Fibroids
(Uterine Myomas)

Fibroids, also known as uterine myomas or leiomyomas, are non-cancerous growths that develop in or on the uterus.

These common tumours affect many women, particularly during their reproductive years.

While fibroids are typically benign, they can cause a range of symptoms and impact a woman’s quality of life. Understanding the causes, symptoms, risk factors, and treatment options is crucial for managing fibroids effectively.

What Are Fibroids?

Fibroids are composed of muscle and fibrous tissue and can vary in size, from microscopic to large masses that can distort the shape of the uterus. They are classified based on their location within the uterus:

  • Intramural Fibroids: Located within the muscular wall of the uterus.
  • Subserosal Fibroids: Situated on the outer wall of the uterus, extending into the pelvic cavity.
  • Submucosal Fibroids: Found just beneath the inner lining of the uterus, protruding into the uterine cavity.
  • Pedunculated Fibroids: Attached to the uterus by a thin stalk, either inside or outside the uterine cavity.

Causes

The exact cause of fibroids is not well understood, but several factors are believed to contribute to their development:

  • Hormones: Oestrogen and progesterone, hormones that stimulate the development of the uterine lining during each menstrual cycle, appear to promote the growth of fibroids. Fibroids contain more oestrogen and progesterone receptors than normal uterine muscle cells.
  • Genetic Changes: Many fibroids contain alterations in genes that differ from those in normal uterine muscle cells. There is also a genetic predisposition, with fibroids often running in families.
  • Extracellular Matrix (ECM): The material that makes cells stick together is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes changes in the cells themselves.
  • Growth Factors: Substances that help the body maintain tissues, such as insulin-like growth factors, may affect fibroid growth.

Symptoms

Fibroids can cause a variety of symptoms, which can range from mild to severe. Some women with fibroids experience no symptoms at all. Common symptoms include:

  • Heavy Menstrual Bleeding: Prolonged and excessive menstrual bleeding, sometimes with clots.
  • Pelvic Pain and Pressure: Persistent pelvic discomfort or pressure.
  • Menstrual Irregularities: Longer or more frequent periods.
  • Pain During Intercourse: Discomfort or pain during sexual activity.
  • Frequent Urination: Pressure on the bladder leading to a frequent need to urinate.
  • Constipation: Pressure on the bowel causing difficulty with bowel movements.
  • Backache or Leg Pain: Pain caused by pressure on nerves and muscles in the back and legs.

Risk Factors

Several factors can increase the likelihood of developing fibroids:

  • Age: Fibroids are most common in women aged 30-50 years.
  • Family History: A family history of fibroids increases the risk.
  • Ethnicity: African-Australian women are more likely to develop fibroids than women of other racial backgrounds.
  • Obesity: Being overweight increases the risk of fibroids.
  • Diet: A diet high in red meat and low in green vegetables, fruit, and dairy may increase the risk.
  • Hormonal Factors: Early onset of menstruation, use of birth control, and hormone replacement therapy can influence the development of fibroids.

Treatment Options

Treatment for fibroids depends on the severity of symptoms, the size and location of the fibroids, the woman’s age, and her reproductive goals. Options include:

For women with mild or no symptoms, regular monitoring may be recommended. Fibroids often shrink after menopause due to a decrease in hormone levels.

  • Hormonal Therapies: Medications that regulate hormone levels can help manage symptoms. These include
    • Gonadotropin-Releasing Hormone (GnRH) Agonists: These drugs reduce oestrogen and progesterone levels, causing fibroids to shrink. They are usually used for a short period due to side effects.
    • Progestagen-Only Therapies: Such as intrauterine devices (IUDs) that release progestin can help reduce heavy menstrual bleeding.
    • Oral Contraceptives: Birth control pills can help control menstrual bleeding.
  • Non-Hormonal Medications: NSAIDs can relieve pain, and tranexamic acid can reduce menstrual bleeding.
  • MRI-Guided Focused Ultrasound Surgery (MRgFUS): This procedure uses high-frequency sound waves to destroy fibroids. It is a non-invasive treatment that preserves the uterus. Unfortunately it is no longer available in Australia.
  • Uterine Artery Embolisation (UAE): Small particles are injected into the arteries supplying the uterus, cutting off the blood flow to fibroids, causing them to shrink.
  • Laparoscopic or Robotic Myomectomy: Small incisions and specialised instruments are used to remove fibroids while preserving the uterus.
  • Hysteroscopic Myomectomy: A scope inserted through the vagina and cervix is used to remove fibroids within the uterine cavity.
  • Abdominal Myomectomy: An open surgery to remove fibroids through a larger incision in the abdomen. It is often recommended for larger fibroids.
  • Hysterectomy: The surgical removal of the uterus. This is the only permanent solution for fibroids and is considered when other treatments are ineffective, or if the woman does not wish to preserve fertility.
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