Have you ever thought of what causes uterine fibroids to grow? What happens when uterine fibroids and pregnancy co-exist?
Here is an overview of Uterine Fibroid
Firstly, uterine fibroids, also known as leiomyomas, are common. They affect about 20-80% of all women. Fibroids are benign monoclonal tumors of the uterine myometrium that affect the smooth muscle cells.
Secondly, these growths are not cancerous (benign), and they may be with or without symptoms. Uterine fibroid symptoms range from irregular bleeding, pelvic/abdominal pain to pregnancy issues.
Thirdly, uterine fibroid starts as multiple, single-cell seedlings seen on the wall of the uterus. They gradually increase in size over many years. The increase is because of the stimulation by estrogens and progestogens.
Fourthly, as the uterine fibroid gets bigger, it outgrows its blood supply. It means that the central areas will not get adequate blood supply leading to benign degeneration followed by calcification.
Lastly, the cause of uterine fibroid is unknown. The position of the fibroid on the wall of the uterus determines the classification.
Intramural fibroids: This is the most common type of fibroid. It grows between the muscles of the uterus. They are noncancerous and can be very large if left untreated. You can have multiple intramural fibroids in the same area.
Submucosal fibroids: This fibroid grows into the uterine cavity. They may protrude through the cervical os when pedunculated. They can also block the fallopian tubes leading to pregnancy issues (infertility).
Subserosal fibroids: These are benign tumors that grow on the outside of the uterus. They may be attached to the uterus directly or by a stalk. They vary in size and influence how you experience uterine fibroid symptoms.
Subserosal fibroids can be
- Pedunculated subserous
Uterine fibroid symptoms: What causes uterine fibroids to grow?
About half of the women with uterine fibroids have no symptoms. If symptoms occur, it will depend on the position, condition, and size of the fibroid. Furthermore, uterine fibroids are the most common benign tumors in women of childbearing age. It occurs in about 77% of women between the ages of 30-50 years.
Uterine fibroid symptoms include:
Women with uterine fibroids can have heavy periods and intermenstrual bleeding. In fact, excessive bleeding, if not controlled, can cause iron deficiency anemia, lethargy, and pallor.
Larger fibroids are more likely to cause menorrhagia. It is due to a variety of growth factors that promote blood vessel formation. Pedunculated submucosal fibroids (regardless of size) may cause persistent intermenstrual bleeding.
Women with uterine fibroids may experience painful periods.
Pain during pregnancy
About 5% of women with uterine fibroids complain of pain during pregnancy. The pain is due to fibroid degeneration.
How long does fibroid degeneration last? The pain that occurs during fibroid degeneration can last from a few days to weeks. Fibroid degeneration occurs when the fibroid outgrows its blood supply. Some cells die during this period causing the fibroid to shrink in size. NSAIDs like ibuprofen or heating pads help patients relieve the pain.
Pelvic or abdominal pressure
Enlargement of the uterus can cause lower abdominal pain and discomfort. The discomfort is due to the increasing pressure in the pelvic region. The pressure can be on the bladder leading to urinary symptoms. In the same way, if it is on the bowel, it can lead to constipation.
Recurrent miscarriage or infertility
Women with uterine fibroids are more likely to have miscarriages during early pregnancy. If you have multiple or a large uterine fibroid, it increases your chances of miscarrying.
Do submucosal fibroids cause infertility? Yes, submucous fibroids can lead to pregnancy issues (infertility). They block the fallopian tubes and reduce your chances of getting pregnant. In fact, submucous fibroids affect sperm movement and implantation of the fertilized ovum.
Swelling of the lower abdominal region
The swelling in the lower abdominal region is due to the increasing size of the uterine fibroid.
Other uterine fibroid symptoms include :
- Painful sexual intercourse
- Frequent urination
- Low back pains
- Diarrhea or constipation.
Uterine fibroid causes: What causes uterine fibroids to grow?
Uterine fibroids are overgrowths of the smooth muscle tissues in the uterine wall. The muscles in the uterus help it to expand during pregnancy and contract during labor. Numerous risk factors increase your chances of developing uterine fibroids. Note that you can have uterine fibroids with or without these factors.
Uterine fibroid risk factors include:
- A family history of uterine fibroids
- A previous history of fibroids
- Advancing age
- Women that have not been pregnant before
- Race: Uterine fibroids are more common among African American women.
What causes uterine fibroids to grow: Estrogen
It is important to note that uterine fibroids can occur anytime from the moment you start menstruating. During this period, your body starts producing estrogen hormones. Uterine fibroids are estrogen-dependent and grow in response to the hormone.
Fibroids tend to increase in size when the estrogen level is high. The increase in estrogen occurs during pregnancy and is associated with fibroid degeneration. When the level of estrogen is low (during and after menopause), fibroids shrink in size.
Uterine fibroid diagnosis
Your doctor will carry out a pelvic examination on you. The pelvic examination will help to identify abnormal growths and structures in your vagina and cervix. It can also identify abnormal structures in the lower part of your uterus.
Besides, depending on your history, symptoms and, physical examination, you may need
- Imaging test: Pelvic / abdominal ultrasound or computerized tomography (CT)
- Blood tests: Complete blood count (CBC), estrogen levels, and thyroid function tests
Uterine fibroid differential diagnosis: What can be mistaken for fibroids?
Several conditions can be confused with uterine fibroids because of their symptoms.
These conditions include:
Dysfunctional uterine bleeding
It is a condition that affects a lot of women. It is also known as abnormal uterine bleeding (AUB). Dysfunctional uterine bleeding (DUB) causes vaginal bleeding in between periods. Certain medications and hormonal changes can trigger it.
Endometrial polyps attach to your uterus by a thin stalk or a large base. In addition, the polyps can grow to be several centimeters in size. Symptoms include
- Irregular menstrual bleeding
- Bleeding after menopause
- Heavy menstrual flow and then bleeding between periods
Abnormal vaginal bleeding is the most common symptom of endometrial cancer.
Other conditions that can be mistaken for fibroids
- Tubo-ovarian abscess
- Uterine sarcoma
- Chronic pelvic inflammatory disease (PID)
Uterine fibroids treatment: What is the best treatment for uterine fibroids?
Treatment of uterine fibroids can be surgical or medical.
Medical (fibroid treatment without surgery)
Medical treatment helps you alleviate symptoms. It does not remove the tumors. Surgical, on the other hand, removes the uterine fibroid.
Uterine fibroid surgery: What size fibroids need surgery?
Your doctor will advise surgery when:
- You have a large uterine fibroid causing pains due to degeneration.
- You are having pressure symptoms due to an increasing fibroid size.
- Medical treatment could not manage uterine fibroid symptoms despite medications.
- The fibroid is causing pregnancy issues, for example, infertility.
Surgical options include:
Myomectomy is the surgical removal of the uterine fibroids. For women who were unable to conceive, myomectomy helped to improve the chances.
- An abdominal myomectomy is a reliable option instead of a hysterectomy. However, there is a risk of bleeding during and after myomectomy. Hysterectomy becomes an option when bleeding persists. Hysterectomy is the surgical removal of the uterus.
- Laparoscopic myomectomy has several advantages over abdominal myomectomy. They include less abdominal pain, reduced recovery time, and shorter hospital stay.
- Hysteroscopic myomectomy
2. Hysteroscopic endometrial ablation
3. Total hysterectomy
4. Uterine artery embolization (UAE)
5. MRI-guided transcutaneous focused ultrasound