Uterine Fibroids: Causes, Symptoms, and Treatment

What are Uterine Fibroids?

Uterine fibroids are non-cancerous growths made of smooth muscle cells and fibrous tissue. They develop from the myometrium, which is the thick muscle layer of the uterine wall that causes contractions. These growths can appear as single nodules or in clusters, and they can vary in size.

Hormonal changes, especially oestrogen and progesterone determine the growth of uterine fibroids. This is why fibroids often grow during the reproductive years and may shrink after menopause. Fibroids are usually dense and firm, creating solid masses that can change the shape of the uterus based on their size and location. Some remain small and asymptomatic, while others grow rapidly and cause noticeable discomfort or complications.

Types of Uterine Fibroids

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Uterine Fibroid Symptoms

Many people with small fibroids don’t show any symptom at all, which is why these growths often go undiagnosed for years. However, larger fibroids or those in certain locations cause significant discomfort and health complications. Uterine fibroid symptoms develop gradually over months or years and may worsen over time without appropriate medical intervention.

The symptoms of uterine fibroids are:

• Heavy menstrual bleeding: Irregular, prolonged menstrual periods (longer than seven days) and excessive blood loss, which may cause iron deficiency anemia and fatigue. 
• Pelvic pressure or pain: Persistent sensation of fullness or aching or sharp pains in the lower abdomen and pelvis that may increase during menstruation. 
• Frequent urination: Increased need to urinate throughout the day and night due to pressure on the bladder from enlarged fibroids. 
• Painful intercourse: Discomfort or sharp pain during sexual activity when fibroids are located near the cervix or compress the vaginal wall. 
• Constipation: Chronic difficulty with bowel movements when large fibroids press against the rectum and interfere with normal intestinal function. 
• Lower back pain: Persistent aching or sharp pain in the lower back caused by fibroids pressing on nerves or surrounding pelvic structures.

Causes and Risk Factors

The exact cause of uterine fibroids is still not known. However, several factors may increase the risk of developing them. Genetic background, hormonal influence, and certain lifestyle patterns are known to contribute to their growth. These factors continue to be the focus of ongoing research.

• Hormones: Estrogen and progesterone stimulate fibroid growth throughout reproductive years, which explains why fibroids often shrink naturally after menopause when hormone levels decline. 
• Family history: Having a mother, sister, or grandmother with fibroids increases the risk by two to three times compared to those without a family history. 
• Obesity: Excess body weight leads to higher estrogen production in fat tissue, creating favorable conditions for fibroid development and growth. 
• Early menstruation onset: Starting menstrual periods before age ten increases lifetime exposure to estrogen and progesterone, raising fibroid risk.
  
• Vitamin D deficiency: Studies suggest that low vitamin D levels may contribute to fibroid formation, as vitamin D plays a role in regulating cell growth and reducing inflammation 
• Race and ethnicity: African American women have a higher incidence of fibroids and tend to develop them at younger ages with more severe symptoms 
• Age factors: Fibroids most commonly develop during reproductive years, with peak incidence occurring in the premenopausal age range

Diagnosis of Uterine Fibroids

Gynecologists use several diagnostic methods to detect and thoroughly evaluate uterine fibroids. Early and accurate diagnosis allows for better treatment planning and can prevent serious complications from developing. The diagnostic process normally entails:

• Pelvic examination: Manual assessment on normal gynecological visits may reveal an increased, irregularly shaped uterus or a hard uterus, indicating the presence of a fibroid. 
• Ultrasound: Transvaginal or abdominal ultrasound give high-resolution images detailing the size, number, and location of fibroids as well as the blood flow pattern within the masses. 
• MRI: Magnetic resonance imaging provides the most detailed and complete picture of the fibroids, which is needed to plan surgery and make complex treatment decisions.
  
• Hysteroscopy: Direct visualization of the uterine cavity using a thin, lighted scope inserted through the cervix to assess submucosal fibroids and their impact on the uterine lining. 
• Saline sonohysterography: Injection of sterile saline solution into the uterus during ultrasound examination helps detect fibroids protruding into the uterine cavity. 
• CT scan: Computed tomography may be used in specific cases to evaluate large fibroids and their relationship to surrounding organs and structures.

