Uterine Fibroids

Types of uterine fibroids

There are three types of uterine fibroids including:

• Sub serosal fibroids – sub serosal fibroids develop outside the uterus
• Pedunculated fibroids – pedunculated fibroids are sub serosal fibroids that develop a base that supports the fibroid
• Submucosal fibroids – submucosal fibroids are fibroids that grow in the middle muscle layer of the uterus and the least common type of fibroid

Causes of uterine fibroids

Although the cause of uterine fibroids is unknown, they are linked to factors such as:

• Family history – Fibroids tend to run in families. If you have a first-degree relative with fibroids, you are more likely to develop them as well.
• Pregnancy – As pregnancy increases the levels of estrogen and progesterone in your body, fibroids can grow.
• Hormones – Estrogen and progesterone, hormones produced by the ovaries, seem to promote uterine fibroid growth. Fibroids shrink in size after menopause as your hormone levels decrease.

Risks factors for uterine fibroids

There are a variety of factors that increase your likelihood of developing uterine fibroids.

Risk factors of uterine fibroids include:

• Family history of uterine fibroids
• Age (older women are at higher risk than younger women)
• African American women tend to have more and larger fibroids at an earlier age
• Overweight

Symptoms of uterine fibroids

Many women do not experience any symptoms of uterine fibroids and only find out they have the condition in a regular exam or prenatal visit. For women who do experience symptoms, the severity of symptoms may be influence by the size, number and location of the fibroids. Uterine fibroids range in size from very small to large masses that expand the uterus. Some women have only one fibroid, while others may develop multiple fibroids.

The most common symptoms of uterine fibroids include:

• Exceptionally heavy menstrual bleeding
• Consistently having menstrual periods that last more than one week
• Pelvic pressure
• Frequent need to urinate
• Trouble emptying your bladder
• Chronic constipation
• Backache
• Acute pain - acute pain is a rare symptom that occurs when the fibroid begins to die after it outgrows its blood supply.

Diagnosis of uterine fibroids

Uterine fibroids can be diagnosed by your gynecologist or primary care doctor during a pelvic exam. During the pelvic exam, your doctor will evaluate the size, shape and overall health of your uterus.

If your doctor suspects you have fibroids, he or she may order tests such as:

• Transvaginal ultrasound – a transvaginal ultrasound allows your doctor to clearly view the uterus lining and identify fibroids by using a wand that is inserted into the vagina, or your doctor may also use a traditional ultrasound, which uses sound waves to take images of your uterus
• Pelvic MRI – a pelvic MRI takes detailed images of the uterus, ovaries and pelvic organs
• Complete blood count (CBC) lab test – a CBC lab test can help diagnose or eliminate uterine fibroids as the cause of your symptoms

Treatment of uterine fibroids

Your doctor will develop a treatment plan based on your age, the size of your fibroids, and your overall health. Depending on the severity of your fibroids, you may start with conservative treatments, and if these are not effective, move to more advanced treatments.

Home remedies

For many patients, acupuncture, yoga, massage, managing stress, losing excess weight and dietary changes can help manage symptoms from uterine fibroids.

Medications

Your doctor may prescribe medications, such as gonadotropin-releasing hormone (GnRH) agonists, that will cause your estrogen and progesterone levels to drop, which will stop menstruation and shrink fibroids.

Your doctor may also recommend an over-the-counter, anti-inflammatory pain reliever such as Advil to relieve pain associated with the uterine fibroids.

Intrauterine device (IUD) or birth control pills

An IUD is a birth control device that is inserted into a woman’s uterus. An IUD works to prevent pregnancy by releasing the hormone progestin. An IUD can relieve symptoms from uterine fibroids, but it will not shrink your fibroids. Birth control pills can help control bleeding and pain associated with uterine fibroids, but also will not shrink the fibroids.

There are also surgical options for treating uterine fibroids, including:

Myomectomy

If conservative treatments have failed, if your fibroids are very large or if you have multiple fibroids, you may be a candidate for a surgical procedure called a myomectomy to remove your uterine fibroids.

During a myomectomy, which can be performed via open surgery or laparoscopic, your doctor will surgically remove your fibroids. During an open procedure, your doctor will make a large incision in the abdomen, while in a laparoscopic procedure, your doctor will make a few small incisions and use small surgical instruments and a camera to view and remove your fibroids. Fibroids may grow back after a myomectomy.

Hysterectomy

If your fibroids are drastically impacting your quality of life, you do not want to have any additional children and all other treatments have failed, your doctor may recommend a total hysterectomy. During a total hysterectomy, your uterus, ovaries and any fibroid growths in the area are removed. This will eliminate the chance for the fibroids to return.

Minimally invasive surgery

• Forced ultrasound surgery (FUS) – During a forced ultrasound surgery, high-energy, high-frequency sound waves from a special MRI machine are directed at the uterine fibroids to destroy them.
• Myolysis – Myolysis will shrink your fibroid using an electric current or laser.
• Cryomyolysis – Cyromyolysis is a procedure that freezes your uterine fibroids to destroy them.
• Endometrial ablation – Endometrial ablation destroys uterine fibroids using an electric current, heat or hot water aimed directly at the fibroids via a special instrument.
• Uterine artery embolization – During uterine artery embolization, blood supply is cut off to the fibroids, so they eventually shrink.