Uterine Fibroids Treatment

Uterine fibroids are a common condition that may affect women during their childbearing years and beyond, often causing symptoms like heavy bleeding and pelvic pain. For some, fibroids may go unnoticed, while for others, they can significantly impact daily life and overall well-being.

Whether you’ve recently been diagnosed or are exploring uterine fibroids treatment options, understanding this condition may help you understand its causes, symptoms, diagnosis and treatment options, helping you make informed decisions with your healthcare provider.

What Are Uterine Fibroids?

Fibroids in the uterus are non-cancerous growths that develop in or around the muscular walls of the uterus (womb). They are also known as uterine leiomyoma fibroids or myomas. These growths may vary widely in size and number. Some fibroids are so small that they cannot be seen without a microscope, while others can grow large enough to change the shape of the uterus.

Fibroids can grow as a single growth or in clusters. They may remain the same size over time, grow slowly or in some cases shrink, especially after menopause. These growths are common in women of childbearing age and many women with fibroids might not even know they have them because fibroids often may not cause symptoms.

What Causes Uterine Fibroids?

The exact cause of uterine fibroids is not fully understood. Multiple factors may contribute to their development and growth. These factors include:

Hormones: Estrogen and progesterone, two hormones that regulate the menstrual cycle, may influence fibroid growth. Fibroids tend to grow during times of higher hormone levels, such as during pregnancy and may shrink after menopause when hormone levels decrease.
Genetics: A family history of fibroids may increase the likelihood of developing them. Certain genetic changes in fibroid cells have also been identified.
Age: Fibroids are more common as women get older, particularly during their 30s and 40s, until menopause.
Health and Lifestyle Factors: Being overweight or having high blood pressure may increase the risk of developing fibroids. Additionally, vitamin D deficiency and certain dietary factors, such as the consumption of soybean milk, have been linked to fibroid risk.

Which Size of Fibroid Is Normal?

Uterine fibroids can vary widely in size. Some fibroids are as small as an apple seed, while others can grow as large as a grapefruit or even larger. There is no specific size that is considered "normal" because fibroids are non-cancerous growths that affect women differently. Their size alone doesn’t always determine whether they will cause symptoms or need treatment.

The location of a fibroid may play a more significant role than its size in causing certain uterine fibroid symptoms, such as heavy bleeding. However, the size of a fibroid may contribute to symptoms related to its physical presence, including pelvic pressure, increased urinary frequency or constipation. Your healthcare provider can use imaging tests to evaluate the size and location of fibroids and determine how they may be contributing to your symptoms.

How Are Uterine Fibroids Diagnosed?

Many women with uterine fibroids may not know they have them, especially if there are no symptoms. Fibroids are often discovered during a routine pelvic exam. During this exam, a healthcare provider checks the size and shape of the uterus. If fibroids are present, the uterus may feel larger than normal or have an irregular shape.

If a pelvic exam suggests fibroids or if you have symptoms like heavy bleeding or pelvic pain, imaging tests can provide a clearer picture. These tests include:

Uterine fibroid ultrasound: This is the most common test to diagnose fibroids. It uses sound waves to create images of the uterus. The probe can be placed on the abdomen or inside the vagina for a closer view.
Saline Infusion Sonography (SIS): This test involves inserting a small amount of saline (saltwater) into the uterus to enhance ultrasound images and provide more detail.
Magnetic Resonance Imaging (MRI): This test uses magnets and radio waves to create detailed images of the uterus. It may be used to locate fibroids before surgery or if other imaging is inconclusive.
Hysteroscopy: A thin, lighted tube is inserted through the vagina and cervix to view the inside of the uterus. This procedure can identify fibroids that are inside the uterine cavity.
X-rays and CT Scans: These are less commonly used but can be helpful in certain cases.

Can Uterine Fibroids Cause Bleeding During Pregnancy?

Uterine fibroids may sometimes cause bleeding during pregnancy. While many women with fibroids have normal pregnancies, fibroids may lead to complications in some cases, depending on their size, location and how they affect the uterus.

Bleeding may occur if the fibroids interfere with the lining of the uterus or if they grow larger during pregnancy due to increased hormone levels. Some fibroids, especially those located near the placenta or inside the uterine cavity, may increase the risk of bleeding. Fibroids can also lead to other pregnancy-related challenges, such as:

Miscarriage: Fibroids inside the uterus can sometimes interfere with the developing pregnancy.
Placental abruption: Rarely, the placenta may detach from the uterine wall, which can lead to bleeding.
Preterm labor: Fibroids can increase the likelihood of early contractions and delivery.

If you experience bleeding during pregnancy, contact your healthcare provider promptly. They can assess your condition and provide guidance on the best steps to ensure the health and safety of you and your baby.

Treatment for uterine fibroids depends on factors like your symptoms, overall health, fibroid size and location and your personal goals, such as whether you want to have children in the future. Some women with fibroids may not need treatment, especially if they have no symptoms.

If your fibroids are not causing significant symptoms, your doctor may recommend monitoring them during routine check-ups to see if they grow or cause new symptoms. For those who do need care, there are several options to help manage fibroids:

Medications

Hormonal Treatments: Medications like birth control pills, hormonal IUDs or injections may help reduce heavy bleeding and menstrual pain. However, these treatments usually don’t shrink fibroids.
Gonadotropin-Releasing Hormone (GnRH) Agonists: These medications may temporarily shrink fibroids by lowering hormone levels. They’re often used before surgery to make the procedure easier.
GnRH Antagonists: These are newer medications that may reduce heavy bleeding and are usually combined with hormonal therapy to minimize side effects.
Tranexamic Acid: This medication may help control heavy menstrual bleeding but does not affect fibroid size.
Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may relieve cramps and pelvic pain.

Non-Surgical Procedure

Uterine Artery Embolization (UAE): Tiny particles are injected into the blood vessels that supply the fibroids, cutting off their blood flow and causing them to shrink. This option is suitable for women who don’t plan to have children in the future.

Surgical Options

Myomectomy: This uterine fibroid surgery procedure removes fibroids while preserving the uterus, making it an option for women who wish to have children. Myomectomy can be done through traditional surgery, laparoscopy or hysteroscopy, depending on the fibroid’s location.
Hysterectomy: This procedure removes the uterus and is a permanent solution for fibroids. It is often recommended if other treatments haven’t worked, the fibroids are large, or childbearing is not a concern.
Radiofrequency Ablation: This minimally invasive procedure uses heat to destroy fibroid tissue, causing the fibroids to shrink. It can be performed through small incisions or via the cervix. This option is generally recommended for women who have completed childbearing, as it may impact future pregnancy outcomes.

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