May 31, 2024
By Jennifer Nguyen, Drexel University College of Medicine

Uterine fibroids, also known as leiomyomas, are the most common benign (noncancerous) tumors made of smooth muscle and connective tissue that develop in the myometrium layer of the uterus. They are the most common pelvic tumors among women of reproductive age, affecting more than 70% of women worldwide. They vary in size, ranging from pea-sized growths to large masses. The cause of uterine fibroids is unclear, but studies have shown factors such as lifestyle, age, environment, genetic predispositions and hormonal influences may contribute to their development.

Approximately 30% of women with uterine fibroids experience symptoms, meaning many women with uterine fibroids are asymptomatic. When symptoms do occur, they can cause irregular and heavy menstrual bleeding, pelvic pain or pressure, frequent urination and lower back pain. Some women may also experience challenges with fertility and pain during sexual intercourse. While uterine fibroids are generally benign, they can lead to severe complications such as anemia, infertility, preterm labor and recurrent pregnancy loss. Therefore, it is important for women to be aware of potential risks and seek medical advice if they are experiencing symptoms.

Several factors may affect a women’s risk for developing uterine fibroids. This includes age greater than 40 years old, hypertension and family history of uterine fibroids. Studies have also suggested genetics and prolonged exposure to estrogen may increase the risk of women developing uterine fibroids. Most notably, African American women have been shown to be at higher risk of developing uterine fibroids at an early age in comparison to Caucasian women.

The reason for this is not clearly understood. Additionally, uterine fibroids are thought to be under hormonal control and respond to both estrogen and progesterone. They grow rapidly during pregnancy and shrink during menopause.

The evaluation of uterine fibroids is done during a routine pelvic exam. During this exam, a physician may examine the uterus, ovaries and vagina. The physician may feel a firm, irregular mass that could indicate a fibroid. To confirm a diagnosis of uterine fibroids, imaging studies may be performed. The preferred initial imaging study to detect uterine fibroids is transvaginal ultrasonography. This study involves a small instrument that is inserted into the vagina and uses sound waves to capture pictures of internal organs. This allows for a clearer picture of the sizes, shapes and textures of any growths occurring within the uterus.

Understanding uterine fibroids is essential for proper management of the condition. Routine gynecological check-ups are crucial for early detection and monitoring of uterine fibroids. Treatment of uterine fibroids should be tailored to the patient’s age, symptoms, desire for fertility, and size and location of the tumors. For patients without symptoms, treatment is not necessary and continued monitoring is preferred. For patients with symptoms, depending on the severity, medical management with may be indicated. Over-the-counter medications such as NSAIDs or acetaminophen may be used mild pain. Hormonal contraceptives such as birth control pills and levonorgestrel-releasing IUDs may treat abnormal uterine bleeding associated with uterine fibroids. Gonadotropin-releasing hormone agonists may also be used to decrease the size of uterine fibroids. In severe cases, surgery may be considered. For women who wish to have children, a myomectomy is recommended. This procedure removes the fibroids while the uterus stays intact. For women who do not wish to have children, a hysterectomy may be performed. This procedure involves removal of the entire uterus and is the most effective method of uterine fibroid treatment for patients with severe symptoms.

Sources/Resources:

• De La Cruz MS & Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017 Jan 15;95(2):100-107. PMID: 28084714
• Navarro, A., Bariani, M. V., Yang, Q., & Al-Hendy, A. (2021). Understanding the Impact of Uterine Fibroids on Human Endometrium Function. In Frontiers in Cell and Developmental Biology (Vol. 9). Frontiers Media SA. https://doi.org/10.3389/fcell.2021.633180
• Sefah, N., Ndebele, S., Prince, L., Korasare, E., Agbleke, M., Nkansah, A., Thompson, H., Al-Hendy, A., & Agbleke, A. A. (2023). Uterine fibroids — Causes, impact, treatment, and lens to the African perspective. In Frontiers in Pharmacology (Vol. 13). Frontiers Media SA. https://doi.org/10.3389/fphar.2022.1045783
• Qiwei Yang, Michal Ciebiera, Maria Victoria Bariani, Mohamed Ali, Hoda Elkafas, Thomas G Boyer, & Ayman Al-Hendy. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocrine Reviews, Volume 43, Issue 4, August 2022, Pages 678–719, https://doi.org/10.1210/endrev/bnab039