Fibroids are a very common finding with about 70% of people having a fibroid on their uterus. Depending on where in the uterus they are growing, and how big they are, fibroids can cause heavy menstrual bleeding or cause so-called ‘pressure symptoms’, can impact upon conceiving and then carrying a baby.
Thankfully, there are a range of management options available to you, from tablets, a Mirena IUD, minor surgical procedures, to a more major operation and what is right for you will depend on a range of factors. Read on for more information, written by this week’s blog author, Dr Sneha Parghi.
What are uterine fibroids?
Uterine fibroids are noncancerous muscular growths that arise from the muscle cells of the uterus (womb). They arise from one muscle cell and create whorled spherical structures that can vary in size. Their impact depends on their size and location – on the outside of the womb, within the muscle layer of the womb, or impinging on the uterine cavity.
Who suffers from fibroids?
Fibroids are extremely common. About 70% of women will have a fibroid present in their uterus, but not all of these fibroids will cause symptoms. It is the fibroids that cause symptoms that are important. Those that are simply present do not need to be managed.
Types of fibroids and the symptoms they can cause
Most fibroids do not cause any symptoms. The impact of the fibroid will generally depend on the size and location. Fibroids are classified by their location within the uterine wall.
Submucosal fibroids
Submucosal fibroids are those that push into the uterine cavity. 15-25% of all fibroids will be submucosal fibroids.
– Submucosal fibroids can cause heavy bleeding by increasing the surface area of the uterine lining, which thickens and sheds with each cycle. More of this lining can cause more shedding and bleeding. They can also impact uterine contractions, which are needed to push out the blood. If there is a large fibroid within the cavity, it is harder for the uterine muscle to contract adequately.
– Submucosal fibroids can cause recurrent miscarriage by impacting on implantation of the embryo. If the embryo happens to implant over the fibroid, this could be an area of impeded blood supply, and this could lead to miscarriage.
Intramural fibroids
Intramural fibroids are those that are contained within the muscle layer of the uterus (myometrium).
– Intramural fibroids cause heavy bleeding by impacting on the blood vessels around them. The blood vessels of the uterus are spiral arteries, like a telephone cord. The spiral nature of these vessels allows them to squeeze down and stop bleeding when the menstrual period stops. In the presence of an intramural fibroid, these blood vessels have to stretch to reach the uterine lining, and this stretching prevents these vessels from being able to adequately squeeze and stop the bleeding as they should.
– Intramural fibroids, if they grow large enough, can cause a feeling of heaviness or pressure in the pelvis.
Subserosal fibroids
Subserosal fibroids are fibroids that are on the outer surface of the uterus.
– Subserosal fibroids generally do not cause heavy menstrual bleeding
– Large subserosal fibroids, if located in the right place, can cause pressure symptoms to the rectum (leading to constipation) or bladder (leading to needing to empty your bladder more often).
Other
Fibroids can also be located in the cervix, broad ligament, or parasitic fibroids in other locations of the abdomen. Such fibroids are very rare.
What causes fibroids? Risk factors
– A genetic predisposition
– Hormones:
Fibroids are hormonally responsive structures. They express oestrogen and progesterone receptors and respond to the cycling of hormones. How quickly they grow depends on the individual expression of hormone receptors. They generally stop growing and even start to shrink after menopause. Some may grow much faster during pregnancy, or when taking certain hormonal medications.
Complications of uterine fibroids
Complications generally correlate with symptoms, location, and size of the fibroid.
Complications can include:
– Heavy menstrual bleeding, leading to anaemia, or so much bleeding that you need a blood transfusion
– Pressure on surrounding organs such as the ureters, causing increased pressure in the kidneys
– Fibroid degeneration, where the fibroid outgrows its own blood supply, causing localised pain
– Cancerous changes within the fibroid leading to a leiomyosarcoma – this is extremely rare, in the order of 1:1000.
How are fibroids diagnosed?
Fibroids can be suspected on examination, with the finding of a bulky enlarged uterus. However, to determine how many fibroids are present and their size and location, radiological imaging is required. A transvaginal pelvic ultrasound is the preferred way to see the reproductive organs, as these are often deep in the pelvis and can be seen much more clearly on a vaginal ultrasound scan. Sometimes CT scan may be performed for another reason, or to visualise other organs, and this may well demonstrate the presence of fibroids on the uterus.
If there are any features on the ultrasound suggesting that the fibroid has features that are concerning or worrying for cancer, an MRI will be used to look at the fibroid in more detail.
Treatment for uterine fibroids
There are many different treatment options available to manage fibroids, though it needs to be noted that only the ones causing problematic symptoms require treatment.
Treatment options will be divided depending on what your symptoms are and your fertility desires. If you desire fertility then some options may not be the best for you. If you do not desire fertility or have completed your family, then there are more options available to you to manage your symptoms.
We will be diving deep into treatment options in next week’s blog post.
Can I get pregnant if I have uterine fibroids?
Yes absolutely. If you are planning a pregnancy, and fibroids are found on routine assessment, there is no reason to remove these before trying to conceive. Most women fall pregnant with fibroids on their uterus, and in the vast majority of cases these pose no risk. If however you have large submucosal fibroids and either struggle falling pregnant after trying for some time, or have repeated first trimester miscarriages, there may be scope for removal, to see if this improves these outcomes.
Where to see a doctor for fibroids in Melbourne?
Your specialist women’s health GP should be your first port of call to discuss fibroids. If you have fibroids on your uterus, and have concerning symptoms, a conversation with a gynaecologist may be valuable, to help flesh out if the symptoms and the fibroid correlate and what your options are, depending on your treatment goals.
FAQ
What does pain caused by fibroids feel like?
Fibroids generally don’t cause pain unless they are “degenerating” (outgrowing their own blood supply). This can sometimes be seen on ultrasound. The pain will be a focal aching/deep pain.
What do fibroids look like?
Like white dense muscular growths. They sometimes have a rubbery consistency, and some make have calcifications in them.
Can fibroids cause anaemia?
Yes they can. Submucosal fibroids can cause heavy menstrual bleeding leading to anaemia.
What is the difference between fibroids vs polyps?
A polyp is a fleshy growth of tissue, often the lining cells of the uterus, whilst fibroids are dense muscular growths.
Do fibroids need to be removed?
Not all fibroids need to be removed. Most don’t cause any issues and can remain on the uterus. Fibroids that cause problematic symptoms can be removed in an effort to improve those symptoms.
Can fibroids be cancerous?
In rare instances (1:1000) the internal cells of the fibroid can become cancerous, and suspicious features will be seen on imaging.
Do fibroids make you tired?
Sometimes. If you experience abnormal bleeding patterns, or have low iron secondary to your fibroids you may feel tired.
