Definition

Uterine myomas, also known as leiomyomas or uterine fibroids, are benign growths that develop on the uterine wall, inside the uterus, or outside the uterus. Uterine fibroids originate from the muscle and connective tissue of the uterus that grow abnormally. This condition is not associated with an increased risk of uterine cancer and almost never progresses to cancer.

Uterine fibroids are among the most common benign tumors in women of reproductive age. They usually occur between the ages of 30 and 40 years and are rare before puberty. In many cases, uterine fibroids do not cause any symptoms, so women who have them are often unaware. However, in 20–50% of cases, uterine fibroids cause symptoms and may require treatment.

Uterine fibroids can grow as single or clustered lumps. Their sizes vary, with diameters ranging from 1 mm to 20 cm. Comparatively, the size of fibroids can range from that of a seed to as large as a watermelon.

Uterine fibroids are classified into several types based on their location and attachment:

• Fibroids that grow on the uterine wall
• Fibroids located outside the uterine wall
• Fibroids that grow in the inner uterine cavity where the fetus develops
• Fibroids outside the uterus are attached by a thin stalk

Because the size, number, and location of fibroids may vary, the symptoms and severity of the condition also differ for each person. Therefore, treatment will be based on the patient's condition.

Causes

The exact cause of uterine fibroids is unknown. Some studies suggest that this condition may occur due to improper cell placement in the body during fetal development. It is believed that hormones such as estrogen and progesterone are involved in the growth of uterine fibroids. Therefore, in conditions where estrogen levels decrease, such as after menopause or childbirth, the size of uterine fibroids may shrink or even disappear.

In addition to this theory, several factors may contribute to the development of uterine fibroids, including:

• Genetic Changes

In many cases, growing fibroids undergo genetic changes, leading to cell division that differs from normal uterine muscle cells.

• Hormones

Estrogen and progesterone, two hormones that stimulate the thickening of the uterine lining during each menstrual cycle, are known to promote fibroid growth. Receptors for these hormones are found in higher numbers in fibroids than in normal uterine muscle cells.

• Extracellular Matrix (ECM)

ECM is a biological material necessary for cells to adhere to each other. ECM levels increase in fibroids, making the mass more fibrous. ECM can also cause biological changes in cells.

Risk Factor

Several factors can increase the risk of developing uterine fibroids, including:

• Obesity, or being overweight
• Early onset of menstruation (before age 10)
• Age over 40 (until menopause)
• Family history of uterine fibroids
• Never having given birth
• Later onset of menopause
• Vitamin D deficiency
• Diet high in red meat, alcohol consumption, and low in vegetables, fruits, and dairy products

Conversely, some factors are known to reduce the risk of uterine fibroids, such as:

• Menarche after age of 16
• Having given birth more than once
• Consumption of oral contraceptives

Symptoms

Most women with fibroids do not experience any symptoms and therefore do not require treatment other than routine observation by a doctor. However, uterine fibroids can cause complaints in about 20–50% of cases, including:

• Excessive or painful menstrual bleeding
• Bleeding between menstrual periods
• Anemia if excessive blood is lost
• A sensation of fullness or bloating in the lower abdomen
• Increased frequency of urination (if the fibroid presses on the bladder)
• Pain during intercourse
• Back or lower abdominal pain
• Difficulty with bowel movements or constipation
• Abdominal cramps
• Vaginal discharge
• Inability to completely empty the bladder, marked by a persistent sensation of incomplete urination
• Abdominal enlargement, making it appear as if the woman is pregnant

Fibroid symptoms usually disappear after menopause or childbirth due to the decrease in hormone levels.

Diagnosis

Your doctor will diagnose uterine fibroids based on a medical interview and a series of examinations. Your description of fibroid symptoms such as severe menstrual pain and bleeding, along with urinary complaints, may help the doctor diagnose uterine fibroids. You may also be asked about your age, menstrual history, childbirth history, and family history of uterine fibroids.

In sexually active women, an internal vaginal and cervical examination may be performed using a speculum.

To confirm the presence of fibroids and assess their size and number, additional tests may be performed, including:

• Transvaginal Ultrasound (USG)

An ultrasound examination uses sound waves to create an image of specific body structures. This test is the standard for diagnosing uterine fibroids. A USG probe is inserted through the vagina to obtain a radiological image of the uterus and any fibroids present. The size and number of fibroids can be assessed from this image. To obtain a clearer picture, your doctor may first insert a contrast dye into the uterus before performing the ultrasound examination.

• Hysteroscopy

This test uses an instrument called a hysteroscope, which is a small telescope inserted into the vagina and through the cervix to allow direct visualization of the inside of the uterus.

• Laparoscopy

This test uses an instrument called a laparoscope. The doctor makes an incision in the abdomen to insert this instrument into the abdominal cavity. The laparoscope will take direct images of fibroids located outside the uterus.

Other tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, can also be performed but are rarely needed.

Management

Uterine fibroids do not require any treatment if they do not cause symptoms. Small fibroids can be left in place. After menopause, fibroid growth will shrink without treatment. In this case, regular visits to an obstetrician-gynecologist may be recommended to monitor the size and symptoms of uterine fibroids.

If treatment is needed, your doctor will discuss with you the type of treatment to be chosen. The treatment plan will depend on:

• The number and size of the fibroids
• The location of the fibroid growth
• The symptoms experienced
• Your desire to have children
• Your desire to retain your uterus

If your doctor recommends medication to treat uterine fibroids, it will be to address the symptoms. The doctor may prescribe pain relievers, medications to reduce bleeding, and iron supplements. Contraceptive and hormone therapy are also treatment options.

In many cases, fibroids will shrink after menopause, and the symptoms will also disappear.

The only way to definitively treat uterine fibroids is to surgically remove the uterus (hysterectomy). Without a uterus, fibroids cannot recur. This procedure is recommended if the fibroids are large or cause severe bleeding. If you still want to have children in the future or want to retain your uterus, you can undergo a myomectomy, where only the fibroid is removed from the uterus. However, fibroids have a 15–33% chance of recurring.

Complications

Although not dangerous, some complications can result from uterine fibroids, including:

• Anemia (low red blood cell count) due to excessive vaginal bleeding, which can cause symptoms such as weakness, dizziness, fatigue, and shortness of breath.
• Fibroids rarely cause infertility, but if they do, treatment can restore the ability to conceive.
• Fibroids can increase the risk of pregnancy complications, such as placental abruption, restricted fetal growth, and preterm labor.

Prevention

In general, you cannot prevent the growth of fibroids. You can reduce the risk by maintaining an ideal body weight, eating vegetables and fruits, and regularly visiting an obstetrician-gynecologist.

When to See a Doctor?

If you experience menstrual cycle and urinary complaints, you can consult a doctor to determine whether it is normal or requires further examination.

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