Uterine fibroids, medically known as leiomyomas or myomas, are benign (noncancerous) tumors that develop from the smooth muscle tissue of the uterus. They can form within the uterine wall, inside the uterine cavity, or on its outer surface. Though they are non-cancerous, fibroids can lead to a range of symptoms and complications, depending on their size, location, and number.

While many people with fibroids may remain asymptomatic, others can experience distressing symptoms such as excessive menstrual bleeding, pelvic pain, and pressure on nearby organs. Fibroids are among the most common types of gynecological growths, particularly in individuals of reproductive age.

Where Do Fibroids Grow?

Fibroids can vary significantly in size—from tiny nodules the size of a seed to large masses comparable to a watermelon. They can grow:

• Inside the uterine wall (intramural)
• Inside the uterine cavity (submucosal)
• On the outer wall of the uterus (subserosal)
• On a stalk attached to the uterus (pedunculated)

Types of Uterine Fibroids

The classification of fibroids depends on their location in the uterus:

1. Intramural Fibroids o Located within the muscular wall of the uterus. o This is the most common type.
   1. Can enlarge the uterus and cause heavy periods or pelvic pain.
2. Submucosal Fibroids
   1. Develop just beneath the endometrial lining and protrude into the uterine cavity.
   1. Often responsible for heavy menstrual bleeding and fertility issues.
3. Subserosal Fibroids o Grow on the outer surface of the uterus. o May press against nearby organs like the bladder or rectum, leading to urinary or bowel issues.
4. Pedunculated Fibroids o Attached to the uterus by a thin stalk. o Can grow either inside or outside the uterus and may twist, causing acute pain.

How Common Are Fibroids?

Fibroids are extremely common, especially during the reproductive years. Studies suggest that between 40% and 80% of individuals with a uterus will develop fibroids by age 50. They most commonly appear between ages 30 and 50, and their prevalence decreases after menopause due to declining hormone levels.

Symptoms of Uterine Fibroids

Not everyone with fibroids experiences symptoms. When present, symptoms may include:

• Heavy or prolonged menstrual bleeding
• Bleeding between menstrual cycles
• Pelvic or lower abdominal pressure and bloating
• Frequent urination or difficulty emptying the bladder
• Painful sexual intercourse
• Chronic lower back or leg pain
• Constipation or rectal pressure
• Enlarged abdomen or visible abdominal distention

These symptoms tend to subside after menopause, as fibroids usually shrink due to hormonal changes.

What Does Fibroid Pain Feel Like?

• Dull pelvic ache or pressure
• Sharp or stabbing abdominal pains
• Lower back pain
• Pain during intercourse
• Sudden severe pain if a fibroid twists (particularly pedunculated fibroids) Appearance of Fibroids

Fibroids generally have a firm, rubbery texture and are typically round or oval. While some remain embedded within the uterine wall, others may protrude or hang on a stalk, giving them a mushroom-like appearance.

Causes of Uterine Fibroids

The exact cause of fibroid development remains unclear, but several factors are believed to influence their growth:

• Hormonal influence: Estrogen and progesterone appear to fuel fibroid growth.

Fibroids often enlarge during pregnancy and shrink after menopause.

• Genetic factors: A family history of fibroids increases the risk.
• Growth factors: Substances that help the body maintain tissues may promote fibroid development.
• Extracellular matrix (ECM): Fibroids have a high ECM content, which contributes to their stiffness.

Risk Factors

• Obesity and high body mass index (BMI)
• Family history of fibroids
• Early onset of menstruation
• Late onset of menopause
• Nulliparity (never having given birth)

Complications of Uterine Fibroids

• Severe anemia due to chronic heavy bleeding
• Chronic pain or discomfort
• Reproductive challenges, such as infertility or miscarriage
• Pregnancy complications, like preterm labor or the need for C-section

Can Fibroids Cause Anaemia?

Yes. Persistent or heavy menstrual bleeding caused by fibroids can lead to irondeficiency anaemia, a condition where the body lacks enough red blood cells to carry adequate oxygen. Symptoms include fatigue, dizziness, and shortness of breath.

How Are Fibroids Diagnosed?

