Uterine Fibroids

Uterine fibroids are, usually, a benign growth inside a woman’s uterus that may be present a woman’s entire life. Generally they appear in a woman’s childbearing years and are called leiomyomas or myomas. They develop in the smooth muscular tissue (myometrium) via a rapidly dividing cell forming a firm, rubbery mass. Every woman is different and each fibroid is different as well, some may grow large and become painful depending on location. Other fibroids may disappear over time and never be detected. Symptoms include:

  • Heavy menstrual bleeding (menorrhagia)
  • Prolonged menstrual bleedings (lasting over one week)
  • Pressure or pain on pelvis
  • Frequent urination – feeling as if bladder is never empty
  • Difficulty discharging bladder
  • Constipation – inability to defecate
  • Backaches
  • Leg pain.

Irregularly, a fibroid may cause pain when it outgrows its blood supply, and it continues to grow until it runs out of nutrition. When a fibroid dies, it is known to cause pain and fever, occasionally. If you live in Denver and feel these symptoms visit the Denver Holistic Center for more information. Fibroids that hang by a stalk inside or outside the uterus are knows as pedunculated fibroid, and they may trigger pain when they twist on their stalk and cut off their own blood supply.

There are different types of fibroids with different symptoms:

  • Subserosal – project outside the uterus; put pressure on the bladder; can press on the rectum → pressure sensation or backache
  • Intramural – grow within muscular uterine wall; large ones can distort shape of uterus → heavy, prolonged period.

Symptoms that are cause for concern, and a patient should see a physician immediately include:

  • Pelvic pain is consistent
  • Unmanageable heavy and prolonged periods
  • Spotting or unprovoked bleeding between periods
  • Dyspareunia – pain during sexual intercourse
  • Palpable, enlarged uterus or abdomen upon examination
  • Severe issues with urination.

Furthermore, causes of fibroids may be idiopathic, meaning they occur without reason. However, some causes include:

  • Genetic/Hereditary – some fibroids contain genes that differ from those in normal uterine muscle cells. Sometimes a type of fibroid is genetic and runs in a family.
  • Hormones – estrogen and progesterone promote growth of fibroids. It has been shown that fibroids contain more receptors for these hormones than normal uterine muscle cells. For which reason, they will decrease in size as a woman approaches menopause.
  • Growth factors – insulin-like growth factor may affect fibroid production.

When at risk, a doctor may order the following tests:

  • Ultrasound – image of uterus
  • Lab tests- complete blood count (CBC) to check for:
    • Anemia
    • Thyroid issues.
  • Imaging tests
    • Magnetic resonance imaging (MRI) – show size and location of fibroids
    • Hysterosonography – saline infusion sonogram; uterine cavity and endometrium viewing
    • Hysterosalpingography – dye to highlight uterine cavity and fallopian tubes on X-ray
    • Hysteroscopy – telescope through your cervix to uterus

All in all, there are a number of non-invasive or dangerous procedures which can be applied to help rule out or rule in fibroids when a woman experiences the signs of symptoms. Once a diagnosis is confirmed, then treatment options can be discussed:

  • Watchful waiting – careful monitoring of symptoms and menstrual cycle
  • Medications
    • Gonadotropin-releasing hormone (GnRH agonists)
      • Lupron, Synarel, Leuprolide
    • Progestin-releasing intrauterine device (IUD)
    • Others
      • NSAIDs
    • Noninvasive procedures
    • Minimally invasive procedures
      • Uterine artery embolization
      • Myolysis
      • Laparoscopic or robotic myomectomy
      • Hysteroscopic myomectomy
      • Endometrial ablation and resection of the submucosal fibroids
    • Traditional surgeries

Before choosing a procedure a physician must warn the patient that for all procedures, except a hysterectomy (removal of uterus), fibroids may grow back. No treatment process is 100% for fibroids since many of them follow your body’s normal physiology and will just come back.