org/wiki/File:Uterine_fibroids.png

References (click to show/hide)

  1. Marshall LM, Spiegelman D, Goldman MB, Manson JE, Colditz GA, Barbieri RL, Stampfer MJ, Hunter DJ: A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil Steril 1998, 70(3):432-439.
  2. Parazzini F, Negri E, La Vecchia C, Chatenoud L, Ricci E, Guarnerio P: Reproductive factors and risk of uterine fibroids. Epidemiology 1996, 7(4):440-442.
  3. Patricia Evans, Susan Brunsell. Uterine Fibroid tumours: Diagnosis and Treatment. Am Fam Physician. 2007 May 15;75(10):1503-1508.
  4. Gnanaraj J. Low cost and minimally invasive treatment for infertility in rural areas. mdCurrent-India. January 2014.

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