What Are Fibroids | UCLA Health

In addition to understanding what a fibroid is, here are some other key points about uterine fibroids you should be aware of:

• Uterine fibroids are the most common tumor of the reproductive tract.
• Women who are nearing menopause are at the greatest risk for fibroids.
• Fibroids are most often found during a routine pelvic exam.
• Symptoms may include heavy and prolonged periods, bleeding between periods and pelvic pain.
• There are a variety of treatment options available.

Types of fibroids

Now that you know what a fibroid is, it’s time to discuss types of fibroids. Along with the size and number of fibroids, the type can also affect treatment recommendations. The three main types of fibroids include:

• Subserosal fibroids: These are the most common fibroids. They can push outside of the uterus into the pelvis. Subserosal fibroids can grow large at times and sometimes have a stalk that attaches to the uterus (pedunculated fibroid).
• Intramural fibroids: These fibroids develop in the muscular wall of the uterus.
• Submucosal fibroids: These fibroids are uncommon. They can grow into the open space inside the uterus and may also include a stalk.

What causes fibroids?

The cause of uterine fibroids is not known, although studies demonstrate there may be a genetic component. There is no definite external exposure that a woman can have that causes her to develop fibroids.

Who is at risk for uterine fibroids?

Various factors can increase the risk of developing fibroids:

• Age: Fibroids become more common as women age, especially during their 30s and 40s and up to menopause. After menopause, fibroids are much less likely to form and usually shrink if they’re present.
• Family history: Having a family member with fibroids increases your risk. If a woman’s mother had fibroids, her risk of having them is about three times higher than average.
• Ethnic origin: African-American women are more likely to develop fibroids than other ethnicities .
• Obesity: Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.

What are the symptoms of uterine fibroids?

Most women with fibroids will experience no symptoms at all. However, large or numerous fibroids can cause the following symptoms:  

• Heavy or prolonged periods
• Bleeding between periods
• Pelvic pain and pressure
• Frequent urination
• Low back pain
• Pain during intercourse
• Difficulty getting pregnant

How are uterine fibroids diagnosed?

Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam.

Scans can confirm a diagnosis. These tests are the two main options:

• Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.  Other tests such as MRI may be better for other conditions, such as adenomyosis.
• MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.

Other tests for uterine fibroids

In special circumstances or if doctors can’t identify the source of your pain, you may need additional testing:

• Hysterosalpingogram (HSG): Doctors typically use an HSG for women having trouble getting pregnant. It checks the inside of the uterus (uterine cavity) and fallopian tubes. After a doctor places a catheter (small tube) in the uterus, the doctor slowly injects a special dye for contrast and takes X-rays.
• Hysterosonogram: Doctors use a hysterosonogram to see the inside of the uterus. After they place a small catheter inside the uterus, they inject water while taking a series of ultrasound images. The test can confirm the presence of uterine polyps or intracavitary fibroids that can cause heavy bleeding.
• Laparoscopy: For laparoscopy, a doctor makes tiny incisions in or near the navel. The doctor then inserts a long, thin instrument (laparoscope) into the abdomen and pelvis. The laparoscope has a bright light and a camera. It allows your doctor to see the uterus and surrounding structures. The view can help your doctor determine if you have a condition such as endometriosis, which can cause pelvic pain.
• Hysteroscopy: For suspected abnormalities inside the uterus, a doctor uses a long, thin instrument with a camera and light. The doctor passes the instrument through the vagina and cervix into the uterus. No incision is needed. The doctor can look for fibroids or endometrial polyps within the cavity of the uterus with this approach. Your doctor may also remove some types of fibroids during this procedure.

How are uterine fibroids treated?

Since most fibroids stop growing and may even shrink as women approach menopause, your doctor might initially recommend observation. However, some fibroids might require more active treatment, depending on:

• Extent of symptoms
• Your age
• Your fertility goals
• Number and size of the fibroids
• Any previous fibroids treatments
• Other health conditions present

Learn more about fibroid treatment.

What are the complications of uterine fibroids?

It is uncommon for fibroids to cause severe health consequences. However, women can have heavy bleeding that can lead to dangerous anemia, or lack of red blood cells.

Rarely, large fibroids can press on the bladder and the channel (ureter) that sends urine there from the kidney. This pressure can lead to kidney damage. Other complications include infertility and repeated pregnancy loss.

A Visual Guide to Uterine Fibroids

Medically Reviewed by Dany Paul Baby, MD on June 26, 2022

Uterine fibroids are noncancerous growths of the muscle tissue of the uterus. Fibroids can range in number and size from a single growth to multiple growths, and from very small to large. As many as 70% to 80% of all women will have fibroids by age 50. The medical term for fibroids is leiomyoma or myoma.

