What are uterine fibroids?

Uterine fibroids are benign (noncancerous) tumors that grow on the surface or inside the uterine. It is a common condition. About 70 to 80% of women will develop fibroids during their lifetime. But most of the time, they are asymptomatic and therefore go unnoticed. (1)

Fibroids can measure from a few millimeters (seed) to tens of centimeters (Watermelon). Their weight can also vary from a few grams to several kilograms. For example, the largest fibroid known to have been removed from a living patient weighed 100 pounds. (2)

Read on to learn everything you should know about uterine fibroids.

What are the different types of fibroids?

Fibroids are classified according to their location on the wall of the uterus. First, Let’s take a brief look at the anatomy of the uterus to make it easier to understand.

The uterus is the main organ of the female reproductive system. It is muscular, hollow, and pear-shaped, about 7 centimeters high and 4 centimeters wide. The uterus has four main parts: the fundus, the body, the isthmus, and the uterine cervix, opening into the vagina.

The uterine wall is thick and has three layers :

  • The perimetrium or uterine serosa made of epithelial cells. It is the outer layer surrounding the uterus body and part of the cervix.
  • The myometrium is the thickest intermediate layer of the uterine wall. It is mainly made of smooth muscle fibers.
  • The endometrium or the inner lining of the uterus. It is cellular tissue that is rich in blood vessels.

credit: Shutterstock

As mentioned above, there are three possible locations of the fibroids related to the uterine wall.

  • Subserosal fibroids: they grow towards the outside of the uterus.
  • Intramural fibroids: they develop in the muscular layer of the uterine wall (the myometrium). These are the most common fibroids.
  • Submucosal fibroids: these fibroids are uncommon. They develop under the uterine inner lining (the endometrium). Therefore, they can take up space in the uterine cavity either totally or partially, with the rest of the fibroid penetrating the myometrium.

Sometimes, subserosal or submucosal fibroids may be attached to the uterus by a stalk. These are called pedunculated fibroids. It is possible to develop more than one kind of fibroid.

Credit: Shutterstock

What causes fibroids?

Doctors don’t know what causes uterine fibroids, but they have identified several factors that promote their development.

  • The genetic factor: The muscle cells in the uterine wall can undergo spontaneous genetic modification and produce too much muscle tissue.
  • Race: Fibroids are more common in black or African-American women. Their fibroids are often larger, more numerous, and appear at an earlier age. (3)
  • Heredity: there is a family predisposition to develop one or more fibroids. Thus, a woman whose mother or sister had a fibroid is more likely to have one herself.
  • The hormonal factor: Estrogen, produced by the ovaries, can increase the size of fibroids.
  • Weight: Women who are overweight or obese are also at a slightly higher risk of fibroids.
  • Other factors: dietary habits, alcohol consumption, the onset of menstruation before the age of 12, and vitamin D deficiency

What are the symptoms of fibroids?

In most cases, fibroids are asymptomatic. Doctors often discover the fibroids during a routine gynecologic exam, prenatal care, or an ultrasound scan. However, about 30% of women with fibroids will develop symptoms. Symptoms will vary depending on the location, size, and number of fibroids. The most common symptoms include :

  • Heavy bleeding during menstruation (menorrhagia) or bleeding between periods (metrorrhagia). It can lead to iron-deficiency anemia, especially in the case of submucosal fibroids.
  • Pelvic pain
  • Frequent urges to urinate
  • Feeling of pressure in the lower abdomen
  • Constipation
  • Dyspareunia (pain during sex)


Can fibroids prevent pregnancy?

The majority of fibroids do not limit the chances of getting pregnant. However, in some cases, they can impact fertility, depending on their location and size.

  • Intramural fibroids are rarely a barrier to pregnancy. However, in a few cases, the fibroids are so large that they can prevent pregnancy by disrupting the implantation of the egg in the uterine wall.
  • Subserosal fibroids do not affect the uterine muscle; therefore, they have no impact on fertility.
  • Regardless of their size, submucosal fibroids can interfere with nidation due to the deformation of the uterine cavity and endometrium.

How do fibroids affect pregnancy?

  • Intramural fibroids usually don’t impact pregnancy. However, some of them may become bigger due to the rising estrogen levels, especially in the first and second trimesters. They can also become necrotic later in the pregnancy and cause intense pain that is difficult to relieve.
  • Subserosal fibroids do not interfere with egg implantation or pregnancy.
  • In rare cases, pedunculated subserosal fibroids can increase the risk of premature delivery if the stalk is twisted and the fibroid becomes necrotic.
  • Submucosal fibroids are usually the most problematic because they can prevent egg implantation or increase the risk of miscarriage.
  • Fibroids may also increase the risk of certain pregnancy complications like placental abruption.
  • On the other hand, fibroids can cause complications during childbirth. In most cases, fibroids are not an obstacle to natural childbirth. A cesarean section may be necessary if the fibroid is huge and block the opening of the cervix that allows the baby to pass through the birth canal during delivery.
  • Large intramural fibroids may also interfere with uterine contraction during labor and slow cervical dilation. Excessive bleeding may also occur due to poor uterine retraction after delivery.

When a fibroid can be problematic during the delivery, doctors must assess the situation to ensure the mother and child’s safety.

What is the treatment for fibroids?

Treatment is not necessary if the fibroids are small and don’t cause any symptoms. The doctor will make recommendations based on the severity of symptoms, the patient’s age, the size and type of fibroids, and her desire to conceive in the future. Several treatment options include pain management with pain medication, hormonal therapy. Sometimes surgery to destroy fibroids may be necessary to improve fertility. This procedure is known as myomectomy.

If other treatments fail and the fibroids continue to grow, the doctor may recommend a hysterectomy. Unfortunately, this means that the patient won’t be able to get pregnant in the future. Her health care provider must fully consider her goals and desire about a possible pregnancy in the future before performing a hysterectomy.

During pregnancy, treatment options are limited. A myomectomy is not recommended because of the risks to the baby. Pain management with bed rest, hydration, and safe pain medication are the best options.

References

1-https://www.uclahealth.org/fibroids/what-are-fibroids

2-https://www.washingtonpost.com/health/2018/09/08/woman-showed-up-hospital-struggling-breathe-because-pound-tumor-her-uterus/

3-https://www.acog.org/womens-health/faqs/uterine-fibroids?utm_source=redirect&utm_medium=web&utm_campaign=otn

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About the Author

Hermione M.

My name is Hermione. I am the founder of WomenH and I write about women's health, wellness, mental health, and personal growth. I created this platform to inspire women to take care of themselves mentally, physically, and emotionally to become their best selves. Thank you for stopping by.

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