Uterine fibroids are non-cancerous tumors that grow within the muscle tissue of the uterus. There are 4 primary types of fibroids: intramural, subserosal, submucosal, and pedunculated. It is common for a woman to have multiple types of fibroids.
Intramural fibroids are the most common type of fibroids, which usually grow within the uterine wall then expand from there. When these fibroids expand, they make the uterus feel enlarged and are often mistaken for pregnancy or weight gain. Other symptoms include heavy menstrual bleeding, prolonged menstrual cycles, pelvic pain, and frequent urination.
Subserosal fibroids usually grow on the outer uterine wall, which can continue to grow outward. The increased size will put pressure on surrounding organs causing pelvic pain and pressure. This type of fibroid does not usually cause excessive bleeding.
Submucosal fibroids develop under the lining of the uterine cavity, which can block the fallopian tubes when they increase in size and can cause complications with fertility. These are the least common type of fibroids. Some women will experience no symptoms while other women will experience heavy and prolonged menstruation.
Pedunculated fibroids grow on a stalk, which can grow into the uterus or outside of the uterine wall, resulting in pedunculated submucosal or subserosal fibroids. Some women will experience pain and pressure due to the fibroids twisted on the stalk.
Symptoms depend on the size, location, and the number of fibroids. Symptoms can be so severe that daily activities are unbearable. However, many women who have fibroids experience very minor symptoms or none at all.
Millions of women have uterine fibroids but experts are not positive what causes them. Researchers believe estrogen, progesterone, growth hormones, and genetic changes are related to fibroid growth. Stress and unbalanced micronutrients (such as iron and vitamin D) may also contribute to fibroid growth. Most likely, many factors interacting together cause fibroids.
Uterine fibroids only need to be treated if they cause serious symptoms. Many women never experience symptoms; thus, do not know they have fibroids. If the fibroid tumors do cause symptoms, there are a couple of treatment options.
Birth control pills can help with managing excessive bleeding and other fibroid symptoms. However, there are many potential side effects that come with birth control pills and researchers believe once birth control treatment ends, fibroid symptoms return.
Gonadotropin-releasing hormone (GnRH) agonists can be prescribed to relieve fibroid symptoms by reducing levels of testosterone and estrogen in the blood. Prolonged use of GnRH agonists can cause bone loss so treatments usually do not extend the past 6 months. After treatment ends, fibroids and symptoms tend to come back.
NSAIDs may be prescribed for pain associated with uterine fibroids.
Uterine fibroid embolization (UFE) is a minimally invasive procedure performed by an interventional radiologist. Through a small incision, the interventional radiologist inserts a catheter to deliver tiny particles to the fibroid location, which cuts off blood supply and causes the fibroids to shrink and disappear. The procedure typically takes less than an hour and has a short recovery time.
Other benefits of UFE include:
UFE is generally a safe option. However, with any invasive procedure, there is a risk of bleeding, infection, and bruising as well as the possibility of a bad reaction to the anesthesia used.
Surgical options to treat uterine fibroids include hysterectomy and myomectomy.
Myomectomy is a surgery that removes fibroids from the uterus without taking away healthy tissue and leaving the uterus intact. The benefit of this treatment option is that the uterus remains intact and future pregnancy is possible.
Hysterectomy is the surgical removal of all or parts of the uterus. Depending on the patient's needs, the surgeon may also remove the fallopian tubes, ovaries, and/or the cervix. Hysterectomies are usually a final treatment option for chronic issues such as: uterine fibroids, endometriosis, pelvis support problems, abnormal uterine bleeding, cancer, and chronic pelvic pain.
The disadvantages of both Myomectomy and Hysterectomy are due to the invasiveness of the procedures that requires a large incision, general anesthesia, and risks associated with surgery like blood loss, pain, infection, and longer recovery. The hospital stay usually lasts 1-3 days and recovery time is generally 2-6 weeks.