If you are a woman in your reproductive years or even older, there is an 80 percent chance that you are likely to get fibroids at some stage in your life though not everyone will have symptoms.
Below is a comprehensive overview of uterine fibroids, including risk factors, symptoms, diagnosis, and treatment options to empower you to monitor changes in your body and seek appropriate care.
What are uterine fibroids?
Uterine fibroids are very common non-cancerous growths that develop in the muscle of the uterus. Though they are common and typically do not become cancerous, they can cause a range of symptoms depending on their size, number, and location.
Many women may have fibroids without even knowing it, especially if the fibroids are small. However, for others, fibroids can cause significant discomfort and complications.
Are there known risk factors for Uterine Fibroids?
Yes, there are several factors that can increase the likelihood of developing uterine fibroids. These include:
Age: Fibroids are most common in women between the ages of 30 and 40. Their risk tends to increase as women approach menopause.
Genetic Factors: A family history of fibroids raises the likelihood of developing them. Women with a mother or sister who has had fibroids are at a higher risk.
Ethnicity: Black African women are more likely to develop fibroids, often at a younger age, and may experience more severe symptoms and larger fibroids.
Hormones: High levels of estrogen and progesterone, which regulate the menstrual cycle, can stimulate the growth of fibroids.
Obesity: Women who are overweight or obese are at greater risk of developing fibroids, likely due to higher estrogen levels produced by fat cells.
Diet: A diet high in red meat and low in fruits and vegetables may increase the risk of fibroids.
Reproductive History: Women who have had no children or delayed childbirth may be at higher risk. Pregnancy may reduce the risk of fibroids, likely due to hormonal changes during pregnancy.
Vitamin D Deficiency: Some studies suggest that a lack of vitamin D may contribute to an increased risk of fibroids.
Hypertension (High Blood Pressure): High blood pressure has been linked to an increased risk of fibroid development.
What symptoms can I be on the lookout for?
Fibroids can vary greatly in size, from tiny growths to very large masses. While some women may have fibroids without experiencing any symptoms, larger fibroids or a higher number of fibroids can cause significant discomfort. Common symptoms of fibroids include:
Heavy bleeding: Excessive menstrual bleeding is a common symptom. If you’re soaking through a pad or tampon in less than an hour or bleeding for more than 8 days, this may be a sign of fibroids. This can lead to iron deficiency anemia and fatigue.
Pelvic pressure and pain: Large fibroids can cause a feeling of fullness or pressure in the pelvic region, sometimes making the abdomen appear swollen or “pregnant.”
Bladder and bowel issues: Fibroids can press on the bladder, leading to frequent urination. When fibroids press on the rectum, they may cause constipation or alternating constipation and diarrhea.
Fertility issues and pregnancy complications: While many women with fibroids can get pregnant without problems, fibroids that affect the shape of the uterus can make conception more difficult. Fibroids can also increase the risk of miscarriage, though age is often a more significant factor. Larger fibroids or multiple fibroids may increase the risk of pregnancy complications, including pain, improper baby positioning, the need for a cesarean section (C-section), and excessive bleeding after birth (postpartum hemorrhage).
How is the diagnosing of uterine fibroids done?
If your doctor suspects that you have fibroids based on your symptoms, they may conduct an abdominal and pelvic exam to check for any signs of an enlarged or irregularly shaped uterus. A pelvic ultrasound, often using a transvaginal scan (TVS), is the most common and reliable method to confirm the presence of fibroids. This test uses sound waves to create an image of the uterus and any growths.
What treatment options are there for Uterine Fibroids?
The treatment for uterine fibroids depends on several factors, including the severity of your symptoms, the size and location of the fibroids, your age, and whether you want to have children in the future. Some treatment options focus on symptom management, while others aim to remove or shrink fibroids.
If your fibroids are not causing any symptoms, you may choose not to undergo treatment. Fibroids often do not require intervention if they do not affect your quality of life.
However, for women experiencing symptoms, several treatment options are available, including medications, observation, and surgery. While medications can help manage symptoms, they do not shrink or eliminate fibroids thus surgical treatment is recommended.
If medications are not effective, or if your fibroids are large, surgical treatments may be necessary. Some options include:
Myomectomy: This is surgery to remove fibroids while leaving the uterus intact, allowing women to maintain fertility. The approach will depend on the location and size of the fibroids. While fibroids can return after surgery, most women do not need additional surgeries.
Uterine Fibroid Embolization (UFE): In this procedure, blood vessels supplying the fibroids are blocked, causing them to shrink and stop bleeding. UFE is mainly for women who do not plan to get pregnant in the future, as it may affect fertility.
Endometrial Ablation: This procedure destroys the lining of the uterus to stop heavy bleeding. While it can help with bleeding, it does not shrink fibroids. Pregnancy is not recommended afterward.
Hysterectomy: A hysterectomy is the removal of the uterus and is considered a permanent solution for fibroids. However, this procedure eliminates the possibility of future pregnancies.
While surgery for fibroids is common, especially in populations with higher incidences like African women, many individuals may still have concerns about the procedure. It is important to remember that untreated fibroids can pose serious risks, such as excessive blood loss or even blood clots. Therefore, it is essential to weigh the risks and benefits with your healthcare provider.
By Dr Joan Okemo,Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi and Senior Instructor, Aga Khan University’s Medical College
