Uterine fibroids or leiomyomas or myomas are a common type of noncancerous muscular tumour that vary a lot in size, shape and location and can grow in your uterus, on uterine wall, its surface or attach to your uterus by a stalk- or stem-like structure. While some fibroids are so small that your doctor can’t even see them with the naked eye, others grow in big masses that can affect the size and shape of your uterus.
They are one of the commonest benign tumours of the reproductive tract found in women. About 40-77% of women may reportedly develop uterine fibroids at some point of their life but not all of these will cause any symptoms or complications.
According to Dr Anjali Kumar, Senior Consultant Gynaecologist, Obstetrician and Founder of Maitri Woman’s Health, listed that based on the location, the fibroids can be of various types:
1. Intramural – Fibroid is present within the muscular wall of the uterus
2. Submucosal – Fibroid is bulging into the cavity of the uterus
3. Subserosal – Fibroid is located on the outer surface of the uterus
4. Pedunculated – Fibroid is attached only with a thin stalk to the surface of the uterus
Dr Anjali Kumar revealed, “In spite of major developments in the field of medical science and technology, we have still not been able to pin-point the exact reason why fibroids develop in some women but not in others. The risk factors have been identified but the exact cause is still unclear. We do know, however, that fibroids are hormone dependant tumours that develop in response to the female hormones- estrogen and progesterone.”
She added, “In some women, the effect of these hormones leads to overgrowth of the uterine muscle tissue and thus causes the formation of fibroids. This is supported by the observation that the fibroids are rarely diagnosed before puberty and are known to shrink in size after menopause. Similarly, they are known to increase in size during pregnancy when the estrogen and progesterone content in the body is higher.”
It is important to note that not all of the uterine fibroids will cause any symptoms or complications and the development of its symptoms depends to a large extent on the size, location and the number of fibroids present in the uterus. Dr Anjali Kumar asserted that many women who have fibroids may not experience any symptoms at all but about 25-50% of women may experience problems like:
1. Heavy and/or prolonged periods
2. Bleeding in between two periods (Inter-menstrual bleeding)
3. Painful periods
4. Pelvic pressure or pain
5. Difficulty in passing urine
6. Frequent urination
8. Lump in abdomen
9. Difficulty in conceiving
10. Pain during intercourse
For the uninitiated, fibroids can develop in any woman and at any age and given these are hormone dependant tumours, they are found more commonly in women who have certain risk factors like:
1. A family history of uterine fibroids
4. African-American origin
5. Age 30 years or older
Highlighting that the doctor may do a physical abdominal and pelvic examination of the presence of fibroids, Dr Anjali Kumar shared that one may be advised to undergo certain tests based on the symptoms and clinical examination. These include:
1. Ultrasound of the pelvis and abdomen to detect the number and size of the fibroids.
2. Magnetic Resonance Imaging ( MRI) – This is required in certain cases to differentiate the fibroids from other benign or cancerous conditions like adenomyosis or sarcomas.
3. CT scan may be required to study the organs of the pelvis and abdomen in detail.
4. Hysteroscopy is a minimally invasive procedure where a thin and long camera is introduced into the uterus through the vagina to study the cervix, uterine cavity and endometrial lining. This may help diagnose submucosal fibroids or fibroid polyps.
5. Laparoscopy is also a minimally invasive technique where a thin telescopic camera is introduced into the abdomen under anaesthesia to study the internal organs, uterus, tubes and ovaries.
“Small, asymptomatic fibroids which are diagnosed only by chance and are not causing any symptoms do not require any specific treatment and are usually just kept under observation by an annual ultrasound and clinical examination,” explained Dr Anjali Kumar. However, she revealed that larger fibroids or the fibroids that are causing symptoms require treatment and there are various options available like:
1. Over the counter medications- Painkillers and medications for controlling the bleeding may be prescribed by your doctor.
2. NSAID’s- These are medications that help control the pain and bleeding.
3. Hormonal medications- These can be either oral or injectables.
4. Intrauterine device containing the hormone levonorgestrol has been found very effective in controlling the bleeding and works well for 5 years.
5. Surgical procedures- Sometimes, when conservative medical methods fail or are unsuitable for some women, the doctor may recommend a surgical procedure to remove only the fibroids (Myomectomy) or occasionally, the entire uterus may need to be removed (Hysterectomy).
6. Other methods- Some newer methods are being used to control the symptoms and growth of the fibroids. These include High Intensity Focussed Ultrasound (HIFU) or Uterine Artery Embolisation (UAE).