Fibroids in Women – Symptoms, Causes And Treatments

Woman in menstrual pain

Fibroids (or Uterine Fibroids) are tumors that develop in a woman’s uterus. They can grow large and cause severe pain in the abdomen as well as heavy periods. In some cases, the affected woman may not experience any symptoms whatsoever. Fibroid growths are usually benign (non-cancerous). Other names for uterine fibroid include Fibromas, Uterine Myomas, Myomas, and Leiomyomas.

According to the US Government’s Office on Women’s Health, at least 80% of women globally are affected by uterine fibroids by the age of 50.

The Incidence of Uterine Fibroids Among Nigerian Women

Uterine fibroid is common among Nigerian women. However, most cases do not show any symptoms [1, 2, 3]. Several medical studies have shown an increased incidence of uterine fibroid among women of African descent [4, 5, 6]. Different studies [7] across Nigeria have shown that between 8% and 10% of gynecological conditions were linked to uterine fibroids.

Types of Uterine Fibroids

There are different types of uterine fibroids. The types are largely dependent on the location of the Fibroid.

Intramural fibroids are the most common form of fibroids. They usually appear within the walls of the uterus. These fibroids may grow large and stretch the woman’s womb. Subserosal fibroids usually form outside the womb. This part of the womb is known as the serosa. In some cases, these fibroids may be large enough to make the womb look bigger on one side. In some cases, a stem develops under subserosal fibroids. This stem is a slender base that anchors the tumor. When subserosal fibroids develop this stem, they are referred to as Pedunculated fibroids. Submucosal fibroids usually develop in the myometrium of the uterus. The myometrium is simply the middle muscle layer of the uterus. They are the least common form of fibroid.

Why Do Fibroids Occur?

Medical science does not fully understand why fibroids occur. However, researchers have identified several factors which are related to their formation.

Hormones

A woman’s ovaries produce two major hormones: progesterone and estrogen. Both hormones cause the regeneration of the lining of the uterus. This happens during each menstrual cycle and can stimulate the growth of fibroids.

Family History

Fibroids may be hereditary. If there is a history of this condition in a woman’s family, there is a possibility that the woman may also have it.

Other Factors

Some other factors which could increase a woman’s risk of developing fibroids include the individual being aged 30 and above, being overweight and being of African descent.

Symptoms of Uterine Fibroid

The symptoms of this condition depend on the number of tumors, their size(s) and where they are located. For example, symptoms of submucosal fibroids include difficulty in conceiving and heavy menstrual flow.

Common symptoms of fibroid include:

  • Pelvic pains or pains in the lower back
  • Heavy menstrual bleeding. You may see blood clots in the bleeding
  • Frequent urination
  • Menstrual cramping
  • Painful intercourse
  • Fullness or pressure in your lower abdomen
  • Prolonged menstruation
  • Abdominal enlargement or swelling

If a woman has reached menopause, she may not experience any symptoms. This is because fibroids shrink when a woman attains menopause. During menopause, there is a significant drop in the level of estrogen and progesterone in a woman. And both hormones play important roles in stimulating the growth of fibroids.

Diagnosing Fibroids

To get the right diagnosis, a woman must consult her gynecologist for a pelvic examination. During a pelvic exam, the gynecologist checks the shape, size, and overall condition of the uterus. Other tests may also be required to confirm a diagnosis. In addition to the physical examination, medical imaging tests are a useful tool for diagnosing fibroids.

There are several medical imaging tests that can be used to diagnose fibroids. The ultrasound scan is an imaging technique that can be used to view internal structure around a woman’s uterus. This can help to identify fibroids. Sometimes, doctors may recommend a transvaginal ultrasound. In this technique, the gynecologist inserts the ultrasound wand into the vagina and gets clearer pictures. The pictures are clearer because the vagina is close to the uterus. Another technique available is a Pelvic MRI. This technique produces images of the woman’s ovaries, uterus and other areas around the pelvis.

Treating Fibroids

There are several options for treating fibroids. The optimal approach is dependent on several factors including the woman’s age, the size of the fibroids, and patient’s overall health. In many cases, treatments are combined.

Medications

The doctor may prescribe medications to regulate the level of hormones in the woman’s blood. The regulation of these hormones in turn causes the fibroids to shrink. Some of the drugs can cause a significant drop in progesterone and estrogen levels. Eventually, menstruation stops, and the fibroids shrink. Others can stop the production of follicle-stimulating hormones and luteinizing hormones. They also ultimately cause fibroids to shrink.

Gynecologist can also prescribe medications to control bleeding and pain which may occur when a woman has fibroids. These medications will not, however, eliminate or shrink the fibroids.

Any medication should only be used when prescribed by a doctor.

Surgery

The doctor may opt for the surgical approach to remove fibroids. The surgical procedure is called a myomectomy. During a myomectomy, the surgeon will make an incision into the patient’s abdomen. The surgeon then gains access to the uterus through the abdomen and extracts the fibroids. In some cases, surgery may be done laparoscopically. In laparoscopic surgery, some small incisions are made on the woman’s abdomen. A camera and surgical tools are inserted into this incision to perform the surgery.

In some cases, fibroids may regrow after surgery. If the condition persists, or if other treatments fail, then the doctor may recommend a hysterectomy. A hysterectomy is the surgical removal of the womb. Women who undergo a hysterectomy won’t be able to conceive again.

Non-Invasive Treatment Procedures

Forced Ultrasound Surgery is a noninvasive surgical procedure. For this surgery, the patient will lie within an MRI machine to enable doctors to see the inside of the uterus during the procedure. Then the surgeon will direct high-energy sound waves at very high frequency at the fibroids to destroy or ablate them.

Uterine artery embolization is another option. This involves the doctor injecting small particles into the womb to block the blood supply to the fibroid.

The Prognosis for Uterine Fibroids

The prognosis for uterine fibroids depends on the location and size of the fibroids. Small fibroids may not need treatment. Larger ones may require some form of treatment or the other. However, this will depend on your doctor’s assessment of your condition. If you suffer from any of the symptoms listed previously, consult a doctor as soon as you can.

References

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  2. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science. 2005;308:1589–1592.
  3. Evans P, Brunsell S. Uterine fibroid tumours: Diagnosis and treatment. American Family Physcian. 2007;75:1503–1508
  4. Vollenhoven BJ, Lawerence AS, Healy DL. Uterine fibroids: a clinical review. British Journal of Obstetrics and Gynaecology. 1990;97:285–298
  5. Omu AE, Ihejerika IJ, Tabowei G. Management of uterine fibroids at UBTH. Tropical Doctor. 1984;14:82–85
  6. Briggs ND. Common gynaecological tumours. Tropical Journal of Obstetrics and Gynaecology. 1995;12(12):62–71
  7. Okogbo, F O et al. “Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome.” African health sciences vol. 11,2 (2011): 271-8.
  8. Ogunniyi SO, Fasubaa OB. Uterine Fibromyoma in Ilesha, Nigeria. Nigerian Medical Practioner. 1990;19(6):93–95
  9. Emembolu JO. Uterine fibromyomata; presentation and management in Northern Nigeria. International Journal of Gynecology and Obstetrics. 1987;25:413–416