Introduction: What are fibroids and uterine fibroids?
Fibroids are growths or tumours that can occur in any organ of the body. The term ‘fibroma’ is also used to describe a fibroid tumour which usually does not need to be removed from the body unless they are harmful or cancerous. Fibroids are made up of fibrous or connective tissue that can be hard or soft, non-cancerous or cancerous and may potentially appear on the skin (sometimes called skin tags), in the body such as the lungs, spinal column and womb (uterus).
Fibroids are given specific names by the location of where the growth appears in the body. A growth that originates from the smooth muscle layer of a woman’s uterus is called ‘uterine fibroid’ and is usually non-cancerous. It is common amongst women of middle and later reproductive years. The term ‘uterine leiomyoma’, ‘myoma’, ‘fibromyoma’ and fibroleiomyoma all describe non-cancerous or benign tumours found in the uterus or womb. In very rare cases, a cancerous growth or malignant tumour called ‘aleiomyosarcoma’ may potentially appear in the uterus.
Fibroids that appear in the uterus vary in size and usually multiple. Some are similar in size of a pea which you may not know are there or grow in size of a small melon and cause heaviness and swelling in the pelvis, discomfort and pain. Uterine fibroids can grow and increase in size but they can also decrease in size or go away in time. They can be felt in the lower abdomen or pelvis when they are large enough to cause symptoms. Uterine fibroids that grow can potentially cause painful and heavy periods, back pain, a woman may experience discomfort and pain during sexual intercourse, frequent and urgent need to urinate and constipation. In extremely rare cases, fibroids may cause infertility and during pregnancy.
Types of uterine fibroids
There are four types of common fibroids that can occur within the womb. They are:
- Intramural fibroids
These fibroids grow within the muscle tissue in the wall of the uterus (womb) and are the most common place for fibroids to occur. When these fibroids increase in size, it tends to make the uterus feel larger than normal and can mistaken for weight gain or pregnancy. It can cause prolonged and excessive menstrual bleeding, pelvic pain and the passing of blood clots. The additional pressure placed on the surrounding organs by the enlarged growth may potentially cause urgent and frequent urination.
- Subserous (subserosal) fibroids
These fibroids grow from the outside of the wall of the uterus and into the pelvis and can grow in size. The growth can put excess pressure on the surrounding organs and cause pelvic pain and pressure rather than causing heavy and excessive bleeding during menstruation.
- Submucous (submucosal) fibroids
These fibroids grow from the inner wall into the middle cavity of the uterus and are the least common of the various types of uterine fibroids. As the growth enlarges in size, it can potentially block the fallopian tubes which can cause complications with fertility. Submucosal fibroids can include excessive menstrual bleeding and prolonged menstruation. It can also cause the passing of blood clots, which left untreated can cause problems such as anaemia (iron deficiency) and fatigue.
- Pedunculated fibroids
These fibroids grow from the outside wall of the uterus and are attached to it by a narrow stalk. It can also grow from the inside wall of the uterus. Pain and pressure can be felt when the stalks twist.
A woman may have one or all of the fibroids mentioned above. It is common for a woman to have multiple fibroid growths and it may be difficult to know which fibroid type is causing the symptoms.
Why do uterine fibroids develop?
Although many researchers have been done in the past, the precise causes of uterine fibroids are unknown. It is also unknown what causes it to grow and shrink but it is known to shrink once a woman reaches menopause.
It is also is known that uterine fibroids are maintained and managed by the production of oestrogen and progesterone levels in the body. Uterine fibroids grow rapidly when the oestrogen hormone levels are high in the body. Oestrogen is the female reproductive hormone that are produced by the ovaries in the reproductive organs.
What the symptoms of fibroids?
Most women may not display any symptoms at all and may probably be unaware they have uterine fibroids. However, some women may feel swelling, tenderness and pain around the pelvis area. Women who have uterine fibroids may experience the following symptoms:
Heavy menstrual bleeding
- A woman may experience a sudden gush of blood or flooding.
- Prolonged menstruation which disrupts the regular menstrual cycle. Periods may be ten days compared to four to five days previously.
- A woman may experience large blood clots passing through her vagina, probably the size of a 50 pence coin or possibly more.
The symptoms above can be distressing when experienced during menstruation. It restricts daily activities and work. Tiredness and discomfort are often experienced during this time.
- Iron deficiency
- Lack of concentration
- General weakness in the body
Excessive bleeding during menstruation may potentially lead to anaemia. It is a condition that depletes the mineral iron required to maintain a healthy level of red blood cells in the body. Iron is required to produce red blood cells which help store and carry oxygen in the blood. Reduced red blood cells in the body will provide insufficient oxygen required by the organs and tissues in the body and may lead to fatigue, dizziness, lack of concentration and general weakness.
- Pain and cramps experienced in the lower abdomen and pelvis area during menstruation
- Passing of large blood clots through the vagina during menstruation
- Lower back pain
Large blood clots can cause severe pain and cramps. Large fibroids that press against the lower back or lumber and sacral nerve may lead to chronic pelvic pain.
Pressure related on nearby organs in the body
Large sized fibroids may potentially apply pressure on the nerve and blood vessels which can lead to a dull ache and varicose veins. Pressure from large subserosal fibroids can potentially lead to the following symptoms:
- Increased frequency to urinate.
- Urgent need to urinate but only small amounts are passed out.
- Leaking and dribbling of urine.
- Occasional cystitis occurs when the urine is trapped and later becomes infected.
- Constipation and haemorrhoids caused by pressure on the rectum.
- In severe cases, difficulty to pass urine may require a catheter to be inserted into the bladder to urinate.
Painful and discomfort during sexual intercourse
A woman may experience discomfort and painful sexual intercourse when the uterine fibroids press against the cervix or they may hang through the cervix into the vagina. Bleeding may also be experienced.
Who is at risk of uterine fibroids and are they common?
There are no confirmed risk factors; however it is known that fibroids are common in women that are of child-bearing. It is also common in women in their thirties and increasingly progresses into the menopause phase.
The risk of uterine fibroids is increased:
- With increasing age, it is common to develop uterine fibroids in women.
- Develop in women from age 30 to 50.
- Can run in the family line of females.
- Women who have had children have a lower risk of developing uterine fibroids. The risk decreases further with more children.
- The risk of uterine fibroids increases in women who experienced early puberty and it decreases in women who experienced late puberty.
- Weight gain and obesity. Women with a higher proportion of body fat who weigh over 11 stones (70 kg) are thought to be the probable cause in higher levels of oestrogen in overweight women.
- Uterine fibroids are two to three times more common in Afro-Caribbean women and tend to be larger and numerous and usually benign.
- The risk of uterine fibroids are likely unaffected by hormonal methods of contraception. Research has shown the effect of hormonal methods of contraception and the risk of uterine fibroids are conflicting and the effect is considered inconclusive by experts.