What are Fibroids?

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A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea to as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus.

About 30% of women older than 30 years have fibroids, and they usually appear between the ages of 35 and 45. Some women are more likely to get fibroids, including black women, women who have never been pregnant and women who have a mother or sister with fibroids

The cause of fibroids is unknown. However, the female hormone estrogen seems to play a role in stimulating the growth of some fibroids.

Symptoms

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Some women never realize that they have fibroids because they have no symptoms. In other women, uterine fibroids are discovered either during a routine gynecologic exam or during prenatal care.

When symptoms of fibroids occur, they can include:

• Pelvic pain or pressure
• Heavy menstrual bleeding
• Bleeding or spotting between menstrual periods
• Unusually frequent urination
• Abdominal swelling
• Low back pain during intercourse or during menstrual periods
• Fatigue or low energy from heavy periods and excessive bleeding
• Infertility, if the fibroids are blocking the fallopian tubes
• Constipation
• Repeated miscarriages

Diagnosis

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Usually, a woman doesn't realize that she has a fibroid until her gynecologist feels it during a pelvic exam. If your gynecologist thinks you have a fibroid, several tests can confirm the diagnosis:

• Pelvic ultrasound — In this radiology test, a wand-like instrument will be moved over your lower abdomen or may be inserted in your vagina to view the uterus and other pelvic organs more closely. The instrument produces sound waves that create an image of your pelvic organs.
• Hysterosalpingogram — In this X-ray procedure, a dye is injected into your uterus and fallopian tubes to outline any irregularities.
• Hysteroscopy — During this procedure, a narrow instrument that looks like a telescope is inserted through your vagina into your uterus. This lets the doctor look for abnormal growths inside your uterus.
• Laparoscopy — In this procedure, a thin tube-like instrument called a laparoscope is inserted through a small incision in your belly so the doctor can look inside the abdomen.

Types

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The classification of a fibroid depends on its location in the uterus.

The three main types of fibroid are:

• Subserosal fibroids: These are the most common type. They grow on the outside of the uterus.
• Intramural fibroids: These grow inside the muscular wall of the uterus.
• Submucosal fibroids: These grow into the open space inside the uterus.

Some fibroids can become pedunculated

Causes

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It remains unclear exactly what causes fibroids. Their development may be linked with the person’s estrogen levels.

During a person’s reproductive years, estrogen and progesterone levels are higher. When estrogen levels are high, especially during pregnancy, fibroids tend to swell.

Low estrogen levels are associated with the shrinkage of fibroids. This can occur during and after menopause. It can also occur when taking certain medications, such as gonadotropin-releasing hormone (GnRH) agonists or antagonists.

Genetic factors may also affect the development of fibroids. For example, having a close relative with fibroids is associated with an increased risk of developing them oneself.

There is also evidenceTrusted Source to suggest that red meat, alcohol, and caffeine are associated with an increased risk of fibroids. An increased intake of fruit and vegetables may be linked with a reduced risk.

Overweight and obesity are associated with an increased risk of fibroids.

Childbearing is associated with a lower risk of developing fibroids. The risk reduces each time the person gives birth.

Diagnosis

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The following diagnostic tests can help a doctor detect fibroids and rule out other conditions:

• Ultrasound scans: A doctor can create ultrasound images by scanning over the abdomen or by inserting a small ultrasound probe into the vagina. Both approaches may be necessary to detect fibroids.
• MRI scans: An MRI scan can determine the size and number of fibroids.
• Hysteroscopy: During a hysteroscopy, a doctor will use a small device with a camera attached to the end to examine the inside of the uterus. They will insert the device through the vagina and into the uterus via the cervix. If necessary, they may also take a tissue sample, known as a biopsy, to look for cancer cells.
• Laparoscopy: A doctor might also perform a laparoscopy. They will insert a small, lighted tube into a small incision in the abdomen to examine the outside of the uterus and its surrounding structures. If necessary, they might also take a biopsy.

As fibroids often do not cause symptoms, a person may not know that they have fibroids until they undergo a routine pelvic examination.

Treatment

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Most fibroids do not cause symptoms and do not require treatment. In fact, they often shrink or disappear after menopause.

If fibroids are causing uncomfortable symptoms, however, various medical treatments can help.

A doctor may recommend different treatments depending on the symptoms, the severity of the symptoms, and the location of the fibroids.