Uterine fibroids – Symptoms & Causes

Overview

Fibroids are abnormal growths, noncancerous growths, benign lumps that grow in or on the uterus. It is muscular tumours that grow in the wall of the uterus.

Fibroids grow at different rates, Its size ranges from seedlings to bulky masses that can distort and enlarge the uterus. Women’s body either have a single fibroid or multiple ones. In unusual cases they can become very large.

It is estimated that 70-80% of women will develop fibroids in their lifetime Fibroids are most common in women in their 40s and early 50s.

A fibroid may be inside the uterus (sub mucosal), outside the uterus (subserosal), or in the wall of the uterus (intramural).Fibroids can also grow out from the uterus on stalks called peduncles.

Symptoms of uterine fibroids include:

Most women with fibroids (also known as leiomyoma) experience no symptoms. But for at least 30% of women patients, some symptoms will occur.

• Heavy menstrual bleeding.
•  Menstrual periods lasting more than a week.
• Pelvic pressure or pain.
• Frequent urination.
• Difficulty emptying the bladder.
• Constipation.
• Backache or leg pains.
• Pain during sex
• Complications during pregnancy
• Reproductive problems
• bloating in the pelvis or stomach
• enlarge lower stomach area
• mild to severe cramping

Causes of Uterine Fibroids

Multiple factors play a role in their growth. Uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus Growth of Fibroids varies from time to time. Some fibroids go through growth spurts, and some may shrink on their own. A single cell divides repeatedly, eventually creating a firm, rubbery mass distinct from nearby tissue.

• Genetics – Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
•  Growth hormones Estrogen and progesterone- Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids
• Micronutrients, such as iron, that the body needs only small amounts of in the blood. ,a deficiency of vitamin D may be associated with uterine fibroids. …
• Major stresses
• Dietary pattern- Refined Carbohydrates, like pasta, white bread, white rice, cakes, and cookies have been known to alter estrogen levels, causing fibroids to increase in size.
• Extracellular matrix (ECM). ECM is the material that makes cells stick together, it stores growth factors and causes biologic changes in the cells. it is increased in fibroids and makes them fibrous.

Risk factors

Fibroids usually grow in women of childbearing age, and research suggests that they may shrink after menopause.

• Age -older women are at higher risk than younger women, its happen usually in 40s and early 50s. .
• African American race- Black women tend to have more and larger fibroids at an earlier age.
• Obesity- Women who are overweight or obese are also at a slightly higher risk for fibroids.
• Family history of uterine fibroids.- If your mother or sister had fibroids, you’re at increased risk of developing them.
• High blood pressure.
• No history of pregnancy- Women who have given birth appear to be at lower risk for uterine fibroids.
• Vitamin D deficiency-lack of vit d in blood profile.
• Food additive consumption-junk food,soya products, red meats.
• Poor nutrition- Women having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

There are factors that reduce or lower the risk of Fibroids–

• Pregnancy -the risk decreases with an increasing number of pregnancies
• Long-term use of oral or injectable contraceptives
• Late menarche (older than 16 years)

Types of Uterine Fibroids

Uterine fibroids are classified based on exactly where they occur in the uterus.

Subserosal Fibroids- It is the rare type Fibroids, start under the uterine lining (endometrium) and may protrude into the uterine cavity. the least common type, start under the uterine lining (endometrium) and may protrude into the uterine cavity.  It grows on the outside of the uterus. These extend beyond the wall of the womb and grow within the surrounding outer uterine tissue layer. They may grow large enough and make womb appear bigger on one side. As they grow larger, they can cause pain due to their size . Subserosal fibroids grow on the outer surface of the uterus and don’t usually cause bleeding

1. Intramural fibroids-This is the most common type of fibroid, grow in the muscles of the uterus. It grows within the uterine wall and can be very large if left untreated. It’s common to have multiple intramural fibroids located in the same area. This type of leiomyoma may distort the shape of the womb. Intramural fibroids, which grow in the uterine wall, also cause bleeding.

3. Sub mucosal Fibroids- Submucosal fibroids, which impinge on the uterine cavity, This grow just beneath the inner lining of the uterus  and bulge into the uterine cavity. Submucosal fibroids  are presumed to cause heavy menstrual bleeding and leading to anaemia

How are uterine fibroids diagnosed?

Fibroids are found during a routine gynaecologic visit with a pelvic examination and by physical examination.

A pelvic exam allows the doctor to feel the size and shape of the uterus; if it is enlarged or irregularly shaped, fibroids may be present.

1. Ultrasound– Ultrasound is also a safe and reliable way to look for fibroids The procedure takes between 30 to 60 minutes. The initial portion of the exam is performed with the transducer on the abdomen. Conducting gel is placed on the skin, which feels wet and cool. The transducer is moved around as the technologist takes pictures of the uterus and ovaries It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids.

2.Magnetic Resonance Imaging (MRI) – This imaging test does not use radiation, and allows your provider to gain a road map as to the size, number, and location of each of your fibroids. MRI is the preferred imaging modality for characterizing uterine fibroids and identifying their exact anatomical location, though initial identification..The MRI scans give your doctor the precise location of a uterine fibroid and the locations of nearby structures to be avoided,such as the bowel and bladder. While the MRI monitors the targeted fibroid and surrounding structures.

3. Hysterosonography-This is also called sonohysterography, uses sound waves to … Determining the locations of certain abnormalities in uterus like fibroids.  This is a procedure that allows the doctor to look directly inside the uterus and see fibroids located in the uterine cavity. hysterosonography better demonstrates the contents of the endometrial cavity.

