Uterine Fibroids – What are they, Causes, Symptoms, and Treatment Options

Uterine fibroids, which some also call uterine leiomyomas, are very common. According to some statistics [1]https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=50, 75% of women around the world experience them at some point in life. That is on pair with the common cold.

Fibroids can range in size from few millimeters, up to the size of a pea and a grapefruit. A report by the New England Journal of Medicine states that fibroids are the most frequent indication for major gynecological surgery [2]http://www.jwatch.org/na45257/2017/10/20/bolstering-our-knowledge-about-uterine-fibroids-and-their?query=etoc_jwwomen&jwd=000020054348&jspc=. In fact, more than 200,000 hysterectomies are performed on an annual basis due to uterine fibroids.

These fibroids are non-cancerous tumors found within the uterine walls. They result in a change in the size and shape of the uterus, and they can deliver some nasty and unpleasant symptoms. They get the name because they develop within the uterine wall, hence, uterine fibroids.

Some women experience pain, menstrual changes, and other complications. Others, never deal with symptoms of uterine fibroids. The problem is, it is not always obvious that you have fibroids.

What are uterine fibroids

What are uterine fibroids

As mentioned previously, fibroids are basically abnormal growths on or in the uterus [3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212348/. The tumors, which are non-cancerous, can vary in size from very small to some that are large enough to distend the uterus.

While the tumors are non-cancerous and benign, they can result in physical problems like pain, heavy menstruation, and sometimes complications with pregnancy and conception.

Four types of fibroids

Intramural

The most common type of uterine fibroids are the intramural ones. They appear in the uterine lining and usually grow very large.

Due to their size, they can stretch the uterus out of normal proportion. And that is when complications happen.

Pedunculated

These tumors develop a stem or base, which supports the tumor itself. Not as common, but when they appear, they are hard to get rid of.

Submucosal

These fibroids develop in the inner cavity of the uterus. As with the previous type, submucosal tumors are not common. However, when they appear, they can cause pregnancy complications.

Subserosal

Unlike previous three types of uterine tumors, the subserosal ones grow on the outside of the uterus. This area is called “the serosa” or wall, hence the subserosal name.

Being that they grow very large, they can make one side of the uterus appear bigger than the other.

The causes of the growth of these tumors and fibroids are still undetermined completely. However, scientists suspect in several factors and possible reasons.

What causes uterine fibroids?

Uterine Fibroids

As mentioned previously, doctors do not fully understand and know the cause of uterine fibroids. Luckily, some research and clinical experience can point to several factors [4]https://clinicaltrials.gov/ct2/show/NCT00339547.

Many believe that these fibroids develop from stem cell in the smooth muscular tissue of the uterus. A single cell divides repeatedly and eventually creates a firm and rubbery mass that is different from tissue around.

The growth patterns can vary from slowly to rapidly, or they may also remain the same size. In some cases, fibroids go through growth spurts. Some may even shrink on their own.

With that in mind, let’s break down the causes of fibroids in women.

Genetic changes

Fibroids contain changes in genes that differ from those in normal uterine muscle cells. These changes cause the tumors to appear.

Genetics

Another way genetics affect whether you develop fibroids or not is by your skin color. Sadly, there is nothing you can do about that.

But studies have shown that by the age of 35, two thirds of African American women have fibroids, compared to just 40% of Caucasian women [5]https://www.azuravascularcare.com/infoufe/african-american-women-and-fibroids/.

You cannot change your genetics, but you can focus on other causes and risk factors that you can control.

Hormones

The two main hormones that stimulate development and growth of uterine lining are estrogen and progesterone. The problem is, these two also promote the growth of fibroids.

These hormones stimulate development during each menstrual cycle in preparation for pregnancy. Clinical experiences have shown that fibroids contain more estrogen and progesterone than normal uterine muscle cells do.

On the flip side, after menopause, due to decrease in hormone production, fibroids shrink.

Having less than two children

There is no scientific proof for this one. However, according to experience and clinical trials, the more children you have, the less likely you are to develop fibroids.

Now, this doesn’t mean you should have more children just so that you avoid fibroids. In fact, it is not clear to researchers why this happens.

Drinking alcohol

A study by the Black Women’s Health Study, showed that African-American women consuming alcohol are more likely to develop fibroids [6]https://academic.oup.com/humrep/article/19/8/1746/2356298.

This is even more notable when that alcohol is beer. That being said, consider reducing your beer consumption to once per week.

Not consuming enough fruit

We know that consuming fruits is usually something linked to a healthy lifestyle. That applies to fibroids as well. A study on dietary habits showed that 2 servings of fruits per day are associated with lower risk of uterine fibroids.

The study also showed that more preferred fruits are citrus fruits. Consider consuming more fruits and vegetables on a daily basis. Not just for fibroids prevention, but also for improving the quality of your life.

