FAQs About Fibroids

Uterine fibroids can have a profound effect on the health of women of reproductive age. Here are some FAQs about fibroids.

What are fibroids?

Fibroids, also known as uterine leiomyomas, are benign (non-cancerous) growths that mostly appear when women are of reproductive age. They can range in size from small bean-like structures that go relatively undetected to ones that can enlarge the size of the uterus itself. Also, some women have just a single fibroid while others can have multiple ones.

Where do they usually occur?

Fibroids can occur at several sites in the uterus. Depending on their localization, they are classified as intramural, subserosal, submucosal, intracavity, and cervical.

What are the symptoms of fibroids?

Fibroids largely go unnoticed in many women. In fact, only about 20 to 50% of affected women experience any symptoms that differ based on where they occur. Common symptoms include:

• heavy, prolonged menstrual bleeding (menorrhagia) that can include clots
• pain in the pelvic area
• frequent yet difficult urination
• constipation
• anemia
• fatigue
• painful intercourse (dyspareunia)

What are some of the causes and risk factors?

There is no exact consensus on what exactly causes fibroids. However, research suggests that several factors can promote the formation of fibroids. These include genetic and hormonal changes, increased levels of growth factors in the body, and increased production of extracellular matrix (ECM) that promotes uterine cell growth and adhesion. A growing body of evidence suggests that women with fibroids tend to have high estrogen and progesterone levels. As women approach menopause and the levels of these hormones decrease, the fibroids also tend to shrink.

There are several risk factors that impact fibroid development. These include age, race, heredity, obesity, vitamin D deficiency, alcohol intake, and lower consumption of green vegetables. The incidence of fibroids is higher in women of reproductive age compared to post-menopausal women.

How do doctors diagnose fibroids?

A skilled doctor can feel fibroids as a lump or mass in the uterus during a regular pelvic examination. They usually describe their size to the patient in a manner that corresponds to the size of the uterus during a particular week of pregnancy or compared to common objects such as a golf ball, grape, walnut, etc.

Ultrasound (abdominal or vaginal) and magnetic resonance imaging (MRI) are some of the visualization techniques that can confirm the presence of fibroids. However, there can be instances where doctors misdiagnose patients with adenomyosis. Adenomyosis is much more diffuse in the uterus compared to fibroids, which are generally singular and with clear borders.

A more direct visualization for a confirmed diagnosis of fibroids is possible via surgical techniques such as hysteroscopy and laparoscopy. Hysteroscopy involves inserting a small telescope into the vagina to visualize the fibroid outgrowths in the uterus. Laparoscopy, on the other hand, requires small incisions to be made in the pelvic cavity to enable better visualization of the uterus and pelvic region via a laparoscope. Laparoscopy also allows the excision of a fibroid mass for further biopsy.

Doctors can diagnose fibroids near the fallopian tubes using a special X-ray technique called hysterosalpingography (HSG). HSG uses a contrast dye to reveal any blockages in the fallopian tubes.

Can fibroids become cancerous?

Fibroids are generally benign outgrowths and rarely become cancerous. The incidence of fibroids being cancerous, also called leiomyosarcoma, is less than 1 in 1,000 cases. Moreover, pre-existing fibroids do not usually turn cancerous, and neither do they increase the risk of leiomyosarcoma or other uterine cancers.

Can fibroids affect pregnancy?

Fibroids in most cases do not affect pregnancy. However, large ones that distort the shape of the uterus can pose problems such as infertility, preterm labor, miscarriages, and other labor complications such as needing a C-section, having a breech baby, and having a placental abruption. Infertility can occur if a fibroid grows near the opening of the fallopian tube, thereby restricting the release of the egg into the uterus.

In addition, fibroids can lead to high levels of progesterone and estrogen hormones during pregnancy. Another condition during pregnancy called “red degeneration” can also occur wherein the blood supply to the fibroids is cut off causing them to turn red and die. This can lead to intense abdominal pain and possible miscarriage.

At Seckin Endometriosis Center, we are able to clearly visualize this red degeneration thanks to our patented aqua blue contrast technique.

What is the prevalence in various populations?

The prevalence of uterine fibroids shows large variations ranging between 4.5% and 68.6%. However, this is not very consistent across studies, geographies, and ethnic groups. Most studies include a combination of symptomatic and asymptomatic cases. There has only been one comprehensive study of asymptomatic women with fibroids reporting a 15% prevalence.

Incidentally, uterine fibroids seem to disproportionately affect women of Afro-Caribbean descent. It is estimated that by age 50, about 80% of African-American women will have developed fibroids. Also, these women are two to three times more likely to have recurring fibroids compared to white women. The reasons for such disparities are a subject of ongoing research. Epidemiological data on Hispanic women and other groups are not fully available.

What are some of the questions to ask your doctor?

It is important to get all your questions clarified in a language you understand during your doctor’s appointment. Be sure to ask questions like how many fibroids you have, their sizes, localization, rate of growth, potential problems they may cause, tests you need and their frequencies, treatment options, and whether they are likely to affect your fertility. It is also a good idea to keep track of your symptoms in a personal record or pain diary for a more fruitful discussion with your healthcare provider.

What are the current modes of treatment?

There are several surgical treatment options for fibroids.

Traditional surgical procedures include abdominal myomectomy and hysterectomy. These are usually necessary in cases of large and deep fibroids.

Minimally invasive procedures such as uterine artery embolization, radiofrequency ablation, laparoscopic myomectomy, hysteroscopic myomectomy, and endometrial ablation are increasingly preferred to reduce scarring and alleviate symptoms.

It is important to note that the optimal surgical method is very dependent on the location and size of the existing fibroids.

However, not all minimally invasive procedures have the same benefits. Uterine artery embolization and radiofrequency ablation can greatly reduce the chances of getting pregnant. Hysterectomy and endometrial ablation will result in complete infertility. You should discuss with your doctor the pros and cons of all applicable procedures before making a decision.

There are also non-surgical options to manage the symptoms of fibroids. These include using medications that act on the hormones involved in the reproductive cycles such as GnRH agonists (leuprolide, goserelin, triptorelin) to create a temporary menopause state, progestin-releasing IUD to prevent pregnancy and reduce heavy bleeding, tranexamic acid to ease menstrual periods, and non-steroidal anti-inflammatory drugs (NSAIDs) for general pain relief.

Why laparoscopic surgery is the best way to preserve fertility?

While hysterectomy was historically the only treatment option for uterine fibroids, there are now several minimally invasive procedures that can help preserve fertility. For instance, hysteroscopic myomectomy can be performed to remove smaller fibroids inside the uterine cavity. Though more invasive than a hysterectomy, myomectomy can help preserve fertility.

Nowadays, doctors have the choice of opting for a laparoscopic-assisted open myomectomy wherein they can first thoroughly visualize the inner structure of the uterus before opening it up or a true laparoscopic surgery in which all surgery takes place internally. Laparoscopy also aids the surgeon as it provides better visualization than the naked eye, thus aiding in controlling bleeding to the capillary level and reaching conventionally inaccessible corners of the pelvis. A skillful hand at laparoscopy ensures minimal risk of bleeding and infection to the uterus.

At Seckin Endometriosis Center, our goal is always to help preserve fertility whenever possible. We do not advocate for hysterectomy unless absolutely necessary and the patient does not wish to further have children. Dr. Seckin has over 16 years and 10,000 hours of experience in laparoscopic surgery and is able to remove fibroids of all sizes and localizations with extreme precision and high attention to detail while helping preserve fertility.

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