What is Leiomyoma (Uterine Fibroids)?
Leiomyomas, also known as fibroids, are the most frequently found non-cancerous tumors in women before menopause. They have a significant economic impact as it’s estimated that about 11 million women are affected by fibroids, costing around 34 billion dollars in the US each year. This summary will explain how to identify fibroids, what causes them, their physical characteristics, and how to treat them.
What Causes Leiomyoma (Uterine Fibroids)?
Leiomyomas are made up of identical cells that come from the myometrium, which is the middle layer of the uterus wall. The cause of leiomyomas, also known as fibroids, is still being researched. However, several studies have found certain gene changes that are linked to fibroids. Some of these gene changes are believed to cause an issue with the RNA polymerase II transcriptional mediator subunit, known as MED12. This unit is crucial for transforming cells, so any defects can lead to health problems like fibroids.
Risk Factors and Frequency for Leiomyoma (Uterine Fibroids)
Leiomyomas, also known as fibroids, are common in women, particularly as they age. By the time they are 50, almost 70% of white women and over 80% of black women will be diagnosed with this condition. However, black women are twice as likely to experience symptoms compared to white women.
Several factors can increase a woman’s likelihood of developing fibroids. These include being of African descent, beginning menstruation early, using birth control before the age of 16 and having an increased body mass index. On the other hand, using certain types of birth control that contain only progestin, as well as having given birth multiple times, can reduce this risk.
- Fibroids are common, affecting nearly 70% of white women and over 80% of black women by the age of 50.
- Black women are twice as likely to experience symptoms of fibroids.
- Factors such as African ancestry, early menstruation, early use of birth control, and high body mass index increase the risk of fibroids.
- Using birth control with only progestin and having multiple births can lower this risk.
Signs and Symptoms of Leiomyoma (Uterine Fibroids)
Fibroids can present in different ways, with some women not experiencing any symptoms while others have constant and worsening symptoms that disrupt their everyday activities. Common symptoms include pain, pressure, and unusual vaginal bleeding. What determines these symptoms is typically the location, size, and number of these growths, also known as leiomyomas. A physical examination will often reveal an enlarged uterus with an irregular shape.
- Pain
- Pressure
- Unusual vaginal bleeding
- Location, size, and number of leiomyomas
- Enlarged, irregularly shaped uterus upon physical examination
Testing for Leiomyoma (Uterine Fibroids)
To diagnose uterine leiomyomas, which are also known as fibroids, your doctor will first conduct a detailed physical examination and review your medical history. The most common evidence of this condition during a physical exam is an irregularly shaped, enlarged uterus. An ultrasound, or pelvic sonogram, can usually confirm this diagnosis. This is a cost-effective technique that quickly helps diagnose the condition.
In some cases, the doctor might also use a magnetic resonance imaging (MRI) scan. This kind of imaging can provide more detailed information about the fibroids, such as how much blood is reaching them and whether they have started to break down. The MRI also shows how the fibroids are related to the serosal (outer) and mucosal (inner) surfaces of the uterus, which can guide treatment decisions.
The International Federation of Gynecology and Obstetrics (FIGO) has a system to classify fibroids, which uses numbers 0 to 8. A lower number means the fibroids are closer to the inner lining of the uterus, called the endometrium.
If your major symptoms include bleeding and concern for anemia or other issues due to ongoing blood loss, your doctor may recommend a complete blood count (CBC). This is a blood test that checks different components of your blood. In some cases, you might also have a test for thyroid-stimulating hormone to make sure any excessive bleeding isn’t due to thyroid disease.
Right now, medical professionals do not suggest keeping track of your fibroids with regular imaging scans. Although they can show whether the fibroids are growing, there are currently no specific guidelines for how frequently this should happen. Your doctor will usually only recommend a check-up if your symptoms change.
Treatment Options for Leiomyoma (Uterine Fibroids)
Uterine fibroids, also known as leiomyomas, can have a big impact both on a woman’s daily life and on healthcare costs in the United States. So, finding an effective treatment is not only good for the woman, but also helps to reduce the financial burden on the health system.
