HOW SERIOUS ARE UTERINE FIBROIDS?

Uterine fibroids develop by cell growth in the myometrium—the muscular uterine tissue. These are distinct from surrounding uterine tissues, and generally vary in sizes—ranging from sizes undetectable by the eye to bulky structures. Fibroids may undergo periodic growth phases or may shrink in size. For example, fibroids observable during pregnancy may disappear following delivery.

Symptoms

Many women may be unaware of their uterine fibroids due to the lack of associated symptoms. In others, common symptoms include heavy prolonged periods, pelvic pain or pressure, back pain, frequent or difficult urination and constipation. When a fibroid begins to die, acute pain or fever can be experienced from the formation of cellular byproducts that enter into surrounding tissues.

Women who experience severe persistent pelvic pain, excessively heavy periods, spotting between periods, painful intercourse, enlarged abdomen and difficult urination need to promptly consult their physician.

Detection            

A uterine fibroid may be detected during pelvic examination or by vaginal ultrasound. Other tests to identify fibroids include MRI, hysterosonography (saline infusion into the uterus followed by ultrasound) and hysteroscopy (catheter inserted into vagina into uterine cavity for visualization).

Types of Fibroids

• Submucosal fibroids grow in the inner side of the uterus. They cause heavy menstrual bleeding and may even be a fertility concern.
• Subserosal fibroids form outside of the uterus. If these press on the bladder, urinary symptoms may develop. On the other hand, subserosal fibroids that grow from the back of the uterus lead to bowel movement problems and backache.
• Intramural fibroids develop in the uterine wall, causing distorted shape of the uterus and excessive menstrual bleeding and pain.
• A pedunculated fibroid is one that hangs in the uterus after it has twisted on its stalk, leading to disrupted blood supply to the fibroid.

Causes

• Genetic Factors: Uterine fibroids may be caused by defective genes in uterine cells, leading to their abnormal growth. Fibroids may also have a hereditary genetic component, and therefore women who have related family members with fibroids may develop the same themselves. In addition, uterine fibroids are more common in some races—e.g. African-Americans have a higher chance of developing fibroids compared with Caucasian women.

• Hormones: Uterine fibroids tend to have more estrogen and progesterone receptors, and their growth is stimulated by these hormones. After menopause, these female hormone levels decrease, leading to the shrinking of the fibroids. Other growth factors, such as insulin-like growth factor (IGF) may also contribute to the growth of fibroids.
• Miscellaneous factors:  Lifestyle choices, such as excessive intake of red meat, alcohol consumption may also affect a woman’s chances of getting uterine fibroids.

Complications

Very rarely do uterine fibroids cause major health complications. These rare complications can include thrombo-embolism, acute urinary retention, severe blood loss and intestinal infection, and need to be treated with surgery. In addition, patients may experience anemia from excessive blood loss due to uterine fibroids.

Some types of uterine fibroids may cause fertility issues. Submucosal fibroids can cause obstruction inside the uterine cavity, thereby preventing embryo implantation. Fibroids may also distort the shape of the uterus, or obstruct the Fallopian tubes. It can be necessary in some women to surgically remove the fibroids before attempting pregnancy.

Treatment

Treatment of uterine fibroids depends on a patient’s circumstances, including age, symptoms, type of fibroid and pregnancy.

• Medications: Birth control pills may be administered to regulate menstrual bleeding. Pain medications can alleviate pain experienced with uterine fibroids. Hormone therapy may help temporarily shrink the fibroids. Intrauterine devices may be placed inside the patient to release hormones to control fibroid growth. Iron supplements can be given to prevent anemia from excess blood loss.

• Surgery: Various surgical interventions are possible to treat uterine fibroids. Hysteroscopy and myomectomy involve the surgical removal of the fibroids from within the uterus. Another approach is uterine artery embolization that can remove the blood supply of fibroids, leading to their eventual shrinkage and death. Women who do not plan to have children, may undergo hysterectomy to completely remove their uterus.

Prognosis

Uterine fibroids are benign growths, and no treatment is necessary when a woman does not have obvious symptoms. If, however, treatment is necessary, uterine fibroids can be well-controlled with available medical interventions.