Diseases

Uterine fibroids

Leiomyoma, myoma

Uterine fibroids are benign tumors (growths) that arise from the smooth muscles (myometrium) of the uterus. Uterine fibroid is a very common problem which affects 75% of all women at some point in their lives. Uterine fibroids can be of different types depending on where they are located. Myometrial fibroids are located in the muscular wall of the uterus. Submucosal and subserosal fibroids are located under the inner lining and he outer lining of the uterus respectively. Pedunculated fibroids originate inside the uterus but protrude outside it due to the presence of a long stalk.

Published December 17, 2021

Causative & risk factors

Uterine fibroids have been noted in several women belonging to the same family; hence their genetic make-up plays a role in their development. This is also the reason why certain races, especially blacks have a higher risk of developing fibroids compared to others. Fibroids tend to appear in a woman’s 20’s or 30’s, grow larger and tend to shrink after menopause; since the estrogen levels drop at that time. Thus hormones also play a role in development of uterine fibroids.

Clinical presentation

Many times, uterine fibroids remain asymptomatic and are discovered accidentally on a pelvic ultrasound. The number of the fibroids as well their size is extremely variable. A woman may have a single or numerous fibroids and the size can range from a few millimeters to several inches.

When fibroids are very large or numerous, they start producing symptoms. The menstrual bleeding becomes very heavy or prolonged. Large fibroids can give rise to a sense of discomfort or pain in the pelvic region.

Fibroids can exert pressure on the bladder, giving rise to difficulty in passing urine (dysuria) or a need to urinate frequently. Constipation and backache are other symptoms that may arise due to large fibroids. Intercourse may become difficult for some women. Occasionally a woman may find it difficult to attain pregnancy (conceive) due to the presence of fibroids.

Investigations

The presence of uterine fibroids can be easily noted on an ultrasound or MRI scan of the pelvis.

Sometimes specialized investigations may be suggested such as a hysterosonography, hysterosalpingography or a hysteroscopy. If malignancy is suspected, a biopsy of the fibroid is tested.

Treatment

Fibroids do not need any treatment if they are very small, asymptomatic or mildly symptomatic or of the woman is nearing menopause.

For symptomatic fibroids, several modes of treatment are available – both conservative and surgical.

The conservative modes of treatment include the use of painkillers, oral contraceptive pills and use of Gonadotropin-releasing hormone (Gn-RH) agonists. RU486 and newer compounds are also being used to treat uterine fibroids. Embolization of the uterine artery is a minimally invasive procedure which cuts off the blood supply to the fibroids and they start shrinking.

Some women may require surgery to remove the fibroids. Fibroid removal (myomectomy) can be done hysteroscopically (from within the uterus) or laparoscopically. Women with multiple or very large fibroids may need to undergo surgery to remove the entire uterus (hysterectomy).

Recent updates

MRI-guided focused ultrasound surgery (MRGFUS) is a new advanced technique of treating uterine fibroids which uses ultrasound waves to destroy fibroid tissue.