Fibroids (also called leiomyomas) are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous.
What Causes Fibroids?
The cause of uterine fibroids is not known, although studies demonstrate there may be a genetic component. There is no definite external exposure that a woman can have that causes her to develop fibroids.
Types of Fibroids?
The three main types of fibroids include:
Intramural fibroids: Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.
Subserosal fibroids: Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.
Pedunculated fibroids: Subserosal tumors can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.
Submucosal fibroids: These types of tumors develop in the middle muscle layer, or myometrium, of your uterus. Submucosal tumors aren’t as common as the other types.
What are the symptoms of uterine fibroids?
Most fibroids do not cause any symptoms and don’t require treatment other than regular observation by your healthcare provider. These are typically small fibroids. When you don’t experience symptoms, it’s called an asymptomatic fibroid. Larger fibroids can cause you to experience a variety of symptoms, including:
- Excessive or painful bleeding during your period (menstruation).
- Bleeding between your periods.
- A feeling of fullness in your lower abdomen/bloating.
- Frequent urination (this can happen when a fibroid puts pressure on your bladder).
- Pain during sex.
- Low back pain.
- Constipation.
- Chronic vaginal discharge.
- Inability to urinate or completely empty your bladder.
- Increased abdominal distention (enlargement), causing your abdomen to look pregnant.
Who is at risk for uterine fibroids?
Various factors can increase the risk of developing fibroids:
- Age: Fibroids become more common as women age, especially during their 30s and 40s and up to menopause. After menopause, fibroids are much less likely to form and usually shrink if they’re present.
- Family history: Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin: African-American women are more likely to develop fibroids than other ethnicities .
- Obesity: Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
How are uterine fibroids diagnosed?
Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam. Scans can confirm a diagnosis. These tests are the two main options:
- Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results. Other tests such as MRI may be better for other conditions, such as adenomyosis.
- MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.
Other tests for uterine fibroids
In special circumstances or if doctors can’t identify the source of your pain, you may need additional testing:
- Hysterosalpingogram (HSG): Doctors typically use an HSG for women having trouble getting pregnant. It checks the inside of the uterus (uterine cavity) and fallopian tubes. After a doctor places a catheter (small tube) in the uterus, the doctor slowly injects a special dye for contrast and takes X-rays.
- Hysterosonogram: Doctors use a hysterosonogram to see the inside of the uterus. After they place a small catheter inside the uterus, they inject water while taking a series of ultrasound images. The test can confirm the presence of uterine polyps or intracavitary fibroids that can cause heavy bleeding.
- Laparoscopy: For laparoscopy, a doctor makes tiny incisions in or near the navel. The doctor then inserts a long, thin instrument (laparoscope) into the abdomen and pelvis. The laparoscope has a bright light and a camera. It allows your doctor to see the uterus and surrounding structures. The view can help your doctor determine if you have a condition such as endometriosis, which can cause pelvic pain.
- Hysteroscopy: For suspected abnormalities inside the uterus, a doctor uses a long, thin instrument with a camera and light. The doctor passes the instrument through the vagina and cervix into the uterus. No incision is needed. The doctor can look for fibroids or endometrial polyps within the cavity of the uterus with this approach. Your doctor may also remove some types of fibroids during this procedure.
Sources: https://www.healthline.com/health/uterine-fibroids#diagnosis, https://www.uclahealth.org/fibroids/what-are-fibroids, https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids
To be continued next week………