Complications of Large Uterine Fibroid

A large uterine fibroid(more than 5 centimeters in diameter), can cause major symptoms due to its size and the pressure it exerts on surrounding organs and tissues. These enlarged fibroids need more aggressive treatment methods and can have serious effects on activities of daily living, work productivity, and general quality of life. The challenges associated with large fibroids include:

• Bladder compression: Severe pressure on the bladder leads to frequent urination, urgency, inability to empty completely, or urinary retention that needs medical treatment. 
• Constipation: When the fibroids are large, they may squeeze against the colon and the rectum, resulting in chronic constipation, bloating, and severe digestive pain. 
• Abdominal enlargement: Visible swelling or distension of the abdomen that may be mistaken for weight gain, pregnancy, or other abdominal masses. 
• Breathing difficulty: Extremely large fibroids can push upward against the diaphragm, causing shortness of breath, especially when lying flat or during physical activity. 
• Circulatory problems: Massive fibroids may compress blood vessels, potentially affecting circulation to the legs and increasing the risk of blood clots

Clinical Impacts of Multiple Uterine Fibroids

When several fibroids develop simultaneously within the same uterus, the condition becomes more complex to diagnose and manage effectively. Multiple uterine fibroids create overlapping symptoms that are more severe than those caused by single fibroids and require comprehensive, multifaceted treatment approaches.

The combination of several fibroids often leads to cumulative effects that dramatically impact reproductive health, such as:

• Increased bleeding: The presence of several fibroids severely disrupts normal uterine contractions and significantly increases menstrual flow, often leading to severe anemia.
• Uterine distortion: The normal shape and function of the uterus become altered, affecting fertility, menstruation patterns, and the ability to carry a pregnancy to term.
• Longer surgery duration: Surgical removal becomes considerably more complex when dealing with several fibroids in different locations, requiring extended operating time and specialized techniques.
• Diagnostic challenges: Multiple uterine fibroids may require advanced imaging techniques and careful mapping to identify all locations accurately before treatment planning.
• Symptom complexity: Overlapping symptoms from different fibroid locations can make it difficult to determine which fibroids are causing specific problems

Uterine Fibroids Treatment Options

Treatment decisions for uterine fibroids depend on multiple factors, including symptom severity, fibroid sizes and location, patient age, desire for future pregnancy, and overall health status. Many uterine fibroids treatment approaches focus on symptom management and improving quality of life rather than complete fibroid elimination. The goal is to provide effective relief while minimizing treatment risks and preserving reproductive function when desired.

• Observation: Regular monitoring through periodic examinations and imaging studies without active treatment for asymptomatic fibroids or those causing minimal symptoms 
• Hormonal therapy: Birth control pills, hormonal intrauterine devices, or progestin therapy can help control heavy bleeding, but do not shrink existing fibroids 
• GnRH analogs: Medications that temporarily shrink fibroids by dramatically reducing estrogen levels, often used for three to six months before surgery to reduce bleeding and fibroid size 
• Focused ultrasound therapy: Non-invasive treatment using high-intensity ultrasound waves guided by real-time MRI imaging to destroy fibroid tissue without surgical incision 
• Uterine artery embolization: A minimally invasive procedure that blocks the blood supply to fibroids by injecting particles into the arteries, causing fibroids to shrink over time

Surgical Treatment For Fibroids

When conservative treatments fail to provide symptom relief or when fibroids cause severe complications, surgical treatment becomes necessary for effective management. The best suited surgical procedure depends on fibroid characteristics, symptom severity, the patient’s reproductive goals, and overall wellbeing. Modern surgical techniques offer both minimally invasive and traditional approaches with improved outcomes and reduced recovery times:

• Myomectomy: Surgical removal of fibroids while preserving the uterus, suitable for those desiring future pregnancy or wanting to maintain their uterus 
• Hysterectomy: Complete removal of the uterus, considered the definitive treatment when other approaches have failed or are inappropriate for the patient’s situation 
• Endometrial ablation: Destruction or removal of the uterine lining to reduce menstrual bleeding, but it is not effective for large uterine fibroid cases or numerous fibroids 
• Laparoscopic or robotic surgery: Minimally invasive techniques using small incisions and specialized instruments that reduce recovery time and surgical complications compared to traditional open surgery

Fibroids and Pregnancy

Uterine fibroids can complicate pregnancy and delivery, though many people with small fibroids have completely normal pregnancies and deliveries. The impact on pregnancy depends heavily on fibroid size, specific location within the uterus, and the total number of fibroids present. Gynecologists monitor pregnancies complicated by fibroids more closely throughout all stages to detect potential complications early and implement appropriate interventions.