Procedure take nearly 30 min,and A small catheter is inserted through the cervix and a small balloon is inflated to hold it in place. Sterile saline is injected into the uterus and ultrasound pictures are taken.

4. X-rays– which use a form of electromagnetic radiation to “see” into the body

5.Computed tomography –This is the procedure which scans the body with X-rays from many angles to create a more complete picture.It  diagnose leiomyomas with advanced imaging

Treatment 

Treatment depends on whether they cause any problems or symptoms. Treatment is only recommended for those women experiencing symptoms as a result of fibroids. If the fibroids are not affecting quality of life, treatment may not be necessary. Treatment depend upon The location of the fibroids, the severity of symptoms, and any future childbearing plans can all affect the decision.

*Medication– The first line of treatment for fibroids is medication.

1.Pain medicine– medicine is often used for mild or occasional pain from fibroids. acetaminophen (Tylenol), ibuprofen (Advil) and naproxen can help ease the pain.

2.Gonadotropin-releasing hormone agonists (GnRHa)- Medications called GnRH agonists treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. As a result, menstruation stops, fibroids shrink and anemia often improves. These drugs are expensive.long use of these medicines makes us osteoporosis .

4-Progestin-releasing intrauterine device (IUD)-this reduces heavy and painful bleeding but does not treat the fibroids themselves. It is not recommended for women who have very large fibroids, which can block the uterine cavity.

5- Birth control pills: Oral contraceptives help regulate the ovulation cycle, and they may help reduce the amount of pain or bleeding during periods.

Surgical Treatment

This treatment depends upon the part and on how bad your symptoms are

Cutting into the uterus to take out just the fibroids could cause a problem with how the uterus works in a future pregnancy. Pelvic pain that you had before either surgery may not get better.Surgical therapy comes down to three options: endometrial ablation, myomectomy, and hysterectomy.

1. Myomectomy –In this Surgery removes the fibroids, leaving the uterus in place. If the fibroids are few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Complete recovery takes 2 to 6 weeks.

2. Endometrial ablation-In this surgery Doctors destroys (ablates) the lining of your uterus (endometrium). Thus helps to reduce menstrual flow. Endometrial ablation should never be performed on women who wish to have children.

3. Hysterectomy –It is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes, and other surrounding structures. his procedure leaves the ovaries intact, and should not induce menopause. Menopause begins when the ovaries are removed or when they no longer produce estrogen.

Natural way to treat Fibrosis

1. Dietary modification– The right nutrition can help you maintain a healthy weight and reduce your risk. Add plenty of fresh and cooked green vegetables, fresh fruit, legumes, and fish to your plate. Eat cooked and raw vegetables like tomaotes,cruciferous vegetables, beans legumes, broccoli, spinach, and lettuce

Instead of simple carbohydrates have complex carbs like brown rice, oats, and millets.

Research suggests that food high in calories or energy is more likely to get fibroids.

We need to avoid fried, high sugar foods. Replacing red meat (beef, ham, or lamb) with white meat (chicken or turkey) may help. Food rich in Vitamin A, Certain vitamin like vitamin c, flavonoids were less likely to have uterine fibroids.

Milk and dairy may help to reduce fibroids, as they contain more calcium, magnesium, and phosphorus which helps to reduce the formation of fibrosis.

2. Weight management- Fibroids are more common in people who are overweight or obese, so maintaining a healthful weight can also protect against fibroids. Getting regular exercise and eating a healthful diet are very effective ways to lose weight.

3. Manage blood pressure-High blood pressure may trigger fibrosis. To manage blood pressure do 30 min moderate exercises, Limit foods with added salt or sodium, avoid red meat and fried foods.

4. Get enough vitamin D.-take minimum 15 min sunbath daily

5. Stop smoking-Try to control or stop smoking as its effect the health

6. Drink herbal green tea daily-It helps in detoxification. And it is rich in EGCG which reduce the size and number of fibroids and also reduce inflammation and remove toxins from your body.

7. Stress management- yoga and exercise helps to manage stress. Warm water shower and massage therapy induce better sleep by relaxing your body muscles.

What are the complications of uterine fibroids?

• Severe pain or very heavy bleeding that needs emergency surgery.
• Twisting of the fibroid — This can cause blocked blood vessels that feed the tumour.
• Anaemia due to heavy bleeding.
• Large fibroids can press on the bladder and ureter, leading to kidney damage.
• Other complications include infertility and recurrent pregnancy loss.

Prevention

Preventing uterine fibroids may not be possible, but only a small percentage of these tumours require treatment. But exercise could reduce the circulation of sex hormones and insulin levels, and that this may explain how regular, intense workouts could reduce the risk. Exercise also helps prevent obesity, which carries with it a higher risk of developing the tumours.

Lifestyle modification like moderate exercises, stress management, eating healthy food, iron food which helps women’s to prevent anaemia helps us from developing tumours.

Conclusion

Uterine fibroids are common benign tumours in women. Common symptoms include abnormal uterine bleeding, pelvic pressure and pain, infertility, recurrent pregnancy loss, and decreased quality of life. Treatment will depend on the size and location of your fibroids.

References

1. https://www.dovepress.com/uterine-fibroids-an-update-on-current-and-emerging-medical-treatment-o-peer-reviewed-article-TCRM
2. https://www.ncbi.nlm.nih.gov/books/NBK546680/
3. https://f1000research.com/articles/6-2109/v1