Starting menstruation early

As we mentioned previously, fibroids and hormones are closely related. That means that your estrogen levels vastly affect the quality of life. Women who begin their menstruation cycle earlier in life, for example before the age of 11, are more likely to develop fibroids.

This is because your body is affected by the estrogen hormone for a longer period of time. Women starting menstruation after age 13 are less likely to develop fibroids. Sadly, there is not much you can do about when your menstruation starts.

Exposure to childhood abuse

Physical and mental health problems usually start early in childhood. Being exposed to abuse and trauma early in life usually leads to both physical and mental problems.

Some studies have shown a connection between childhood abuse and development and growth of uterine fibroids [7]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137864/.

You cannot do anything to change what has happened early in your life. But you can start taking care of your emotional and physical health as soon as possible.

Vitamin D deficiency

Many of us are very much familiar with the benefits of vitamin D. It is one of the key vitamins our body needs to function properly. The sunshine vitamin is present in certain foods, but our bodies need to produce vitamin D when exposed to sunlight.

Vitamin D has the ability to diminish the growth of cells, and also regulate the immune system. These two are crucial in prevention o fibrous tissue and limiting the production of fibroid cells.

Using hair relaxers

You will be surprised, but certain hair products can actually increase the risk of fibroids. Such are hair relaxers, some of which contain phthalates.

These are a group of chemicals considered to be hormonally disruptive. In some studies, levels of phthalates found in urine were associated with higher risk for developing fibroids.

Major life stresses

Experiencing major and stressful life events like loss of a child, loss of a spouse, birth of a first child, divorce, or anything else are also associated with fibroids.

We all know the effect stress has on hormone levels, and change in hormone production can encourage development of fibroids [8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675159/. Take care of yourself by finding ways to manage and control stress in your life.

Risk Factors

In addition to all the causes of fibroids in your uterine walls, there are also risk factors that can increase the risk.

Of course, being a woman of reproductive age is the biggest risk factor. But there are others as well.

  • Heredity – if your mother or sister had fibroids, the risk is higher that you will have as well
  • Race – black women are more likely to develop fibroids than any other racial group. Black women also develop fibroids at younger ages
  • Environmental factors – including use of birth control, obesity, diet high in red meat and similar

Complications

Uterine fibroids are generally not considered dangerous and life-threatening. However, they can cause discomfort. In some cases, they can also lead to complications like anemia, due to the heavy blood loss.

Prevention

Researchers continue to look for causes of fibroids constantly. And while they have identified a couple of causes, there is still little scientific evidence available on prevention.

The good news is that only a small percentage of these tumors require treatment and in most cases, making small and healthy lifestyle changes can reduce the risk of developing fibroids.

Uterine fibroids symptoms

There are a couple of different types of symptoms of uterine fibroids.

Let’s break them down.

Menstrual

The most obvious symptom is having heavier than normal periods. You will lose more blood, which increases the risk of anemia, as mentioned previously.

Other menstrual symptoms include painful cramping, abdominal discomfort, and menstrual flow that requires thicker pads and/or tampons. In some cases, women experience irregular menstrual cycles, including spotting.

Women can also experience abnormally prolonged menses in length up to seven days and more. Heavier and longer menses is the most common symptom women experience.

Pelvic symptoms

Pain and pressure in the abdomen and pelvic area can be chronic and constant. Women have also reported discomfort or pain during sexual intercourse.

Others have also reported pressure, bloating, and swelling within the abdominal wall.

Bowel and bladder control

Fibroids can also cause frequent urination and loss of bladder control. In some cases, women have said they need adult diapers just so they can get through the day.

Conversely, some women also say they find it difficult to empty their bladders, and have experienced constipation. In some rare cases, kidney blockage is also possible.

Pregnancy and conception problems

One of the first symptoms of fibroid tumors is a difficulty or inability to conceive. Now, you might not notice this unless you are trying to get pregnant. But these fibroid tumors will make it difficult or nearly impossible to conceive.

The sad part is miscarriages are also a factor, and some other complications can occur with ongoing pregnancies. These include placental abruption and premature labor.

Pain in back and leg

Back and leg pain caused by fibroid tumors comes on suddenly and sharply without warning. It can be constant and chronic. You will need a gynecologist to administer a pelvic exam in order to determine whether there are tumors causing your back and leg pain.

They will check the size and type of tumors if there, and inspect the overall condition of your uterus. In some cases, a doctor may prescribe ultrasound test or pelvic MRI.

When to see your doctor:

If you are experiencing any of the following symptoms, you should seek prompt medical care.

