Uterine myomas, (“fibroids”), are smooth-muscle tumors that grow in the uterine walls. More than 99% are benign. The cause is a mutation affecting the regulation of growth in a uterine muscle cell; the affected cell undergoes excessive growth and replication, until constrained by lack of space or blood flow. Myomas are affected by hormones and genetics. Women are more likely to develop fibroids if they have a family member with the condition, if they are overweight (thus increasing blood estrogen levels) or if they are black. Most fibroids cause no symptoms and require no treatment. Uterine fibroids are most common in women over the age of 30, increase through the 40s and tend to shrink away after menopause. Uterine fibroids usually grow slowly but rapid growth can be very symptomatic.
Symptoms of Uterine Fibroids
The most common symptoms of myomas are:
- Heavy bleeding
- Feeling of fullness
- Pelvic pressure
- Lower back pain
- Frequent urination (due to the enlarged uterus pressing on the bladder)
- Difficulty with bowel movements
- Pain or pressure with sexual arousal or orgasm
- Infertility, miscarriage or premature labor
- Acute pelvic pain due to the liquefaction of a myoma which outgrows its blood supply.
Complications of Uterine Fibroids
Uterine fibroids may cause infertility or pregnancy complications by preventing implantation and growth of an embryo. If the fibroids have caused infertility or miscarriage, or are in a location where this is likely, Dr Howe may recommend removing the fibroids before attempting another pregnancy. Fibroids present during pregnancy may increase the risk of premature delivery and cesarean section.
Diagnosis of Uterine Fibroids
Uterine fibroids are commonly discovered during a pelvic exam or by imaging:
- MRI scan
- CT scan
Of these methods, ultrasound and MRI are the most reliable and have the advantage of requiring no X-ray exposure. Ultrasound is much faster than MRI and is a very useful first test for fibroids.
Treatment of Uterine Fibroids
If fibroids are not causing problems or symptoms, no treatment is necessary, in such a case Dr Howe may advise to monitor them. When uterine fibroids cause uncomfortable symptoms, anti-hormonal medications may be prescribed to shrink the fibroids. If this fails, several specific therapies are available:
- Endometrial ablation and resection of fibroids
- Embolization, is a minimally invasive procedure that blocks blood flow to uterine fibroids, shrinking or destroying the tumors that grow on the uterine walls. There are several other minimally invasive procedures available to treat uterine fibroids without the use of surgery.
Fibroids of moderate size may be removed by laparoscopy or by hysteroscopy. The latter operation places a viewing scope into the uterus, with which the fibroids can be scraped away. In cases where the uterine fibroids are very large, more traditional surgical methods such as an abdominal myomectomy or hysterectomy may be performed. A hysterectomy is an option only for women who no longer want to have children, as the uterus is removed.