Uterine fibroids are benign (non-cancerous) growths that grow underneath the uterine lining, inside the uterine wall or outside the uterus, and often appear during childbearing years. Fibroids are very common in women during their reproductive years. Uterine fibroids develop from the smooth muscular tissue of the uterus. A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue. The growth patterns of uterine fibroids vary – they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus, and can be single or multiple.
Many women don’t feel any symptoms with uterine tumours or fibroids. But for others, these fibroids can cause excessive menstrual bleeding, prolonged or abnormal periods, pelvic pressure or pain, uterine bleeding, frequent urination, backache or leg pains, pain during sex, and infertility.
Surgery for uterine tumours can involve removing the entire uterus – known as a hysterectomy. While a hysterectomy is a proven way to get rid of fibroids, it may not be the best choice for every woman. If you hope to later become pregnant, you may want to consider alternatives to hysterectomy like a myomectomy. During a myomectomy, surgeons remove the fibroids but not your uterus.
Factors that can increase a woman’s risk of developing fibroids:
- Age. Fibroids become more common as women age, especially during the 30’s and 40’s through menopause. After menopause, fibroids usually shrink.
- Family history. Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
- Ethnic origin. African women are more likely to develop fibroids than white women.
- Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits. Eating a lot of red meat is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.
Tests and diagnosis
Uterine fibroids are frequently found during a routine pelvic exam. Irregularities in the shape of your uterus may be felt, suggesting the presence of fibroids. If you have symptoms of uterine fibroids, we may order these tests:
- Ultrasound. An ultrasound uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids.
- Magnetic resonance imaging (MRI). This imaging test can show the size and location of fibroids, identify different types of tumours and help determine appropriate treatment options.
- Hysterosonography. A hysterosonography uses sterile saline to expand the uterine cavity, making it easier to get images of the uterine cavity and endometrium. This test may be useful if you have heavy menstrual bleeding despite normal results from traditional ultrasound.
- Hysterosalpingography. Hysterosalpingography (HSG) uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images. In addition to revealing fibroids, it can help us to determine if your fallopian tubes are open.
- Hysteroscopy. For this, we insert a small, lighted telescope called a hysteroscope through your cervix into your uterus. We then inject saline into your uterus, expanding the uterine cavity which allows us to examine the walls of your uterus and the openings of your fallopian tubes.
- Laparoscopy: A long thin scope is inserted into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows us to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
Surgical treatment options include:
- Myomectomy, or fibroid removal. A myomectomy is the surgical option of choice for women who want to retain their fertility. This may improve your chances of having a baby if the fibroid is inside the uterus and prevents a fertilised egg from implanting in the uterus. Removing fibroids in other locations of the uterus may not improve your chances of becoming pregnant. Fibroids are removed using instruments inserted through the vagina and cervix into the uterus, or by laparoscopy or hysteroscopy.
- Hysterectomy, or uterus removal. This is only recommended for women who have no future pregnancy plans. Hysterectomy is the only fibroid treatment that prevents regrowth of fibroids. It improves quality of life for many women.
Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina, or through a larger abdominal cut (incision). The method depends on your condition, including where, how big, and what type of fibroid is growing in the uterus and whether you hope to become pregnant.