Uterine fibroids are benign tumors that affects 75-80% of women. These growths are common in the age group of 20-30 years (the reproductive age) and are usually asymptomatic. When they are symptomatic, uterine fibroids can show symptoms like heavy menstrual bleeding, back pain, frequent urination, etc. The exact cause of uterine fibroid is not known yet. Small fibroids might not need any treatment. But larger fibroids need to be treated with medications or surgery. This article will explore the causes, symptoms, and diagnosis of uterine fibroids.

What are Uterine Fibroids?

Uterine fibroids, also known as leiomyomas, are non-cancerous growth on the wall of the uterus. These fibroids, made up of muscle and connective tissues, can grow as a single nodule, or in clusters. Their size can range from 1 mm to 20 cm in diameter.

Several risk factors play roles in the development of uterine fibroids, such as:

• Obesity
• Family history of fibroid
• Early menarche
• Late menopause
• Not having children

 Uterine fibroids are of different types:

1. Submucosal fibroids: Fibroids growing inside the uterine cavity
2. Intramural fibroids: These fibroids are embedded into the inner uterus wall.
3. Subserosal fibroids: These fibroids are located on the outer wall of the uterus.
4. Peduncalated fibroids: These fibroids have a mushroom-like appearance that are connected to the outer uterine wall with a thin stem. 

Uterine fibroids might grow or shrink with time. It can occur due to hormonal fluctuation, especially during puberty, pregnancy, and menopause.

Symptoms of Uterine Fibroids

The symptoms of uterine fibroids vary from person to person. People having smaller uterine fibroids may feel nothing at all. In such cases, they come to know about the condition following a routine pelvic exam. People with larger fibroids typically feel back pain and pelvic discomfort. These are the common signs and symptoms you can experience if you have uterine fibroids:

1.   Heavy menstrual bleeding:

Fibroids can stimulate the growth of uterine blood vessels which can cause heavier or irregular periods and spotting between periods.

2.   Menstrual period lasting more than a week

Uterine fibroids pressurize the uterine lining causing more bleeding than usual. Also, due to the location of the fibroid, the uterus may not contract properly causing period lasting longer than usual.

3.   Pelvic pressure or pain

Large fibroids might cause a feeling of heaviness or pressure in the pelvic region or the lower abdomen. People with uterine fibroids often complain about persistent pelvic discomfort.

4.   Frequent urination

People with uterine fibroids might experience a constant pressure on their bladder which can cause frequent urination, urinary incontinence, and dribbling.

5.   Difficulty emptying the bladder

The uterine fibroid might be located in a position that impacts on the urethra or the ureters, causing difficulty emptying the bladder.

6.   Constipation

Uterine fibroids might also put pressure on the bowels, thereby causing constipation.

7.   Backache or leg pain

Sometimes, uterine fibroids press on the nerves and blood vessels that extends to your back and the legs. This might cause pain in your back and leg. Some might experience dull ache in the thigh.

How are Uterine Fibroids Diagnosed?

Uterine fibroids, typically the smaller, asymptomatic ones, are found during a prenatal pelvic exam. However, if you have symptoms like heavy bleeding or pain in the pelvic region, you should consult your physician to get an examination. Your doctor might recommend you get some tests done, such as:

• Ultrasonography
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Hysteroscopy
• Hysterosalpingography
• Sonohysterography
• Laparoscopy

How are Uterine Fibroids Treated?

Mild-to-moderate cases of uterine fibroids can be treated with medications, such as:

• Over-the-counter (OTC) pain medications such as ibuprofen and acetaminophen
• Iron supplements
• Birth control
• Gonadotropin-releasing hormone (GnRH) agonists
• Oral therapies like Elagolix

In severe cases of uterine fibroids, you might need surgery, such as:

• Myomectomy: Removal of the uterine fibroids.
• Laparotomy: It is a surgical incision into the abdominal cavity to remove the uterine fibroids.
• Hysterectomy: Partial or complete surgical removal of the uterus.
• Uterine fibroid embolization: In this treatment procedure, a small catheter in put inside the uterine artery and small particles are used to obstruct the flow of the blood. The loss of blood flow helps improves the symptoms.
• Radiofrequency ablation

Can Uterine Fibroids Cause Pelvic Organ Prolapse?

Leiomyoma, or uterine fibroids, have a risk of prolapsing into the vagina. Pelvic masses, like large uterine fibroids, are also known to be a risk factor for pelvic organ prolapse. If you undergo a hysterectomy for uterine fibroids, it can increase your risk of developing pelvic organ prolapse as well.

Uterine fibroids are pretty common among women. Though often undetectable, uterine fibroids sometimes show symptoms like heavy menstrual bleeding, frequent urination, backache, leg pain, and even prolapse. Much like uterine prolapse, uterine fibroids can cause urinary difficulties. Medications and surgical treatments can help with uterine fibroids.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.

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