what are uterine fibroids? what you need to know about causes, symptoms and treatments
6 minute read
of all the women who develop fibroids, roughly 10 to 20 per cent will experience severe symptoms that significantly reduce their overall quality of life.
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uterine fibroids are common, with as many as 70 per cent of canadian women developing at least one by the age of 50. of that 70 per cent, 20 to 50 per cent cause symptoms, some of which can devastate a woman’s quality of life.
yet, even though they affect many women, the conversation around what they are and the significant, negative impacts they can have on women when symptoms develop isn’t as ubiquitous.
what are uterine fibroids?
uterine fibroids, which can also be referred to as leiomyoma or myoma, are tumours that develop in the wall of the uterus. almost all these tumours are non-cancerous, with less than one in 1000 turning into cancer. when that happens, they are referred to as leiomyosarcoma.
they are composed of muscular tissue and can grow as solo tumours (singular) or in groups (multiple).
in some cases, dozens can develop in the womb, with the number varying significantly from woman to woman. these growths can be so small they’re undetectable, or larger than a grapefruit.
they can grow in many areas of the uterus. intramural fibroids develop within the lining of the uterus and grow into the uterus, whereas submucosal fibroids are found just under the lining. the latter causes more symptoms, but is less common.
what causes uterine fibroids?
uterine fibroids are highly under-researched, and to date, no direct cause has been found. investigations into women’s health issues, including fibroids, have garnered more attention in the last year, but so far, only certain risk factors have been found to play a role in their development, including:
- changes in genes, as uterine fibroids often contain genes that are not the same as those found in other cells in the uterine muscle.
- hormonal influence, as cells in fibroids bind more easily to estrogen and progesterone, which encourages growth
- other substances, such as insulin-like growth factor, are thought to play a role in the growth of fibroids
- ethnicity, as they are more common in black people than any other race
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do uterine fibroids have symptoms?
in many cases, uterine fibroids are a silent condition and cause no symptoms at all. women with these types of fibroids may never know they have them, or they may only find out during routine testing or during pregnancy.
that said, if more fibroids are present or they are larger in size, they can cause symptoms that can be debilitating. symptoms include:
- painful or prolonged periods
- irregular periods
- heavy bleeding that could lead to anemia
- anemia symptoms, including tiredness or weakness
- spotting or bleeding between periods
- enlargement or a full feeling in the lower abdomen and stomach area
- bloating and swelling of the abdomen
- the need to urinate frequently, urgently, and difficulty emptying the bladder
- incontinence
- pain during intercourse
- pain in the lower back
- consistent pain that does not go away
- constipation, depending on where the fibroid grows
- rectum discomfort
- weight gain
- feeling as though you need to go to the bathroom even when your bowel or bladder is empty
in some cases, emergency symptoms will develop that require prompt medical care. they can include:
- sharp, sudden pain in the abdomen that doesn’t go away
- severe vaginal bleeding
- light-headedness, extreme fatigue, or weakness
heavy bleeding is the most common symptom and is found in roughly 25 per cent of women who develop fibroids. of all the women who develop fibroids, roughly 10 to 20 per cent will experience severe symptoms that significantly reduce their overall quality of life.
when symptoms develop, diagnosis involves imaging tests, including pelvic ultrasounds, mri, a specific type of x-ray known as the hysterosalpingography, or hysteroscopy.
what are the potential complications of uterine fibroids?
the most notable complication of uterine fibroids is infertility, and having the growths is associated with up to 10 per cent of infertility cases. in one to three per cent of infertility cases, they are the direct cause.
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if a woman develops uterine fibroids, or they grow during pregnancy, they can lead to further complications, including:
- miscarriage
- preterm labour
- cesarean delivery (c-section) or other delivery complications, including breech
- blocked blood vessels that can damage tissues or organs
- torsion, which can cut off the blood supply to the uterus
- necrosis
the heavy bleeding that can occur can lead to anemia, which can be life-threatening in some cases. if a woman has fibroids, it’s essential to watch for symptoms of anemia, including:
- fatigue
- weakness
- shortness of breath
- pale skin
- rapid or irregular heartbeat
- fainting
anemia can cause complications all its own, such as organ damage and heart failure.
uterine fibroids can also cause psychological complications that affect a woman’s well-being and mental health. according to research, women with symptomatic fibroids may also experience:
- low self-image and low self-worth
- difficulties in relationships driven by feelings of inadequacy or feeling undesirable
- missed work, leading to financial impacts
- increased risk of developing depression and anxiety
- increased risk for self-harm
- higher levels of stress that cause hormonal imbalances, potentially leading to more growth
are there treatments available for symptomatic fibroids?
there are four forms of treatment avenues a woman with fibroids can take if required:
- medical management
- non-invasive treatment
- minimally invasive therapy
- surgery
many medical management therapies do not eliminate the fibroid, but rather manage its symptoms, mainly heavy bleeding.
in terms of medical management, there are specific drugs that target hormones involved in the menstrual cycle to address symptoms. they include:
- gonadotropin-releasing hormone (gnrh) agonists, which block the production of estrogen and progesterone to stop feeding uterine fibroid growth
- gonadotropin-releasing hormone (gnrh) antagonists, which work by treating the heavy bleeding caused by uterine fibroids
- progestin-releasing intrauterine device (iud), a form of birth control that can reduce heavy bleeding
- tranexamic acid, which is a non-hormonal drug that reduces heavy bleeding
- low-dose birth control pills to control bleeding
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over-the-counter pain relievers may also be used for pain relief, with iron supplementation recommended for individuals with anemia. heating pads can also be suggested to relieve cramping.
non-invasive treatments utilize mri scanners and ultrasound technology. it’s known as an mri-guided focused ultrasound surgery (fus) and is relatively new. a fus is performed by lying in an mri machine, and when the fibroid is located, sound waves are pumped into the fibroid to heat the cells, allowing them to be destroyed.
minimally invasive techniques include:
- uterine artery embolization, which involves injecting the arteries that supply blood to the uterus with small particles that cut off blood flow to the fibroid to encourage it to die.
- radiofrequency ablation, which involves introducing radiofrequency heat energy into the fibroid through small cuts in the stomach to destroy it
- laparoscopic or hysteroscopic myomectomy, which removes the fibroids surgically through non-invasive surgical methods
- endometrial ablation, a procedure that works to reduce heavy bleeding by introducing a device that utilizes heat, microwave energy, hot water, cold temperatures, or electrical currents to destroy uterine lining tissue, effectively eliminating the fibroid
surgical treatments are typically reserved for those with the most severe symptoms. a myomectomy is performed to remove the fibroid while preserving the healthy tissue surrounding it. this form of surgery is used for women in their childbearing years who still wish to conceive following treatment.
in the event that a woman does not want kids, a full hysterectomy will be performed, which removes the entire uterus.
in treatments besides hysterectomy that eliminate the fibroids, there is a risk of new fibroids developing. according to research, as many as 33 per cent of women will experience recurring fibroids after surgical treatment.
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given the prevalence and potential severity of fibroids in women, increased awareness and research are needed to identify causes, prevention, and better treatments.
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