What are fibroids?
Fibroids are benign tumors of the uterus. They are also called leiomyomas or myomas. Uterine fibroids are the most common tumors of the female genital tract and the leading reason for hysterectomy in the U.S. Fibroids occur in over 50% of women by the age of 50, although most do not cause symptoms or require treatment.
Fibroids are named according to their location within the uterus. They may occur under the inner lining of the uterus (submucosal), within the muscular wall of the uterus (intramural), or on the outer part of the uterus (serosal or subserosal).
Fibroids grow over time. How quickly growth occurs varies greatly from patient to patient. However, hormonal changes cause fibroids to stop growing once a woman has reached menopause.
What are the symptoms of fibroids?
While fibroids may appear in patients in their twenties, most patients do not experience any symptoms until their late thirties or forties. Many patients will never experience symptoms. For those that do, symptoms will vary based on fibroid type and severity.
Heavy menstrual bleeding: The most common symptom associated with fibroids is heavy menstrual bleeding, often with clots. The result can be longer periods and an increase in the number of heavy days of bleeding. Anemia (low blood cell count) is a common side effect. This symptom is associated with submucosal or intramural fibroid types.
Cramping: Menstrual cramps are a common symptom of fibroids, particularly in women who have heavy menstrual bleeding. This can be due to the passage of blood clots or from the disruption of normal uterine contractions that might occur at the time of menstrual bleeding.
Discomfort and pressure: Fibroids can cause discomfort, a feeling of heaviness, bloating, a dull ache, or mild tenderness of the pelvis. Discomfort may also be felt in the lower back or in the thighs. Symptoms can be worse just before and during the menstrual cycle, and during or after exercise or sexual intercourse. This fibroid symptom is associated with intramural and subserosal fibroid types.
Urinary and rectal symptoms: Fibroids can cause or contribute to increased urinary frequency (including the need to get up at night to urinate), incontinence (urine leakage), rectal pain, or difficulty with bowel movements. In rare cases, fibroids can make it difficult to urinate. These symptoms may get worse in the days leading up to the start of the menstrual period and during the period.
Pain: On rare occasions, a fibroid may suddenly die due to a loss of its blood supply. This is a painful process that may last several days.
What causes fibroids?
A combination of genetic factors and the interaction of various hormones and growth factors appear to lead to a fibroid’s development. However, the exact cause of fibroids is still not fully understood.
African-American women are over three times as likely to develop fibroids as Caucasian women, an increased risk that may be due to genetic differences. There is some variation among other racial groups.
While the link is not definitive, some research suggests that high blood pressure and obesity may contribute to fibroid growth.
How are fibroids treated?
If fibroids are not causing symptoms, surveillance may be the only care required. If fibroids are creating health issues, there are several non-surgical and surgical treatment options.