Fibroids: Prevalence, Types, Causes, Diagnosis, and Treatment

Fibroids, also called Uterine Leimyomata, are common benign and noncancerous neoplasms recognized to affect many women of reproductive age.

Although they are benign, they can significantly impact a woman’s physical and mental well-being.

In a 2003 study, the estimated incidence of fibroids in women by year 50 was 70% for white women and up to 80% for black women.

Therefore, learning about them and seeking early diagnosis and treatment is necessary for faster recovery.

This comprehensive article sheds light on uterine fibroids’ prevalence, location, causes, risk factors, diagnosis, and treatment.

What are fibroids

Uterine Fibroids (UF), also recognized as Leiomyomas or Myomas, are benign tumors in the wall of the uterus (womb).

These are the most common types of uterine growth in women of reproductive age.

UF is made of smooth muscle cells and fibrous connective tissue.

As per the American College of Obstetricians and Gynecologists, UF’s size, shape, and location can vary.

They can range from pea-sized small growths to several inches in length.

Generally, UF is found near the uterus lining, inside or outside.

Are fibroids cancerous

No, UF is non-cancerous. They are just benign tumors developed inside or outside the uterine cavity.

Further, there is no association between UF and increased Endometrial or Ovarian Cancer incidence, according to the Journal of Cancer.

Where are fibroids found

As mentioned earlier, UF is majorly found in the proximity of the uterus, either inside or outside the uterine cavity.

However, in rare cases, fibroids can also be found in the cervix.

Types of fibroids

There are four types of UF:

• Intramural: Grows within the muscular uterine walls and are called intramural fibroids
• Submucosal: They bulge into the uterine cavity and are called submucosal fibroids
• Subserosal: They project to the outside of the uterus
• Pedunculated: They hand from the stalk either inside or outside the uterus

Fibroids signs and symptoms

The range of uterine fibroid symptoms is as follows:

• Menstrual pain and irregular periods with UF
• Fibroid discharge
• Pain during sexual intercourse
• Bloating with fibroids
• Difficulty in urination and bowel movement
• Cramps during fibroids
• Complications during pregnancy
• Difficulty getting pregnant
• Fibroids weight gain
• Vaginal bleeding

What causes fibroids

The exact cause of UF is still unknown. However, numerous underlying reasons can help in the growth of the UF.

The most common causes of UF in women are as follows:

• Gene changes: UF can be developed as a result of genetic mutation
• Hormones: These are mainly Estrogen-dependent, as no prepubertal cases have been reported. Further, Progesterone is essential for its growth
• Insulin-like growth factor: UF and myometrium (the muscular outer layer of the uterus) contain an excessive amount of Insulin-like growth factor compared to other growth factor protein
• Extracellular matrix: ECM is increased in the case of UF and makes them fibrous. Further, ECM can also store growth factors and induce biological changes within the cell

Risk factors for fibroids

The following risk factors can elevate the risk of developing UF:

• Age: Growing age is a significant risk factor for fibroid development
• Family history: If a woman’s mother had UF, her risk of developing them is three times higher
• Race: African American women are more likely to have UF compared to caucasian or white women at younger ages
• Early menarche and late Menopause: UF can occur in women who tend to have early menarche or late Menopause
• Diet: Eating less fruits and vegetables and consuming red meat can increase the risk of developing UF
• Vitamin D deficiency: Vitamin D deficiency is also recognized to increase the risk of fibroid development
• Obesity: Obesity can alter sex hormone metabolism, cause inflammation, and reduce sex hormone-binding globulin, causing more free Estrogen and fibroid risks
• Excessive alcohol: Excessive alcohol intake can also cause hormonal changes and decrease Estrogen metabolism, elevating fibroid risk
• High blood pressure: Elevated blood pressure causes injury to the smooth muscle cells and release of cytokine and, thus, increases the risk of onset or growth of UF
• Stress: As per a 2010 report, increased stress intensity was also associated with fibroid risk in white women

Complications of uterine fibroids

UF is associated with the following complications in women:

Infertility

Women with UF may find it difficult to conceive and ensure a healthy pregnancy.

They can cause infertility in the following ways:

• It can block the fallopian tubes and impair gamete transport
• Changes in the uterus shape can also affect the movement of sperm or embryo
• Changes in the shape of the cervix
• Implantation difficulty by affecting the blood flow to the uterine cavity
• By affecting the uterine lining

Of all the types, sub-mucosal fibroids are most likely to affect fertility.

Pregnancy and live birth rates are low in women with submucosal fibroids.

As per a study on the outcome of Assisted Reproductive Technology (ART), the following were the results of pregnancy rates per transfer:

Further, as per the study, it was found that pregnancy and implantation rates were comparatively lower in women with intramural or submucosal fibroids, even if there were no uterine deformations.

Miscarriage

As per a 2001 study, it was found that the rate of spontaneous loss of pregnancy in women with UF was two times higher than in women without it.

Further, the risk of miscarriage is much higher in people with multiple UF when compared to women with a single fibroid.

The mechanism of how exactly UF causes miscarriage is not recognized. However, the following factors can elevate the risk of miscarriage:

• Increased irritability of the uterus
• The pressure exerted by UF on the uterus
• It may compromise the blood supply to the developing placenta and fetus

Fibroids diagnosis

UF can be diagnosed in the following ways if you have the symptoms of the condition:

• Ultrasound
• Blood test
• Magnetic Resonance Imaging (MRI)
• Hysterosonography
• Hysterosalpingography
• Hysteroscopy

Fibroids treatment

After necessary diagnostic tests, a healthcare practitioner can prescribe the following UF treatment options depending on the severity of the condition:

Medications

UF treatment without surgery includes medications as follows:

• Gonadotropin-releasing hormone (GnRH) agonists
• Birth control pills, rings, or injections
• Tranexamic acids
• Progestin-releasing Intrauterine Device (IUD)
• Pain relievers, such as Ibuprofen

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Surgery

The surgical options for fibroid removal include:

• Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS)
• Uterine Artery Embolization (UAE)
• Radiofrequency ablation
• Laparoscopic myomectomy
• Hysteroscopic myomectomy
• Endometrial ablation
• Abdominal myomectomy
• Hysterectomy for fibroids

Conclusion

Fibroids are benign and noncancerous tumors affecting many women of reproductive age.

It can range from a small pea-sized growth to several inches larger.

They are mostly found in the proximity of the uterus, either inside or outside the uterine cavity.

It can show symptoms such as menstrual irregularity and pain during sex.

They can be diagnosed with an ultrasound, hysteroscopy, hysterosalpingography, and laparoscopy.

Further, a healthcare practitioner can recommend fibroid treatment depending on the severity of the condition, including medications and surgical treatment.

Thus, after learning about the symptoms, causes, and associated complications, consult a healthcare practitioner and seek medical attention if fibroids are suspected.

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