Uterine fibroids, also known as uterine leiomyomas, are the most common pelvic tumors. These are noncancerous outgrowths that can be solitary or multiple and appear on different parts of the uterus. Many women have them at some point in their life, but they mostly remain asymptomatic. Sometimes, women can experience abnormal uterine bleedings, pelvic pain, pain during sex, frequent urination, constipation, pregnancy complications, etc. There are several risk factors influencing the development of the fibroids such as age, race, genes, lifestyle, diet, and other diseases. The diagnosis is based on the pelvic examination and ultrasound. The treatment depends on the size, location, and whether there are any symptoms present. Various options are available, including medications and different procedures.
The prevalence of uterine fibroids is estimated to be around 75% of women in their reproductive age. [1] Leiomyomas do not occur before puberty, their frequency increases with age and decreases in postmenopausal women. The prevalence is higher in African-American women, they also tend to have uterine fibroids at a younger age and are more prone to get larger or more fibroids with more severe symptoms.
There are several modifiable and non-modifiable risk factors influencing the development of this disease.
These include age, race, genetic predisposition, the onset of menarche (first menstruation) and menopause (last menstruation), infertility, and other diseases like diabetes, polycystic ovary syndrome. The modifiable risk factors are related to lifestyle and diet. Obesity, unhealthy diet, stress, alcohol and caffeine consumption, low physical activity, low vitamin D levels and hormone replacement therapy are some of the most important risk factors that can be influenced by some lifestyle changes.
There is a genetic predisposition to leiomyomas. It can develop as part of an autosomal dominant disease - hereditary leiomyomatosis and renal cell cancer. This condition results from an inherited mutation of the FH gene (fumarate hydratase), which is an enzyme involved in the Krebs cycle. Sometimes only one copy of the gene is affected, but the disease develops due to mutations of the second copy in certain cells throughout life. More commonly it presents as a disease with multifactorial inheritance and multiple genes can be affected.
A lot of cases of uterine leiomyomas are asymptomatic. The fibroids can be solitary or multiple, they can grow slowly or rapidly, remain the same or shrink in size. These growths can develop within the wall of the uterus, inside the main cavity of the organ, or even on the outer surface.
We can divide the symptoms into 3 categories: abnormal uterine bleedings (heavy or prolonger periods, menstrual cramps), symptoms related to the physical presence of the growths (constipation, frequent urination, lower back pain, pelvic pain or pressure, pain during sex, etc) and reproductive dysfunction (infertility, miscarriage, pregnancy complications, etc).
Uterine leiomyomas are frequently found during a routine pelvic examination. Pelvic ultrasound is performed to assess the size and location of the fibroids. Additional imaging examinations can be performed, like MRI, CT, etc.
There are several treatment options for uterine fibroids. In case a woman does not experience any symptoms or only experiences mild symptoms, monitoring the progression is sufficient. There are various medications that can shrink the fibroids but not eliminate them completely. Some non-invasive and invasive procedures can remove the fibroids but the only permanent solution is the removal of the uterus (hysterectomy).
There are several ways to influence the development of uterine fibroids, mostly through lifestyle modifications. It can be beneficial to change your diet: lower intake of red meat, caffeine, alcohol, and higher intake of fish, green vegetables, fruit, and vitamin D. Another protective factor can be high parity (3 or more deliveries) and breastfeeding. In the case of pregnancy, it’s important to monitor the fibroids as they can grow due to hormonal changes.
Uterine fibroids can either shrink (can happen after menopause or after pregnancy), grow (rapidly or slowly), or stay the same. Several complications may develop. Due to heavy or prolonged periods, there can be a drop in the number of red blood cells (anemia) and you can experience fatigue, weakness, dizziness or paleness. Fibroids can also lead to infertility, pregnancy loss, preterm delivery, etc.
Infrequently, a submucosal leiomyoma will prolapse through the cervix and present with a mass, bleeding, and possible ulceration or infection.
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