Women's Health Issues

Fibroids, also known as uterine myomas, leiomyomas, or fibromas.  There are firm, hard, lumps made out of smooth muscle that develop inside the uterus [1]. They are sometimes referred to as benign tumors which means they are not associated with cancer and do not increase a woman’s risk for uterine cancer.

Although little is known about fibroids, they are very common in women of reproductive age. In fact, some studies estimate that between 20-50%  of women of child-bearing age have fibroids [1]. Why are  fibroids so common yet remain virtually unknown? The reason is that in many cases, fibroids go completely un-diagnosed [1].

Causes

The exact cause of fibroids remains unknown but their growth seems to be related to the production of estrogen [1]. Estrogen is a hormone that is naturally produced by the female body and when its levels are high, this may allow fibroids to grow.  For example fibroids are usually seen in pre-menopausal women (where estrogen levels are increased) but will go away during menopause, when estrogen levels are decreased.

Risk factors

There are some risk factors that are thought to increase a woman’s chance of developing fibroids. These include [1,2]:

  • Age – fibroids are estrogen-dependent so they are most common in women in their 30s and 40s. After menopause, fibroids generally shrink or disappear
  • Obesity – women with higher BMI’s are at greater risk of having fibroids
  • Race – Women of African-American heritage are more likely to have fibroids although the reasons for this are not clearly understood
  • Genetics – If your mother or sister had fibroids, you’re at increased risk of developing them yourself

Symptoms 

The symptoms of fibroids vary from person to person and each woman may have a slightly different experience in the severity of her symptoms. Here are some of the most common symptoms of fibroids:

  • Long, heavy menstrual periods with excessive bleeding
  • Chronic pelvic pain
  • Problems with urination or constipation (caused by large fibroids crowding the bladder or lower intestine)
  • Pain during intercourse

In more severe cases, fibroids may also cause:

  • Problems with fertility
  • Repeated miscarriage

When to see your doctor

If you suffer from fibroids it may significantly affect the quality of your life or interfere with your day to day activities. If this happens or you notice any of the symptoms above, schedule an appointment to see your OBGYN right away.

Diagnosis  

Fibroids are most often found during a pelvic examinations. Your doctor will begin by taking a full medical history before carrying out a pelvic and/or abdominal examination. These two things may be enough to help diagnose a fibroid but they are usually followed by an ultrasound scan, CT-scan or MRI to make a firm diagnosis.

In a small number of cases, investigations such as a Hysteroscopy (the use of a camera to view the cervix) or a biopsy (a procedure in which a sample of tissue is obtained from the uterus) may also be used.

Treatment

The treatment of fibroids usually depends on the severity of the symptoms. Fibroids causing no symptoms or minor symptoms may not require treatment. Instead, you may be monitored over a period of time. This is known as ‘watchful waiting’ where your doctor will review your symptoms and the growth of the fibroid every few months to look for any changes.

For women with symptoms that are causing significant discomfort, relief of your symptoms is the goal. Things like abnormal uterine bleeding, or pain and pressure in the stomach can be treated using a variety of methods. This includes things like oral contraceptive pills, simple pain relief medications and in some cases surgery.

Your OBGYN will be happy to sit down with you to discuss your treatment options. They will take into account your overall health, your tolerance for specific medications, your desire to become pregnant and of course your personal preference.

References

1) UCLA Obstetrics and Gynecology. Fibroids
http://obgyn.ucla.edu/fibroids

2) Mayo Clinic. Fibroids. Mayo staff.
http://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/dxc-20212514