  • Severe vaginal bleeding
  • Sharp pelvic pain that comes on suddenly
  • Sharp pelvic pain that does not go away
  • Spotting or bleeding between periods
  • Difficulty emptying your bladder
  • Overly heavy, prolonged, and painful periods

Uterine fibroids treatment

Depending on age, size, and type of the fibroid tumors, doctors can offer one or a combination of treatments. For starters, there are a couple of medications which can help regulate hormone levels.

In some cases, your menstruation may cease, and fibroids can shrink. Anti-inflammatories are always an option, and in some cases, doctors even recommend birth control pills, as they help regulate hormone levels.

In some and less common cases, physicians may recommend surgery. Do not be afraid, many of these procedures are fairly non-invasive.

For example, the laparoscopic procedure uses a small incision and a camera. Another procedure is “forced ultrasound surgery”, which uses high-frequency sound waves to destroy the fibroids and is completely non-invasive.

How to diagnose fibroids?

Before we get to explain the common and frequent treatment, options, let’s talk about diagnosis. You should check with a physician if you experience any severe symptoms.

At that point, your gynecologist will start with a pelvic exam. The pelvic exam will check for the condition, size of the fibroids if they are there, and shape of your uterus.

Other tests are needed in some cases, including:

  • Ultrasound, a test that uses high-frequency sound waves to produce images of your uterus on a screen. This test allows the physician to see the internal structure of your uterus and if there are any fibroids there
  • Pelvic MRI is an in-depth imaging test producing pictures of your uterus, ovaries, and other pelvic organs
  • Hysteroscopy is a method of using a small device with a camera attached to the end and used to examine the inside of the womb
  • Laparoscopy can also be performed to check the outside of the womb and its surrounding structures

Treatment is recommended for women experiencing symptoms due to fibroids. If the fibroids are not affecting your quality of life, there is no need for treatment.

While fibroids can cause heavy periods, if they are not causing any major problem, doctors may choose not to give you treatment. Fibroids often shrink during menopause, and symptoms become less apparent and in some cases even resolve completely.

Medications for fibroids

Medications are the first type of treatment a physician will order if you have fibroids. The first line of defense is a drug known as gonadotropin-releasing hormone agonist, which is basically a drug causing the body to produce less estrogen and progesterone.

This will shrink the fibroids, but also stop your menstrual cycle without affecting fertility at the end of the treatment.

These agonists can cause menopause-like symptoms, including and not limited to hot flashes, vaginal dryness, higher risk of osteoporosis, and a tendency to sweat more.

These are for short-term use only, and they may be given to women before surgery as a way to shrink the fibroids.

Other drugs include non-steroidal anti-inflammatory drugs that reduce the production of prostaglandins, hormone-like lipids that are associated with crampy periods.

Birth control pills in the form of oral contraceptives regulate the ovulation cycle and may help with the amount of pain or bleeding during periods.

Last, but not least, doctors may prescribe levonorgestrel intrauterine system, which is a plastic device placed inside the womb.

This device will release a hormone called levonorgestrel over an extended period of time. The hormone stops the inside lining of the womb from growing too fast. That, in turn, will reduce menstrual bleeding.

Surgery

If the fibroids are severe, they will not react to conservative treatment options. In this case, a surgery is in play. As mentioned previously, surgery for fibroids is non-invasive.

Here are some surgery options:

  • Hysterectomy, partial or total removal of the womb, and considered only for extremely large fibroids or when the patient suffers from excessive bleeding. Total hysterectomy can prevent the return of fibroids, but if the surgeon removes the ovaries and the fallopian tubes, side effects like reduced libido and early menopause may occur
  • Myomectomy is the removal of fibroids from the muscular wall of the tomb. This surgery option helps women who still want to have children. However, women with large fibroids or if the fibroids are located in particular parts of the womb, may not benefit from the surgery
  • An MRI-guided focused ultrasound surgery will help locate the fibroids, and then shrink them using high energy ultrasound waves
  • Endometrial ablation is removing of the lining inside of the womb and can help if the fibroids are located near the inner surface of the womb. It is an effective alternative to hysterectomy
  • MRI-guided percutaneous laser ablation is similar to ultrasound surgery, only this time physicians use fine needles. The needles are inserted through the skin and pushed until they reach the fibroids. After that, a laser device is inserted through the needles and doctors use laser light to shrink the fibroids
  • Last, but not least, physicians may recommend uterine artery embolization, which is cutting off the blood supply to the area to shrink the fibroids. The procedure is quite effective, and can remove or reduce symptoms in 90% of women [9]http://www.radiologyinfo.org/en/info.cfm?pg=ufe. The downside is it cannot be used on pregnant women or those who still want to have children

Home remedies for uterine fibroids

In some cases, certain home remedies and natural treatments can help you. These have a positive effect on fibroids.

