Uterine fibroids are non-cancerous growths of the muscle tissue of the uterus. They can range in number and size from a single growth to multiple growths, and from very small to large.
The medical term for fibroids is leiomyoma or myoma.
Symptoms of fibroids: pressure
Fibroids may cause very mild symptoms, none at all, or symptoms can be severe.
In women who do feel symptoms, these uterine growths can cause:
- Pressure on the bladder or rectum
- Frequent urination
- Constipation and/or rectal pain
- Lower back and/or abdominal pain
If fibroids become very large, they can distend the stomach, making a woman look pregnant.
Symptoms of fibroids: period changes
Fibroids may also cause changes to a woman’s period, including:
- Mild to severe cramping and pain
- Heavier bleeding, sometimes with blood clots
- Longer or more frequent menstruation
- Spotting or bleeding between periods
Fibroids or endometriosis?
Fibroids are one cause of severe menstrual pain, but the pain also can be caused by endometriosis.
Endometriosis occurs when tissue from the inner lining of the uterus grows in other parts of the body.
This tissue breaks down and bleeds during your period, causing pain during your cycle and painful scar tissue. The pain of fibroids or endometriosis also can occur between periods.
What causes fibroids?
The exact cause of fibroids is unknown, but is often linked to oestrogen dominance where the levels of oestrogen are much higher than progesterone levels.
Studies have found that women who start their periods at a younger age are more likely to develop fibroids.
HRT, but not the Pill, are also linked to fibroids.
Types of fibroids
It’s possible to have more than one type of fibroid but these are the most common.
- Intramural fibroids, the most common, grow in the wall of the uterus.
- Subserosal fibroids grow on the outside of the uterus. As they grow larger, they can cause pain due to their size or pressure put on nearby organs.
- Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterus cavity and lead to heavy bleeding and other more serious complications.
- Pedunculated fibroids grow on small stalks inside or outside the uterus.
Who gets fibroids?
While it’s unclear why women develop fibroids, some patterns have been identified.
- They usually occur between the ages of 30 and 40
- They are more common in black women and grow more quickly, and appear at a younger age, in black women according to US studies
- Having a family member with fibroids increases a woman’s risk
- Being overweight or obese and having high blood pressure also may increase your risk
Complications: fibroids and anaemia
Some women with fibroids who experience unusually heavy bleeding during their periods may become anaemic – where the body has fewer red blood cells than normal.
Many cases are due to iron deficiency from heavy or prolonged periods and can be treated with bioidentical progesterone, and a change in diet and lifestyle.
Iron supplements are often prescribed, and liquid forms are more easily absorbed than tablets.
The best food sources are meat, seafood, poultry leafy greens, and iron-fortified breads and cereals as well as lentils, peas, chickpeas, beans, soybeans, and peanuts.
Untreated anaemia can lead to fatigue and lethargy – and, in severe cases, heart problems. whose symptoms include fatigue, chest pain, and shortness of breath.
Fibroids usually do not interfere with fertility and pregnancy. However, some women with fibroids experience more pregnancy complications and delivery risks.
Fibroids may cause the baby to be in an abnormal position and can cause premature labour as well as causing pelvic pain and heavy bleeding after delivery
In some instances, fibroids may block your fallopian tubes and if growing along the inner uterine wall may make it difficult for a fertilised egg to attach.
When to see a doctor
Always check with your doctor if you have the following fibroid symptoms:
- Heavy menstrual bleeding
- Periods that became more painful
- Frequent urination or inability to control the flow of urine
- A change in the length of your period over three to six cycles
- New persistent pain or heaviness in lower abdomen or pelvis
Treatment: pain medication
Pain medications, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve menstrual cramping.
Always check if on medication for high blood pressure before using ibuprofen.
Treatment: birth control
Oral contraceptives contain oestrogen and a synthetic progestin. This usually leads to lighter periods and can alleviate some of the pain associated with fibroids, such as heavy bleeding and cramping.
Other hormonal birth control methods that may lessen fibroid symptoms include progestin-releasing IUDs such a Mirena coil.
Women using the coil or Pill for contraception, not heavy bleeding, are not advised to use bioidentical progesterone unless additional birth control is also used.
This is because the synthetic progestins compete for the same receptor sites in the body as bioidentical progesterone and this will make both less effective.
For mild to moderate symptoms, uterine fibroid embolization may be a good option. A catheter is guided to the uterine artery. Tiny particles of plastic or gelatin are then released into the blood vessels that feed the fibroid, causing it to shrink over time.
Embolization should not be an option for women wanting to get pregnant at some point after treatment.
A myomectomy typically removes the largest fibroids and is an option for women who want to still have children.
A hysterectomy is when the uterus is removed and more common at peri/menopause.
Endometrial ablation, which is good for treating smaller fibroids, destroys the lining of the uterus, so pregnancy is not possible.
Ultrasound is one way to destroy fibroids without risk of damaging the uterus. The treatment uses high-intensity ultrasound waves that kill the fibroid tissue.
Most women recover quickly from this procedure and can return to regular activities within 24 hours.
The long-term effects are still being studied, and it is not recommended for women who want to become pregnant.
Treatment: lifestyle changes
Fibroids and endometriosis are both linked to excess oestrogen so hormone balance is essential to maintain good levels of progesterone as well as oestrogen.
Regular exercise may help prevent fibroids and in one study, women who exercised seven or more hours a week had significantly fewer fibroids than women who exercised less than two hours a week.
Obesity also is a risk factor for fibroids and at menopause weight gain, particularly around the middle, is very common. Exercising regularly can help you maintain a healthy weight and reduce your fibroid risk.
Generally small fibroids may have no symptoms, and no conventional treatment may be needed. However as fibroids and endometriosis are both linked to oestrogen dominance it is advise to ensure you have a good levels of progesterone.
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