Uterine Fibroids

What are uterine fibroids?

Uterine fibroids are benign growths in the wall of the uterus and most often appear during childbearing years. Fibroids are almost never associated with cancer.

Fibroids are rubbery, noncancerous nodules composed of muscle and fibrous tissue in the wall of the uterus. They affect at least 25% of all women in their 30s and 40s and half of Black women in that age group. Their growth is probably stimulated by estrogen; they tend to shrink after menopause when estrogen levels drop.

Fibroids develop from cells in the muscular wall of the uterus that grow slowly into balls of smooth muscle en­cased in fibrous tissue. Most grow inside the wall of the uterus, and many cause no symptoms. Women who have fibroids usually have more than one. Most fibroids are between the size of a walnut and an orange.

Those at higher risk include Black women and women who started their periods at a young age. Other risk factors are vitamin D deficiency, poor diet, obesity, drinking alcohol, and family history of fibroids.

Fibroids can cause pelvic pressure and pain, severe menstrual cramping, and heavy menstrual bleeding that leads to anemia. It can affect your quality of life because of the heavy bleeding, chronic pain, and discomfort.

Though fibroids don't always make it impossible to become pregnant, infertility and pregnancy loss may occur, and women with fibroids are at higher risk of preterm delivery.

Rarity: Common

Symptoms of uterine fibroids

The location of the fibroid in the wall of the uterus usually determines the symptoms. The most common symptom is excessive vaginal bleeding.

• Submucosal fibroids grow just beneath the endometrium (the lining of the uterus) and can stimulate excessive bleeding.
• Pedunculated fibroids dangle from a stalk and either stick out into the uterus (where they may cause cramps as the uterus contracts trying to get rid of the fibroid) or sit outside the uterine wall.
• Subserous fibroids grow against the outer wall of the uterus, where they cause pressure.
• A fibroid pressing on a pelvic nerve can cause chronic hip and back pain.
• Large fibroids can press on the bladder and bowel, increasing frequency of urination and causing constipation.
• If a fibroid blocks a fallopian tube, it can cause infertility.
• If it presses on the cervix, it can cause miscarriage or premature labor.

Top symptoms

• Vaginal bleeding
• Pelvis pain
• Abdominal cramps (stomach cramps)
• Painful periods
• Irregular period

Treatment

Uterine fibroid embolization (UFE), also known as uterine artery embolization (UAE), is a minimally invasive procedure that offers an alternative to surgery for treating symptomatic fibroids. During this procedure, an interventional radiologist uses imaging guidance to insert a thin catheter into an artery in the groin or wrist. The catheter is then guided to the uterine arteries that supply blood to the fibroids. Tiny particles are injected through the catheter to block these blood vessels, cutting off the fibroids' blood supply and causing them to shrink.

UFE typically takes about 1-3 hours and is performed under conscious sedation. Most patients can go home the same day or after an overnight stay. The procedure is effective in reducing fibroid-related symptoms for about 85-90% of women. Benefits of UFE include shorter recovery time compared to surgery, uterus preservation, and simultaneous treatment of multiple fibroids.

While generally safe, UFE does carry some risks. These may include post-embolization syndrome (fever, pain, nausea), infection, and rarely, damage to other organs. Some women may experience changes in menstruation or early onset of menopause. It's important to note that while pregnancies are possible after UFE, more research is needed on its effects on fertility and pregnancy outcomes.

Patients considering UFE should consult with both a gynecologist and an interventional radiologist to determine if it's the right treatment option for their specific case.

You should consult with a gynecologist to try to get relief from your symptoms. Fibroids can be diagnosed through a routine pelvic exam or ultrasound in a doctor's office. Your doctor can prescribe various medications to ease the symptoms and regulate the menstrual cycle.

There are also a number of surgical techniques, some minimally invasive, to shrink or remove the fibroids while leaving the uterus in place. Hysterectomy, or removal of the uterus, is an option in some cases.