What are uterine fibroids?
Definition
- Uterine fibroids, also known as uterine leiomyomas, are benign (non-cancerous) growths that develop in the uterus.
- They are made up of muscle and fibrous tissue and can vary in size, shape, and location – they may be tiny or as big as a football.
- Natural history: they often regress (go away) with no treatment, e.g. after a pregnancy or menopause. This facts affects many treatment decisions.
Epidemiology (who gets them)
- Fibroids are very, very common – affecting 70-80% women over 50 years (and Black women have an increased risk)
- And (normal variant) heavy periods are so common, there is huge overlap; and confusion on whether the fibroids are causing the patients symptoms
- The high prevalence means fibroids in most women are actually normal, not a disease, and usually don’t cause symptoms.
Types
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Intramural: Grow within the muscular wall of the uterus.
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Subserosal: Grow on the outside of the uterus.
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Submucosal: Grow just beneath the uterine lining.
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Pedunculated: Grow on a stalk-like structure.
Different types of fibroid
Symptoms:
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Heavy or prolonged menstrual periods (commonest presentation).
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Low abdominal or pelvic pain or pressure.
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Frequent urination or constipation.
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Infertility or miscarriage.
Diagnosis
- Ultrasound (or MRI in some).
- Histopathological examination (biopsy) – sometimes.
- None are 100% reliable.
Treatment options
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Watchful waiting: Monitoring with regular check-ups.
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Medication: Hormone therapy (e.g. GnRH agonists: leuprorelin (brand name Lupron) and triptorelin (brand name Decapeptyl). and/or painkillers
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Surgery: Removal of fibroids (myomectomy) or uterus (hysterectomy).
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Uterine artery embolisation (UAE): X-ray treatment that blocks blood flow to fibroids.
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MRI-guided focused ultrasound: Non-invasive heat treatment.