Try some of the following natural treatment methods:

  • Acupuncture
  •  Yoga
  • Applying heat for cramps (avoid if you experience heavy bleeding)
  • Massage
  • Gui Zhi Fu Ling Tang, a traditional Chinese medicine formula

What Not to Eat when you have fibroids

As mentioned previously, diet changes can help or worsen the symptoms of uterine fibroids. There are certain foods you need to avoid, and certain foods that help you relieve the symptoms.

Let’s take a look at the foods you need to avoid first:

  • High fat and processed meats, some of the worst food choices for women, no matter fibroids or not. Foods that are high in unhealthy fats like processed meats contain chemical additives and other ingredients that promote inflammation. Stick to plant-based protein or meat from grass-fed animals
  • Conventional dairy, like non-organic dairy that is high in steroids, hormones, and other chemicals that will increase/reduce your hormone levels. Frequent changes in hormone levels encourage the growth of fibroids
  • Refined sugar, same as with processed meats. Consuming a lot of refined sugar will promote inflammation, and create a good breeding ground for fibroids. A lot of sugar will also cause you to gain weight, which will reduce your immune function. There is a big link between weight gain and hormonal imbalance, and you do not want that
  • Alcohol can also contribute to increased inflammation throughout the body and reduce the immune function, two keys to development and growth of fibroids. Reduce or eliminate alcohol to prevent weight gain, inflammation, and hormonal imbalance
  • Refined carbs are another food group you are better staying away from. Managing hormones involves elimination of sugars and refined carbs. Products made with white and bleached flour will cause your insulin levels to spike, and your hormones to go out of order. Refined carbs are basically empty calories, stripped of everything but starch, and you do not want that in your diet, fibroids or not
  • Last, but not least, stay away from caffeine, as too much of it will put a tool on your body, especially your liver. When your liver has to work overtime, and more than it can handle, it is not keeping your hormones in check. The better condition you can keep your liver, the better chances you have of preventing and treating fibroids

What to eat to relieve fibroids symptoms?

The foods on this list can help you prevent fibroids, but also treat the symptoms.

Include these foods in your diet as much as possible.

  • Organic foods, as organic products are grown and made without the use of chemical pesticides. Nowadays, there are a lot of organic food markets in every town. Even locals are grouping and growing fruits and vegetables together in an organic way. Pesticides used in non-organic agriculture can impact estrogen levels, and we know you do not want that
  • Leafy green vegetables have the most potent anti-inflammatory effects, and will discourage growth of fibroids in your body. These vegetables are also high in vitamin, which helps control menstrual bleeding aid in blood clotting
  • Cruciferous vegetables are another veggie group you need to include in your menu. They support detoxification of the liver and help balance estrogen levels. The list of cruciferous vegetables includes cabbage, Chinese cabbage, broccoli, cauliflower, and so on
  • Beta-carotene-rich foods will promote growth and repair of healthy tissue. These foods convert into vitamin A once digested. Vitamin A is one of the keys vitamins in prevention and treatment of fibroids. Some foods on this list include sweet potatoes, kale, spinach, carrots, and winter squash
  • Foods high in iron are extremely needed, as you will lose a lot of blood due to fibroids. Women generally lose blood due to their period, and that means loss of iron. Without consumption of iron-rich foods, fibroids and periods can cause anemia. Therefore, you need to replace the excessive loss of iron due to bleeding
  • Flaxseeds help balance estrogen levels in the body, and that will shrink fibroids. Aim for at least 2 tablespoons of flaxseeds per day if you have fibroids. Sprinkle them on oatmeal, or add them to your morning/afternoon smoothie
  • Last, but not least, stick to whole grains instead of refined grains. This means millet, brown rice, rye, oats, buckwheat, and spelt. These grains are much higher in fiber and contain minerals that can improve your overall health

Uterine fibroids and pregnancy

Uterine fibroids and pregnancy

What are the signs and symptoms that you might notice during pregnancy if you have fibroids?

As mentioned previously, uterine fibroids can cause a number of complications during pregnancy, including miscarriage and premature labor. Fibroids increase the risk of needing a cesarean section by six times [10]http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html#e.

Severe fibroids can also lead to infertility, and make it harder for an egg to become fertilized and then implant on the lining of the uterus.

Your gynecologist might recommend medications prior to becoming pregnant if you have fibroids. These medications will cause the fibroids to shrink.

In some severe cases, a surgery might be required, and it is performed before pregnancy. Surgery cannot be performed if a woman is already pregnant, as it will lead to blood loss and pre-term labor.

Due to increased levels of estrogen, fibroids may actually increase in size during pregnancy. Bleeding and abdominal pain can accompany your pregnancy if the fibroids begin to lose its blood supply.

If you are having fibroids, and you are already pregnant, your physician will recommend more ultrasound checks to monitor the condition.

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