Fibroids are benign (non-cancerous) tumours and they grow on or in the muscular layer of the uterus (womb). When they predominantly grow on the outer layer of the womb muscle they are called subserosal, when they grow inside the womb muscle layer they are called intramural and finally when they grow close and in contact with the womb cavity they are called submucosal. Sometimes they are only hanging from a vascular stalk and are called pedunculated fibroids.
Fibroids are very common in women of childbearing age (often appear between 25 to 40 years of age) and their population prevalence is around 20-30%, they are more frequent in women of Afro-Caribbean origin and high BMI.
Not a lot is known about what causes fibroids and there are a number of factors, amongst them (epi)genetic (familial), hormonal and environmental or their combination. Fibroids tend to originate from a stem cell in the smooth muscular tissue of the uterus (myometrium).
A single cell divides repeatedly under the ovarian hormonal influence (oestrogen/progesterone), eventually creating a firm, rubbery mass distinct from nearby tissues of the womb; often reaching a few centimetres in size.
It is unusual that they grow in menopause, instead during that period they gradual shrink in size. Very rarely (<1%) a fibroid can become malignant, called sarcoma (1).
Fibroid symptoms are comprised of heavy menstrual bleeding, pain and pressure symptoms.
On many occasions fibroids are asymptomatic, and women may incidentally find out about them on a routine gynaecological examination with a pelvic ultrasound scan.
Heavy menstrual bleeding is the most common symptom.
Large fibroids (>5cm) increase the uterine surface area reducing the contractile ability of the womb. In severe cases it can lead to iron deficiency anaemia due to the prolonged and heavy blood loss.
Pain can be experienced when passing large blood clots or due to large fibroids pushing against your lower back (affecting lumbar-sacral ligaments and nerve trunks).
On some occasions women may also experience pain during intimate contact.
When fibroids grow to a large size, they may lose their vascular supply (degeneration) or rotate around their axis (torsion), causing them to become ischemic and necrotic. This can cause sharp and intense pain.
Pressure symptoms depend on the organ or structure being externally compressed.
Urinary symptoms such as frequency or incontinence are commonly observed when large fibroids press against the urinary bladder.
If the tubes connecting the kidneys to the bladder (called ureters) are compressed then this can lead to the swelling of the ureter (hydroureter) or the kidney (hydronephrosis). This is often insidious since it occurs gradually over time, and can lead to loss of kidney function over time.
Constipation and hemorrhoids have also been reported when fibroids affect the colon and impact on defecation.
On rare occasions, pressure against pelvic vessels can cause thrombophlebitis and risk of blood clot formation (deep vein thrombosis).
Fibroids can also cause subfertility due to the distortion of the endometrial cavity and the external compression/blockage of the Fallopian tubes.
If you suffer from heavy bleeding or pelvic pain/pressure symptoms, then contact your gynaecologist for a review and examination.
References:
http://www.britishfibroidtrust.org.uk
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