The best treatment for uterine fibroids depends on the woman’s age, whether she wants to have children, and how severe her symptoms are. There are both medicine-based and surgery-based treatments available. The main goals of any treatment are to ease the symptoms, reduce the size of the fibroids, and preserve or improve the woman’s fertility if that’s important to her.
Medical treatments are often the first step and can include hormone therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), or medicines that change the way the brain and pituitary gland (a small gland at the base of the brain) communicate with each other. The downside of these medications is that they can usually only be used for a short time. After stopping the medication, symptoms often come back, and the fibroids may continue to grow.
Hormone-based treatments can include combined oral contraceptives, progesterone only treatments, or gonadotropin-releasing hormone (GnRH) agonists. Combined oral contraceptives and progesterone treatments mainly help to control heavy menstrual bleeding caused by fibroids. However, they don’t usually reduce the size of the fibroids, and they don’t improve fertility. Also, potential complications can occur with long-term use of these hormones. GnRH agonists work by temporarily putting the body into a menopause-like state, which leads to lighter periods and may decrease the size of fibroids while the medicine is being taken.
Intrauterine devices (IUDs) that release levonorgestrel, a type of hormone, can help reduce menstrual bleeding and improve quality of life. However, they usually don’t reduce the size of the fibroids in the long term.
Non-hormonal treatments include NSAIDs and tranexamic acid. Tranexamic acid acts to stabilize blood clots and therefore reduces heavy periods. The most common side effect is upset stomach, but there’s a small chance of an unwanted blood clot forming. NSAIDs can help reduce menstrual bleeding, but they aren’t as effective as tranexamic acid or levonorgestrel-releasing IUDs.
Surgery is still the most effective treatment for fibroids. This can involve destroying the lining of the uterus (the endometrium), cutting off the blood supply to individual fibroids, or removing the fibroids. These can be good options depending on the woman’s situation, but in some cases fibroids may come back, and another procedure may be necessary. The only permanent solution is to remove the uterus entirely in a procedure called a hysterectomy, but this means that the woman won’t be able to bear children in future. The best method for this operation depends on the woman’s medical history, physical exam, and the surgeon’s skill and experience.
What else can Leiomyoma (Uterine Fibroids) be?
When checking for uterine fibroids (also known as leiomyomas), doctors consider several other conditions that can also cause an enlarged uterus, bleeding, or pelvic pain. These conditions could be benign (noncancerous) or malignant (cancerous). The conditions typically considered include:
- Adenomyosis
- Endometriosis
- Pregnancy
- Leiomyosarcoma (a rare type of cancer in the uterus)
- Endometrial carcinoma (cancer of the inner lining of the uterus)
- Uterine carcinosarcoma (a rare type of uterine cancer)
Even though these cancers are seldom the cause of symptoms similar to uterine fibroids, medical professionals have to stay vigilant during their assessments.
What to expect with Leiomyoma (Uterine Fibroids)
The outlook for uterine fibroids – noncancerous growths in the uterus – can greatly differ from patient to patient. Some individuals may have a very good outlook and may not experience any symptoms for many years, or possibly even forever.
On the other hand, there are those who may not respond well to medical treatments. Depending on their desire to have children in the future, they may also face recurring fibroids which might require multiple surgeries.
Possible Complications When Diagnosed with Leiomyoma (Uterine Fibroids)
Chronic pelvic pain, heavy menstrual bleeding that can result in anemia, complications during pregnancy, infertility, constipation, urinary tract issues like infections or incontinence, twisting of a fibroid that is fireball-like, and degeneration which may or may not be accompanied by an infection.
- Chronic pelvic pain
- Heavy menstrual bleeding possibly leading to anemia
- Complications during pregnancy
- Infertility
- Constipation
- Urinary tract issues such as infections or incontinence
- Twisting of a ball-like fibroid
- Decaying fibroids, which may also have an infection
Preventing Leiomyoma (Uterine Fibroids)
Leiomyomas, also known as fibroids, are non-cancerous growths that are very common among women. Despite being tumors, they are almost never cancerous. In addition, your genetic makeup might affect your likelihood of getting them. This basically means, if your family members had them, it’s possible that you might develop them as well.