• Implantation issues: Submucosal fibroids can physically prevent a fertilized egg from properly attaching to the uterine wall, leading to infertility or early pregnancy loss 
• Increased miscarriage risk: Large fibroids or those located in certain areas of the uterus may increase the chance of first or second-trimester pregnancy loss 
• Fetal growth restriction: Limited space within the uterus due to large or multiple uterine fibroids can restrict normal fetal development and growth throughout pregnancy 
• Labor complications: Large fibroids near the cervix may physically block the birth canal, requiring cesarean delivery or causing prolonged, difficult labor] 
• Placental problems: Fibroids can interfere with normal placental attachment and function, potentially leading to complications like placental abruption or inadequate fetal nutrition

Prevention and Lifestyle Factors

While uterine fibroids cannot be completely prevented due to genetic and hormonal factors, certain evidence-based lifestyle modifications may reduce the risk of developing them or slow their growth rate. These preventive measures focus on maintaining optimal hormonal balance and supporting overall reproductive health through dietary and lifestyle choices:

• Weight control: Maintaining a healthy body weight through a balanced diet and regular exercise helps regulate estrogen levels naturally and may reduce fibroid risk 
• Vitamin D intake: Ensuring adequate vitamin D levels through appropriate sun exposure, diet, or supplements may lower the risk of fibroid development, according to recent studies 
• Balanced nutrition: Consuming plenty of fresh fruits and vegetables while limiting red meat consumption may help prevent fibroid formation through antioxidant and anti-inflammatory effects 
• Physical activity: Regular exercise helps regulate hormone levels, maintain a healthy body weight, and may reduce fibroid risk through improved circulation and stress reduction 
• Stress management: Chronic stress can affect hormone levels and immune function, potentially contributing to fibroid development and growth

Complications of Untreated Fibroids

When uterine fibroids remain untreated, especially large or multiple uterine fibroids, serious complications can develop that impact health and quality of life. Early intervention can prevent many of these serious outcomes from occurring:

• Severe anemia: Chronic heavy bleeding from fibroids can lead to iron deficiency anemia, causing extreme fatigue, weakness, and potentially requiring blood transfusions 
• Infertility: Large fibroids can block fallopian tubes, distort the uterine cavity, or interfere with implantation, making conception difficult or impossible 
• Pregnancy complications: Untreated fibroids during pregnancy can cause miscarriage, preterm labor, placental problems, or delivery complications requiring emergency intervention 
• Urinary problems: Large uterine fibroid masses can compress the bladder or ureters, leading to urinary retention, kidney problems, or recurrent urinary tract infections 
• Bowel obstruction: Extremely large fibroids can compress the intestines, causing severe constipation, bowel obstruction, or other serious digestive complications

Recovery and Follow-up Care

After uterine fibroids treatment, whether surgical or non-surgical, proper recovery and ongoing follow-up care are essential for optimal outcomes and early detection of any complications or recurrence. Recovery times and requirements differ depending on the specific treatment approach used. 

• Post-surgical recovery: Recovery from myomectomy or hysterectomy typically requires several weeks with activity restrictions, pain management, and gradual return to normal activities 
• Monitoring for recurrence: Regular follow-up appointments with pelvic examinations and imaging studies help detect new fibroids or regrowth of treated areas 
• Symptom tracking: Patients should monitor menstrual patterns, pain levels, and other symptoms to identify potential problems or treatment effectiveness 
• Fertility counseling: Those who underwent fertility-preserving treatments may need specialized counseling and monitoring when attempting pregnancy after recovery 
• Long-term care: Some patients require ongoing hormone management or regular surveillance to prevent fibroid recurrence or manage continuing symptoms

When to Seek Medical Attention

Certain uterine fibroid symptoms require immediate medical evaluation to rule out serious complications or other dangerous conditions that may mimic fibroid symptoms. Early intervention can prevent life-threatening complications and improve treatment outcomes significantly. 

Individuals experiencing these warning signs should not delay seeking emergency medical care or contacting their gynaecologist immediately:

• Heavy bleeding lasting more than 7 days or soaking through pads every hour 
• Severe lower abdominal pain that interferes with daily activities 
• Difficulty emptying the bladder completely or inability to urinate 
• Constipation not relieved by over-the-counter medications or dietary changes 
• Infertility concerns after trying to conceive for more than six months 
• Sudden significant increase in abdominal size over weeks or months

Uterine fibroids are a highly common gynecological condition, with symptoms ranging from completely silent to severely debilitating. Knowing about the symptoms, causes, and available treatment options lets you make informed decisions and get appropriate medical care when needed. 

For personalised care and informed treatment decisions, consultati a qualified gynaecologist, even better if they specialize in uterine fibroids treatment.