Fibroids are often found during routine pelvic exams. When symptoms suggest their presence, imaging and diagnostic procedures may include:

• Ultrasound: Uses sound waves to visualise the uterus and fibroids.
• MRI: Offers detailed images and helps assess size and number of fibroids.
• CT Scan: Occasionally used for more comprehensive imaging.
• Hysteroscopy: A camera-equipped scope is inserted through the cervix to inspect the uterus.
• Sonohysterography: A saline solution enhances ultrasound imaging of the uterine cavity.
• Hysterosalpingography (HSG): X-ray test with dye to view the uterus and fallopian tubes.
• Laparoscopy: A minimally invasive surgery to examine and possibly treat fibroids.

Treatment Options for Uterine Fibroids

Treatment depends on factors like the severity of symptoms, size and location of the fibroids, and fertility plans.

1. Watchful Waiting

If fibroids are small and symptom-free, routine monitoring may suffice.

• Medications
  • Pain relief: Over-the-counter NSAIDs like ibuprofen.
  • Hormonal treatments: Birth control pills, IUDs, and hormone-regulating injections.
  • GnRH agonists: Temporarily shrink fibroids and are often used before surgery.
  • Oral therapies:

o Elagolix: Helps reduce bleeding from fibroids. o Tranexamic acid: Non-hormonal option for controlling heavy menstrual bleeding.

• Iron supplements: Used if anemia is present.
• Surgical Treatments

Myomectomy

Surgical removal of fibroids while preserving the uterus. It can be performed via:

• Hysteroscopy
  • Laparoscopy
  • Laparotomy

Hysterectomy

Complete removal of the uterus—considered a definitive cure for fibroids. Options include:

• Vaginal hysterectomy
  • Laparoscopic or robotic hysterectomy

Uterine Fibroid Embolization (UFE)

Minimally invasive technique that blocks blood flow to fibroids, causing them to shrink.

Radiofrequency Ablation (RFA)

Uses heat to destroy fibroid tissue and is effective for smaller fibroids.

Risks of Treatment

• Medications: Side effects may include hormonal changes, bone thinning, or gastrointestinal symptoms.
  • Surgery: Includes risks of infection, bleeding, scar formation, and complications affecting future pregnancies.
  • Myomectomy: May necessitate C-section in future pregnancies.
  • Hysterectomy: Permanently ends fertility.

Size and Surgical Intervention

There’s no universal size that determines the need for surgery. Even small fibroids can require removal if they’re causing significant symptoms. Your provider will evaluate based on both the fibroid’s dimensions and your health status.

1. What Happens if Fibroids Are Left Untreated?

If fibroids aren’t causing symptoms, they may not need immediate treatment. However, untreated fibroids can lead to worsening symptoms, complications with fertility, or increasing pain and pressure.

• Can Fibroids Be Prevented?
  • Maintaining a healthy weight
  • Regular pelvic exams
  • Managing estrogen levels through diet and lifestyle

3. Can I Get Pregnant with Fibroids? 

Yes, many people with fibroids can conceive and have healthy pregnancies. However, large or strategically located fibroids may pose challenges:

• Obstruction of fetal growth
  • Preterm labor
  • Placental issues
  • Increased likelihood of C-section
• Do Fibroids Change Over Time?

Yes. They can grow, shrink, or remain stable. Growth is often influenced by hormonal changes—fibroids typically enlarge during pregnancy and shrink after menopause.

• Do Fibroids Go Away Naturally?

In some individuals, particularly postmenopausal people, fibroids shrink on their own due to decreased hormone levels. When they shrink, associated symptoms often improve.

• Do Fibroids Make You Tired or Look Pregnant?

Fibroids themselves don’t usually cause fatigue, but anemia from heavy bleeding can. Large fibroids can distend the abdomen, causing a bloated or pregnant appearance.

• When Should You See a Doctor?
• Heavy or prolonged periods
• Painful intercourse
• Pelvic pressure or bloating
• Unexplained fatigue
• Fertility issues

 Conclusion

Fibroids are almost always benign. Rarely, a fibroid may transform into a malignant tumor (leiomyosarcoma). Suspicion may arise with rapid fibroid growth, especially after menopause.