Uterine fibroids are non-cancerous growths in the uterus that affect many women of childbearing age – it is estimated that around 30% of US women aged 25 to 44 have the symptoms of uterine fibroids, with African American women often being diagnosed with multiple fibroids.1 In addition, African American women are more likely to be diagnosed with uterine fibroids at a younger age and the fibroids tend to be larger and are associated with more severe symptoms. Other factors that increase the risk of fibroids include:
- Age older than 40 years
- High blood pressure
- Family history of uterine fibroids
- No history of pregnancy
- Low vitamin D levels
- A diet high in red meat and low in green vegetables, fruits, and dairy
There are two types of medications that can reduce the risk of developing fibroids: the progestin-only birth control pill or other oral contraceptives used over a long time, and birth control injections such as depot medroxyprogesterone acetate (Depo-Provera).
What exactly are uterine fibroids?
Uterine fibroids are thought to develop from a single stem cell in the smooth muscular tissue of the endometrium. This single stem cell repeatedly divides, eventually creating a firm rubbery mass that is separate to neighboring tissue. Fibroids grow at different rates, with some growing rapidly and some slowly developing. They can also spontaneously shrink or can undergo rapid growth spurts. Many that are present during pregnancy disappear after birth when the uterus returns to its normal size.
Although uterine fibroids aren’t dangerous, they can cause discomfort and may result in anemia due to heavy blood loss.
The symptoms of uterine fibroids include:
- Menstrual periods that last for longer than a week
- Heavy menstrual bleeding
- Pelvic pressure or pain
- Difficulty emptying the bladder
- Backache or leg pains
How do uterine fibroids affect my chances of becoming pregnant?
Uterine fibroids are classed according to their location. Intramural fibroids grow within the muscular uterine wall, submucosal fibroids grow into the uterine cavity and subserosal fibroids project to the outside of the uterus.
It is submucosal fibroids that grow into the uterine cavity that may interfere with getting pregnant, and are present in around 5% to 18% of infertile women. Submucosal may prevent pregnancy by causing mechanical distortion of the uterus and consequently affecting both the transport of sperm and eggs as well as the implantation of the embryo.
Submucosal fibroids can also increase pregnancy complications such as preterm delivery, fetal growth restriction, and placental abruption.
How are uterine fibroids treated?
Many options for treating uterine fibroids exist and so far there is no single best treatment approach. One option is watchful waiting whereby the uterine fibroids are just regularly assessed but no treatment is undertaken. This is a good option for those women who are experiencing no or mild symptoms.
Medications used to treat uterine fibroids are gonadotropin-releasing hormone (GN-rH) agonists such as Lupron and Syneral. GN-fH agonists put you into a temporary menopausal state in order to shrink the fibroid(s) and are often used before surgery. They can only be used for three to six months due to the risk of inducing osteoporosis. Other medications used to ease the symptoms of uterine fibroids but not to treat them include progesterone-releasing intrauterine devices and tranexamic acid (Lysteda) which help ease relieve the heavy bleeding associated with uterine fibroids. Nonsteroidal drugs (NSAIDs) may also be used to provide pain relief and vitamins and iron may be prescribed if you have anemia.
Magnetic resonance imaging (MRI)-guided focused ultrasound surgery (FUS) is a noninvasive treatment option that preserves your uterus, needs no incision, and doesn’t require that the patient stay overnight in the hospital. MRI-guided FUS involves precisely locating the fibroid with MRI and then using an ultrasound transducer to focus sound waves into the fibroid, resulting in the heating and destroying of tissue.
Minimally invasive procedures
Minimally invasive procedures can destroy fibroids without the use of surgery. These include:
- Uterine artery embolization: small particles are injected into the arteries supplying the uterus, cutting off the fibroid’s blood supply and causing them to shrink and die
- Myolysis: a laparoscopic procedure in which a laser, an electric current or radiofrequency energy destroys the arteries that supply the fibroid
- Cryolysis: freezing the fibroids
- Robotic or laparoscopic myomectomy: the fibroids are either broken up or left intact and are removed via slender instruments inserted into the uterus and the uterus is left in place
- Hysteroscopic myomectomy: a procedure whereby your surgeon accesses and removes fibroids using instruments inserted through your vagina and cervix into your uterus
- Endometrial ablation: a treattment which is performed with a specialized instrument inserted into your uterus, and uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, preventing or reducing menstruation
Traditional surgical procedures
- Abdominal myomectomy: a surgical procedure which is used for women with multiple fibroids, very large fibroids or very deep fibroids and may result in scarring tissue which affect a woman’s ability to get pregnant
- Hysterectomy: removal of the uterus, the only proven permanent solution for uterine fibroids but one that renders women unable to have children