Fibroids may cause very mild symptoms, none at all or symptoms can be severe. In women who do feel symptoms, these uterine growths can cause:

• Pressure on the bladder or rectum
• Frequent urination
• Constipation and/or rectal pain
• Lower back and/or abdominal pain

If fibroids become very large, they can distend the stomach, making a woman look pregnant.

Fibroids may also cause changes to a woman’s period, including:

• Mild to severe cramping and pain
• Heavier bleeding, sometimes with blood clots
• Longer or more frequent menstruation
• Spotting or bleeding between periods

Fibroids are one cause of severe menstrual pain, but the pain also can be caused by endometriosis. Endometriosis occurs when tissue from the inner lining of the uterus grows in other parts of the body — illustrated here by growths on the outside of the uterus and bladder. This tissue breaks down and bleeds during your period, causing pain during your cycle and painful scar tissue. The pain of fibroids or endometriosis also can occur between periods.

The exact cause of fibroids is unknown. Their growth has been linked to the female hormones estrogen and progesterone. Studies have found that women who start their periods at a younger age are more likely to develop fibroids. Although taking female hormones is linked to fibroids, the use of birth control pills is not.

• Intramural fibroids, the most common, grow in the wall of the uterus.
• Subserosal fibroids grow on the outside of the uterus. As they grow larger, they can cause pain due to their size or pressure put on nearby organs.
• Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterus cavity and lead to heavy bleeding and other more serious complications.
• Pedunculated fibroids grow on small stalks inside or outside the uterus. 

It’s possible to have more than one type of fibroid.

While it’s unclear why women develop fibroids, some patterns have been observed.

• They usually occur between the ages of 30 and 40.
• They are more common in black women.
• They grow more quickly and appear at a younger age in black women.
• Having a family member with fibroids increases a woman’s risk.
• Being overweight or obese and having high blood pressure also may increase your risk.

Some women with fibroids who experience unusually heavy bleeding during their periods may become anemic. Many cases of anemia due to iron deficiency from periods are mild and can be treated with a change in diet and iron supplement pills. Untreated anemia can lead to fatigue and lethargy — and, in severe cases, heart problems.

Fibroids usually do not interfere with fertility and pregnancy. However, some women with fibroids experience more pregnancy complications and delivery risks. Fibroids may cause the baby to be in an abnormal position and can cause preterm labor. They may also cause pelvic pain and heavy bleeding after delivery, which may require surgery. In some instances, fibroids may block your fallopian tubes. Fibroids growing along the inner uterine wall may make it difficult for a fertilized egg to attach. 

See your health care provider if you have the following fibroid symptoms:

• Heavy menstrual bleeding
• Periods that became more painful
• Frequent urination or inability to control the flow of urine
• A change in the length of your period over three to six cycles
• New persistent pain or heaviness in lower abdomen or pelvis

Your doctor may feel moderate and large uterine fibroids during a routine pelvic exam. Tests, such as an ultrasound, can show information about size and location of other fibroids. For women with fibroids who are trying to get pregnant, a test called a hysterosalpingogram will show an outline of the uterus and fallopian tubes and may detect abnormalities. Other procedures to visualize the inside of the uterus or abdomen also may be needed.

Pain medications, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like as ibuprofen or naproxen, can help relieve menstrual cramping.

Oral contraceptives manage levels of estrogen and progestin. This usually leads to lighter periods and can alleviate some of the pain associated with fibroids, such as heavy bleeding and cramping. Other hormonal birth control methods that may lessen fibroid symptoms include progestin injections or progestin-releasing IUDs.

Drugs called gonadotropin-releasing hormone (GnRH) agonists may offer temporary symptom relief from fibroids by stopping periods and shrinking fibroids. GnRH agonists block the production of estrogen, so they can also cause bone loss, hot flashes, and vaginal dryness. Fibroids will return to their previous size once treatment ends. These may be used to shrink fibroids before fibroid removal surgery.

For mild to moderate symptoms, uterine fibroid embolization may be a good option. A catheter is guided to the uterine artery. Tiny particles of plastic or gelatin are then released into the blood vessels that feed the fibroid, causing it to shrink over time. Embolization should not be an option for women wanting to get pregnant at some point after treatment.

A myomectomy typically removes the largest fibroids. It’s is an option for women who want to still have children. A hysterectomy is when the uterus is removed. There is a small chance that what was thought to be a fibroid could instead be a cancer called uterine sarcoma. For this reason, the FDA recommends not cutting the fibroid into small sections before removing it, a process called laparoscopic morcellation. Endometrial ablation, which is good for treating smaller fibroids, destroys the lining of the uterus, so pregnancy is not possible.

