Fibroids

Fibroids

Fibroids, also known as uterine leiomyomas or myomas, are noncancerous growths that develop in or on the uterus. They are made of smooth muscle cells and fibrous connective tissue and can vary greatly in size, from microscopic to as large as a grapefruit. While many women with fibroids experience no symptoms, others may have significant symptoms that affect their quality of life. Fibroids are a common condition, particularly in women of reproductive age, with up to 70-80% of women developing them by age 50.

The exact cause of fibroids is not well understood, but several factors are believed to contribute to their development. Hormones, particularly estrogen and progesterone, play a crucial role in the growth of fibroids, as these hormones promote the proliferation of uterine muscle cells. Genetic factors also influence the likelihood of developing fibroids, as women with a family history of fibroids are more likely to develop them. Other factors such as obesity, diet, and early onset of menstruation may also increase the risk of fibroids.

Fibroids can be classified based on their location in the uterus: submucosal fibroids grow into the uterine cavity, intramural fibroids develop within the muscular wall of the uterus, and subserosal fibroids project to the outside of the uterus. The location of the fibroids can influence the type and severity of symptoms a woman may experience. Common symptoms of fibroids include heavy menstrual bleeding (menorrhagia), prolonged periods, pelvic pain and pressure, frequent urination, constipation, and complications during pregnancy and labor. In some cases, fibroids can cause infertility by obstructing the fallopian tubes or altering the shape of the uterus.

Diagnosis of fibroids typically involves a combination of medical history, physical examination, and imaging tests. During a pelvic exam, a healthcare provider may feel irregularities in the shape of the uterus, suggesting the presence of fibroids. Ultrasound imaging is commonly used to confirm the diagnosis and assess the size and location of the fibroids. In some cases, additional imaging tests such as magnetic resonance imaging (MRI), hysterosonography, or hysteroscopy may be needed to provide more detailed information.

Treatment for fibroids depends on the severity of symptoms, the size and location of the fibroids, and the woman's reproductive goals. For women with mild symptoms, watchful waiting and regular monitoring may be sufficient. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies (e.g., birth control pills, GnRH agonists) can help manage symptoms like heavy bleeding and pain. For more severe cases, surgical options such as myomectomy (removal of fibroids while preserving the uterus), hysterectomy (removal of the uterus), or minimally invasive procedures like uterine artery embolization (UAE) and MRI-guided focused ultrasound surgery (FUS) may be recommended. These treatments aim to alleviate symptoms, improve quality of life, and, in some cases, preserve fertility.