Fibroids can be a serious detriment to your life. If you’re here, you’ve probably either experienced the negative impact of fibroids or are looking to learn more about their symptoms: abdominal pain, urinary issues, and heavy periods are all common ones. You’re not alone–fibroids are present in anywhere from 50-70% of women and are one of the most common medical issues for women under 50. Source
Table of Contents
What is a uterine fibroid?
Uterine fibroids are benign (non-cancerous) tumors that arise from the lining of the uterus. Other examples of benign tumors include skin moles, certain colon polyps, and skin tags.
Although fibroids are benign, they can cause a host of problems in some women because of their size and location.
Large fibroids can compress other structures within the abdomen and pelvis causing pain and urinary issues.
Unfavorably located fibroids can grow close to the uterine canal and cause excessive bleeding, especially during menstruation.
Among patients with symptomatic uterine fibroids, 56.4% reported heavy periods, 32.3% reported passage of clots, 26.4% reported spotting between periods, 25.8% reported constipation/bloating/diarrhea, and 20.4% reported pelvic pressure. Source
What symptoms do fibroids cause?
The most common symptoms caused by uterine fibroids are:
Severe menstrual cramping
Frequent urination or inability to control urination
Pelvic pressure, discomfort, or excessive bloating
Abdominal wall distortion caused by large fibroids
Pain with sexual intercourse
How are fibroids diagnosed?
Uterine fibroids are usually diagnosed during a routine gynecological examination. Doctors can often feel the enlarged fibroids during a physical exam. If a fibroid is felt, an ultrasound will usually be ordered to confirm that the doctor is feeling a uterine fibroid as opposed to other types of gynecological masses.
Once you’ve been diagnosed with fibroids, your doctor will ask you questions to see if the fibroid(s) are causing problems.
Not having problems: Your doctor will likely schedule a follow-up clinic appointment in 6 months to make sure you’re still asymptomatic.
Having problems: Your doctor may order an MRI which gives excellent detail regarding the number and size of fibroids that are present. This information is very important if the fibroids need to be treated.
What types of fibroids are there?
There are three types of uterine fibroids which differ based on their location within the uterus. We will discuss the types of fibroids and the layers of the uterus together.
The first layer of the uterus is the endometrium which is the innermost layer of the uterus and is closest to the uterine canal. The endometrium is the layer of the uterus that grows every 4 weeks in preparation for pregnancy.
Fibroids that are located very close to the endometrium are termed submucosal fibroids. Submucosal fibroids are the rarest type of uterine fibroid and certain submucosal fibroids can distort the size of the uterine cavity and can sometimes block the fallopian tubes which can impair pregnancy.
Symptoms of submucosal fibroids include:
Very heavy, excessive menstrual bleeding
Passing of blood clots during menstruation
Anemia and/or fatigue related to excessive bleeding
The second layer of the uterus is the myometrium which is the middle layer. The myometrium is the muscular layer of the uterus and is the major layer responsible for muscle contractions.
Fibroids that develop within the myometrium are termed intramural fibroids which are the most common type of fibroid. When an intramural fibroid expands it distorts the uterine shape and causes the uterus to feel larger than normal. Intramural fibroids are heavily associated with “bulk symptoms” or symptoms related to the enlarged uterus pushing on adjacent structures.
Symptoms of myometrial fibroids include:
Pelvic pain and pressure
Frequent urination or urinary urgency
The third layer of the uterus is the serosa which is the outermost layer. This is a very thin layer that secretes a lubricating substance to reduce friction between the uterus and nearby structures like the bladder and colon.
Fibroids that grow close to the serosa, i.e., near the outer lining of the uterus are termed subserosal fibroids. These fibroids are also referred to as pedunculated fibroids because they often grow on a stalk. Subserosal fibroids cause symptoms related to pressure on adjacent structures. Sometimes the stalk of a subserosal fibroid can twist and cause severe pain.
Pelvic pressure or pain
Difficulty emptying the bladder
Backache or leg pains
Can fibroids be cancerous?
Uterine fibroids are almost always benign (non-cancerous). It is important to note that doctors do not think that benign fibroids become cancerous, i.e., if a fibroid is benign then it is probably always benign. In less than 1 in 1000 patients, a fibroid that is cancerous may look similar to a benign fibroid, i.e., the cancerous fibroid mimics a benign fibroid. Source
Having benign fibroids does not increase the risk of developing a cancerous fibroid. It is usually easy for your doctor to determine if a fibroid is benign or cancerous based on your medical history and medical imaging (MRI). In some patients with abnormal symptoms or irregular imaging, your doctor may order an endometrial biopsy to confirm no cancer is present.
What treatments are out there?
Birth control pills and other hormone therapies like GnRH analogues can be an effective way to treat uterine fibroid symptoms. Unfortunately, these treatments frequently are not enough to manage symptomatic uterine fibroids, and some women have negative side effects related to hormone therapy. Certain hormone therapies like birth control pills do not reduce fibroid growth. Intrauterine devices (IUDs) that slowly release hormones have also been shown to be effective at decreasing heavy menstrual bleeding related to fibroids. Source
No procedure required
50% of women notice no improvement in symptoms
Hot flashes occur in 45% of women
Sweating occurs in 35% of women
Vaginal infection occurs in 10% of women
Myomectomy is a surgical procedure where fibroids are cut out of the uterus. Myomectomy has the most data supporting fertility preservation for women that desire future pregnancy, although this data is limited. When fibroids are numerous or large, myomectomy can be challenging due to increased risk of blood loss and incomplete treatment.
Less invasive than hysterectomy
Preserves the uterus
Most data on fertility preservation
Hysterectomy or complete surgical removal of the uterus has been shown to be an effective method of treating symptomatic uterine fibroids as the entire uterus and all of the fibroids are removed. The advantage of hysterectomy when compared to other procedures is hysterectomy ensures no fibroids will grow back because fibroids only grow in the uterus. Hysterectomy is however a major surgery which usually requires 3-5 days in the hospital and 6-8 weeks of recovery. It is also not an option for women looking to preserve their uterus or for women who want to bear children in the future.
No chance for fibroid recurrence
3-5 day hospital stay
6-8 week recovery
13% chance of requiring blood transfusion Source
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization (UFE) — also referred to as uterine artery embolization (UAE) — is a same-day, minimally-invasive, non-surgical procedure used to treat uterine fibroids. During the procedure, doctors inject tiny particles into the arteries supplying fibroids in order to block their blood supply. Without blood supply, the fibroid will slowly shrink over the course of weeks to months as the body heals naturally. Uterine fibroid embolization is an option for patients who want to avoid surgery and who want to keep their uterus. Also, UFE is a good option for women who want the quickest recovery times possible.
Minimal blood loss (1% chance of requiring blood transfusion) Source
No hospital stay required
Same day, outpatient procedure
3-7 day recovery
Preserves the uterus
Does not require general anesthesia (only twilight sedation needed)
Chance of fibroid recurrence
Now that you know more about fibroids, keep reading to find out if you could be a good candidate for uterine fibroid embolization!