Uterine Fibroids: What They Are, Causes, Symptoms, and Diagnosis

The diagnosis of "uterine fibroids" sounds frightening, although it refers to a benign growth arising from the muscular layer of the uterus. If you have come across this wording in an ultrasound report, let's go through it calmly: what this nodule is, where it comes from, and what the examination shows.

What uterine fibroids are: leiomyoma and fibromyoma

Uterine fibroids are a benign tumor that arises in the muscular layer of the uterus, the myometrium. You may encounter synonyms: leiomyoma, fibromyoma. Fibroids may be single or multiple. This is the most common tumor in women: by various estimates, it occurs in every second to fourth woman of reproductive age, more often after age 30, and accounts for 12–25% of all gynecological diseases.

A nodule is a rounded tangle of chaotically interwoven smooth muscle fibers: from a few millimeters to several centimeters, sometimes up to kilograms. Each nodule grows from a single smooth muscle cell. Fibroids are hormone-dependent: receptors for sex hormones are found in the tissue, the tumor appears at high estrogen levels and regresses after menopause.

Types of fibroids: uterine body and cervix

By the number of nodules, single and multiple fibroids are distinguished. By location, there are intramural (interstitial) nodules within the uterine wall, the most common variant: 50–61%; subserosal nodules on the outer side of the uterus — 26–35%, sometimes pedunculated; submucosal nodules closer to the uterine cavity — no more than 13%, such a nodule may descend into the cervix or vagina. Intraligamentary and cervical fibroids are distinguished separately — a nodule in the cervix.

Causes and risk factors of uterine fibroids

The exact cause is unknown; genetics and growth hormones are discussed, and estrogen and progesterone apparently support nodule growth. Risk factors: age (the older, the higher the risk), Black or Asian ethnicity — in Black women fibroids appear earlier and tend to be larger, fibroids in a mother or sister, onset of menstruation before age 10, absence of a full-term pregnancy, obesity, vitamin D deficiency, high blood pressure, and diabetes. The risk is lower with each pregnancy and with long-term use of hormonal contraceptives.

Symptoms of fibroids, including discharge

In about half of cases, fibroids are asymptomatic, and they are discovered incidentally. If symptoms are present, they depend on the location, size, and number of nodules. Heavy or painful periods and bloody discharge between periods are what is usually sought as "discharge with fibroids." Heavy periods are more often caused by submucosal nodules, and a feeling of heaviness in the lower abdomen by large intramural and subserosal ones.

• pain in the lower abdomen and lower back;
• frequent urination, sudden urges, incontinence;
• bloating, constipation, or pain during bowel movements;
• pain or discomfort during sex;
• difficulty conceiving.

Pain usually occurs during menstruation and may be cramping, but can be constant. Sudden sharp pain is a sign of a rare complication, torsion of the pedicle of a subserosal nodule.

How uterine fibroids are diagnosed

The doctor asks about symptoms and performs an examination: abdomen, pelvic area, internal vaginal examination. If fibroids are suspected, you will be referred to a specialist for an ultrasound — it will show whether there are nodules, how many there are, where they are, and how large they are. Transvaginal or transabdominal ultrasound is the most informative method: nodules are seen as rounded areas of reduced echogenicity. Sometimes fibroids are found on scans for another reason, for example during a pregnancy ultrasound. To distinguish them from an ovarian tumor, an MRI may be suggested, as well as tests for hormones, microflora, and cytology.

Possible complications and when to see a doctor

Without monitoring, fibroids can cause complications: iron-deficiency anemia due to heavy bleeding, urinary tract infections and urination problems due to pressure from a large nodule on the bladder, and less often infertility and miscarriages. Many women with fibroids conceive without problems, but some nodules affect conception, fetal development, and childbirth. You should see a doctor if symptoms appear, if they interfere with life, work, and relationships, and also if painkillers do not help.

The presence of fibroids alone is not a reason to call an ambulance. 103 or 112 — for a life-threatening emergency, as in a serious accident, stroke, or heart attack.

This material is for reference and does not replace a doctor's consultation: discuss your nodules, their sizes, and the monitoring plan with your gynecologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer