In medical terms, fibroids are non-cancerous tumors that grow from the muscle layers of the womb. They can vary from the size of a bean to as large as a melon. The other terms for fibroids are myomas and leiomyomas. Studies show that approximately 30% of women by the age of 35 years and around 20 to 80 percent by the age of 50 years are affected by fibroids. In general, they tend to develop between the ages of 16 to 50 years. These are considered reproductive years during which estrogen levels are higher.
Before diving into the topic, we have prepared a number of facts about fibroids and they are as follows:
- Fibroids are normally more common during reproductive years.
- The majority do not experience symptoms, but they include constipation, lower backache and extremely painful uterine bleeding leading to anemia.
- Complication are very rare but they could be very serious
- They typically appear when estrogen levels are higher than normal
● Types of Fibroids
Doctors typically differentiate between four types of fibroids and they are listed below:
Subserosal fibroids: these are the ones that extend beyond the wall of the womb and develop within the surrounding outer uterine tissue layer. They can also transform into pedunculated fibroids, where they have a stalk and can become quite large.
Intramural: this is the most common type of fibroids. They are embedded in the muscular wall of the womb.
Submucosal fibroids: these fibroids can push into the cavity of the womb. They are generally found in the muscle beneath the inner lining of the wall.
Cervical fibroids: they typically take root in the neck of the womb and are also known as the cervix.
It should be also said that fibroids’ location in the womb determines the classification.
● Symptoms
As was mentioned previously, not everyone experiences symptoms. Only 1 in 3 women with fibroids will eventually experience them. They might include:
- Anemia from heavy periods
- Lower backache or leg pain
- Painful and heavy periods
- Constipation
- Discomfort in the lower abdomen, especially in the case of large fibroids
- Pain during intercourse, known as dyspareunia
- Frequent urination
- Labor problems
- Pregnancy problems
- Repeated miscarriages
- Fertility problems
- Increase in weight if fibroids are large
The growth of fibroids will continue until menopause. When estrogen levels fall after menopause, the fibroids usually shrink.
● Causes
As was mentioned earlier, the exact causes of fibroids are still unknown. However, specialists stress on the idea that fibroids are extremely linked to estrogen levels. Progesterone and estrogen levels are typically higher during reproductive years. When these levels are high, fibroids tend to shrink. In addition to that, they are more likely to develop when birth control bills are taken that contain estrogen. Fibroids also tend to shrink during menopause when the estrogen levels are low.
Apart from that, genetics can stimulate fibroids’ development. The chances of experiencing fibroids increase if someone from your family has already experienced this problem. There are also studies that show that the increased consumption of red meat, fruits, and vegetables might reduce the chances of encountering fibroids while being overweight increases the risks. Doctors also claim that women reduce the chances of getting fibroids each time she gives birth.
● Diagnosis
This type of problem is normally diagnosed during routine pelvic examinations. Some diagnostic tests are able to diagnose fibroids and they are as follows:
- Ultrasound: these images are made by scanning over the abdomen or by inserting a small ultrasound probe into the vagina. Both approaches might be required.
- MRI: this approach allows determining the quantity and size of fibroids.
- Hysteroscopy: this process is done with the use of a small device with a camera that is attached to the end for the purpose of examining the inside of the womb. It is inserted through the vagina and into the womb. In some cases, a doctor will need to take a biopsy in order to determine potentially cancerous cells in the area.
- Laparoscopy: during this procedure, a specialist performs a small opening in the skin of the abdomen and inserts a small tube with a lighted camera that is attached through the layers of the abdominal wall. The main purpose is to evaluate the outside of the womb and its surrounding structures. Apart from that, a biopsy can be taken from the outer layer of the womb.
● Treatment
According to specialists, fibroids treatment is only recommended for those women who experience symptoms as a result of fibroids. If they do not affect the quality of life, treatment might be not necessary. Fibroids are believed to lead to heavy periods but if they do cause major problems, a person might decide to avoid treatment. During menopause, symptoms normally become less apparent or can even resolve completely.
Fibroids treatment may take several forms: either medication or surgery. The decision on the treatment plan is taken based on the location of fibroids, the severity of symptoms and future childbearing plans.
When it comes to medication, doctors typically recommend making use of GnRHa, which stands for a gonadotropin-releasing hormone agonist. It stimulates the body to produce less estrogen and progesterone, which in turn shrinks fibroids. It should be also mentioned that GnRHa stops the menstrual cycle without affecting fertility after the end of treatment. However, this type of medication can cause hot flashes, a tendency to sweat more, vaginal dryness and in some cases, a higher risk of osteoporosis. You should keep in mind that GnRHs are for short-term use only. There are also other medications available but they tend to be less effective in treating large fibroids.
Fibroids treatment can be also done with the use of surgery. This is normally the case when they do not respond to more conservative treatment options. Therefore, the list of possible surgeries is depicted below:
- Hysterectomy: this is a partial or complete removal of the womb. It is mainly used for treating large fibroids or excessive bleeding. This surgery can prevent the return of fibroids. However, if the ovaries and fallopian tubes get removed, a person might encounter side effects such as reduced libido and early menopause.
- Myomectomy: this procedure involves the removal of fibroids from the muscular wall of the womb. It can help women who still want to have kids. This surgery is not beneficial for women with large fibroids or fibroids located in particular parts of the womb.
- Endometrial ablation: it involves the removal of the lining inside of the womb that might help in case if fibroids are near the inner surface of the womb. It can be an effective alternative to a hysterectomy for some women who experience fibroids.
- MRI-guided percutaneous laser ablation: this scan is utilized in order to locate fibroids. It works in the following way: fine needles are inserted through the skin and body tissues of the patient and pushed until they reach the targeted fibroids.
- MRI guided focused ultrasound surgery: this type of surgery locates the fibroids and high energy ultrasound waves are delivered to shrink them.
- Uterine artery embolization: this is the process of cutting off the blood supply to the area shrinks the fibroid. This process removes or reduces symptoms in up 90 percent of people with fibroids. However, it is not suitable for women who are pregnant and for those who still want to have kids.
