What are uterine fibroids?

Fibroids are abnormal growths that form in the muscle of the uterus. The uterus, also called the womb, is the part of the body that holds a baby when a person is pregnant. People sometimes refer to fibroids as "tumors." But fibroids are not a form of cancer.

Who is at risk of having uterine fibroids?

              The growth of fibroids is dependent on the hormones estrogen and progesterone. Thus, those who had early menarche or onset of menstruations at around 10 years old have a risk of developing fibroid due to early exposure to estrogen which is elevated around menstruation. Combined Oral Contraceptives with estrogen in the form of ethinyl estradiol may promote fibroid formation when a woman starts taking them early around 13 - 16 years old.

              In terms of diet, those who regularly consume beef and other red meats increase the risk 1.3 - 1.7 times while those who consume green vegetables and citrus fruits reduce the risk.  Excessive consumption of alcohol also increases the risk of developing fibroids. Finally, those with a daily history or a relative who had a similar condition may also have the susceptibility genes for them to develop the same condition.

What are the symptoms of fibroids?

Fibroids often cause no symptoms at all. When they do cause symptoms, they may cause:

• Heavy or prolonged menstrual bleeding
• Pain, pressure, or a feeling of "fullness" in the belly
• The need to urinate often
• Too few bowel movements (constipation)
• Difficulty getting pregnant

Diagnosis is usually made through assessment by an OB-Gyne with complete history and physical examination and some lab tests and ultrasound imaging to visualize the fibroid location and size.

How are fibroids treated?

There are several treatment options depending on the following factors

• Your symptoms
• Your age (most fibroids shrink or stop causing symptoms after menopause, which is when monthly periods stop)
• Whether you want to get pregnant in the future
• Whether your fibroids cause so much bleeding that you have a condition called anemia
• The size, number, and location of your fibroids
• How do you feel about the risks and benefits of the different options

Depending on the abovementioned factors and the size and location of the fibroid, treatment options include:

• Medicine – The pills, patches, vaginal rings, injections, and implants used for birth control can help reduce excessive bleeding or bleeding problems.
• Surgery to remove the fibroids – This is called "myomectomy." During this operation, the doctor removes the fibroids but leaves the uterus in place. It is effective, but it is not always a permanent fix, because fibroids might come back. Myomectomy is suitable for those who plan to get pregnant in the future.
• Surgery to remove the uterus – This is called "hysterectomy” or the complete removal of the uterus. This surgery gets rid of fibroids and the problems they cause forever. If you have a hysterectomy, your fibroids cannot come back. But you will also not be able to get pregnant in the future.

How do I choose which option is right for me?

Consult your doctor for personalized advice and treatment planning. But before deciding consider the effectiveness, cost, or invasiveness of the procedure and the following considerations:

• Whether you want to get pregnant in the future – If you might want to get pregnant, medicines or a myomectomy are often the best choices. If you do not want to have children, or if you are done having children, you can often choose from all the options.
• How soon you are likely to go through menopause – Fibroid-related symptoms often go away with menopause, so your age might affect your decision about treatment.

              In general, if your mother or any female member from your family have uterine fibroids, starting early lifestyle changes such as a healthy balanced diet, moderate alcohol consumption, weight loss for overweight or obese women, never smoking, and regular physical activity may help promote wellness and prevent the development of uterine fibroids. If you are experiencing any of the symptoms mentioned above, consult your doctor.

/AET

References:

Chakrabarti, A. (2022). Uterine fibroids (leiomyomas): Epidemiology, clinical features, diagnosis, and natural history. UpToDate. Retrieved from https://www.uptodate.com/contents/uterine-fibroids-leiomyomas-epidemiology-clinical-features-diagnosis-and-natural-history?search=uterine%20fibroid%20risk%20factors&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H5286725

UpToDate. (2022). Patient education: Uterine fibroids (The Basics). UpToDate. Retrieved from https://www.uptodate.com/contents/uterine-fibroids-the-basics?search=uterine%20fibroid%20patient%20education%20&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H458187729