“Uterine fibroids are a disease of the uterine muscle. It is a common condition and is not malignant, not cancer, but a growth of tumor masses mostly. The growth is usually slow, and in some cases, the fibroids may not grow or cause any symptoms. The size, location, and number of fibroids vary considerably among patients. Some patients may have a single fibroid but very large, filling the pelvic cavity, while others may have multiple fibroids, etc. These fibroids may grow into the uterine cavity or protrude as lumps outside the uterus, and patients may be able to feel them.”
Factors Affecting the Growth of Uterine Fibroids
- Uterine fibroids can occur at any age but are most commonly found between 30 – 40 years old.
- The exact cause of uterine fibroids is unknown, but it is found that hormones produced by the ovaries, namely estrogen and progesterone, stimulate the growth of fibroids. Additionally, the use of contraceptive pills may also stimulate fibroid growth.
- After menopause or at the end of menstruation, most fibroids tend to shrink in size.
Types of Uterine Fibroids Based on Location – 3 Types
- On the outer surface of the uterine wall: This type usually does not cause problems if the fibroid does not grow because it is outside the uterus and does not affect uterine muscle contractions. However, if the fibroid grows large, it may press on other organs or if it has a stalk, twisting of the stalk may cause severe pain.
- Within the uterine muscle: Most fibroids are located within the uterine wall. This type causes problems such as infertility, menstrual pain, and heavy menstrual bleeding. The severity depends on the size and location of the fibroid.
- Within the uterine cavity: The fibroid protrudes into the uterine cavity, or most or all of the fibroid is inside the cavity. This type causes problems with infertility, frequent miscarriages, heavy and abnormal menstrual bleeding, and menstrual pain. Uterine fibroids may be single or multiple in the same person and may be mixed types. Symptoms may be absent or vary in severity.
Symptoms of Uterine Fibroids
- Only about 20-30% of fibroids cause symptoms. Changes in menstruation such as prolonged, frequent, or increased volume may cause anemia in some cases.
- Pain, especially menstrual pain, may include a dull ache in the lower abdomen.
- Pressure on adjacent organs, such as pressing on the bladder causing frequent or difficult urination, or pressing on the intestines causing constipation, dull pain, or rectal discomfort.
- Palpable lumps in the pelvic or abdominal cavity if the fibroids are large or numerous.
- Frequent miscarriages during pregnancy.
- Infertility.
- Some patients may have no symptoms but are diagnosed during internal examinations or high-frequency ultrasound scans.
Complications from Uterine Fibroids
Generally, complications from uterine fibroids are uncommon. Torsion of the fibroid stalk occurs when the fibroid grows outside the uterus and has a stalk. Symptoms include sudden severe pain accompanied by nausea and sometimes fever. Pressure on adjacent organs, especially the ureters, may lead to kidney disease. Malignant transformation is very rare.
Diagnosis of Uterine Fibroids
Internal examination and high-frequency ultrasound of the abdomen are the most accurate diagnostic methods. Other diagnostic methods include hysteroscopy or laparoscopy. CT scans or MRI are not commonly used because high-frequency ultrasound is highly accurate, easy to perform, and inexpensive.
Careful Symptom Monitoring
This approach is preferred for patients without symptoms, with small fibroids, and near menopause. In such cases, doctors will schedule follow-up examinations every 3 – 6 months. The following symptoms or conditions indicate that treatment is necessary:
- Abnormal heavy menstrual bleeding causing anemia or increased menstrual pain that interferes with daily life.
- Uncertainty whether the detected lump is a uterine fibroid or an ovarian tumor.
- Rapidly growing uterine fibroids.
- Infertility with no other identifiable cause.
- Symptoms caused by pressure from the fibroid.