Ultrasound is one way to destroy fibroids without risk of damaging the uterus. The treatment uses high-intensity ultrasound waves that kill the fibroid tissue. Most women recover quickly from this procedure and can return to regular activities within 24 hours. The long-term effects are still being studied, and it is not recommended for women who want to become pregnant.

Regular exercise may prevent fibroids. In one study, women who exercised seven or more hours a week had significantly fewer fibroids than women who exercised less than two hours a week. Obesity also is a risk factor for fibroids. So exercising regularly can help you maintain a healthy weight and reduce your fibroid risk.

Women with fibroids who are not getting enough iron through diet alone may develop anemia, where the body has fewer red blood cells than normal. Symptoms include fatigue, chest pain, and shortness of breath. Treatment may include eating more iron-rich foods, such as meats, poultry, fish, leafy greens, legumes, and iron-fortified breads and cereals. Your health care provider also may suggest iron supplements.

IMAGES PROVIDED BY:

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(19)    Kate Brittle/Flickr

REFERENCES:

Agency for Healthcare Research and Quality.
American College of Obstetricians and Gynecologists.
American Pregnancy Association.
Baird, D. American Journal of Epidemiology, 2007.
Center for Uterine Fibroids, Brigham and Women’s Hospital.
Discovery Fit & Health.
Focused Ultrasound Surgery Foundation.
Gaskins, A.J. European Journal of Nutrition.
Merck Manual Home Health Handbook.
Myomectomy.net.
National Institute of Child Health & Human Development.
National Uterine Fibroids Foundation.
New York University Langone Medical Center, department of obstetrics and gynecology.
Skilling, J. Fibroids: The Complete Guide to Taking Charge of Your Physical, Emotional, and Sexual Well-Being.
Society of Interventional Radiology.
University of Maryland Medical Center.
University of North Carolina Fibroid Care Clinic.
U.S. Department of Health and Human Services.
UptoDate: “Patient Information: Uterine Fibroids.”
Uterine-Fibroids.org.
WomensHealth. gov: “Uterine fibroids fact sheet.”
Yale School of Medicine, Obstetrics, Gynecology, & Reproductive Sciences.
FDA web site.

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Uterine fibroids along the anterior wall during pregnancy

Updated: January 31, 2020

Liana Nazimovna Aminova — obstetrician-gynecologist, oncologist | Obstetrician-gynecologist, oncologist, candidate of medical sciences

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Contents of the article

• Causes
• Signs and symptoms
• What causes uterine fibroids in the anterior wall during pregnancy
• Diagnosis of fibroids in the uterine wall

900 02
Myoma on the anterior wall of the uterus is a common type of disease. With this pathology, a benign tumor is located in the body of the reproductive organ. In recent years, the prevalence of the disease among young women has increased, due to the fact that the first pregnancy in most cases occurs no earlier than 23 years.

Treatment of myomatous nodes on the anterior wall of the uterus is carried out by various methods. Among which, uterine artery embolization is recognized as the safest and most effective by gynecologists, which allows not only to preserve the reproductive organ, but also to prevent the development of relapses.

Reasons

The reasons for the development of fibroids are not fully understood by specialists. Obstetrician-gynecologist D.M. Lubnin and other qualified specialists believe that the development of nodes is due to damage to the cells of the uterus caused by repeated menstruation.

In the course of numerous studies, it has been established that the growth of nodes occurs under the influence of the hormone progesterone. In women who are overweight, experiencing regular stress, as well as during pregnancy, hormonal imbalances occur, resulting in the progression of the disease.

A number of factors contribute to the development and progression of a benign tumor:

• genetic predisposition. The likelihood of myomatosis is higher in those women whose mothers had this disease;
• difficult births, abortions and diagnostic curettage are associated with mechanical damage to the tissues of the uterus, therefore, in this case, the likelihood of developing benign neoplasms is high;
• chronic diseases of the reproductive system;
• ovarian diseases causing hormonal disruptions;
• diseases of the endocrine system;
• irregular sexual life;
• no orgasms.

Many patients turn to a gynecologist with complaints of signs indicating the development of large nodes. The reason for this is the lack of preventive examinations and untimely visits to a specialist. In the modern world, women can get advice by e-mail from highly qualified specialists, after which they can make an appointment and undergo an examination.

Signs and symptoms

Most women diagnosed with this pathology note that fibroids in the uterine wall developed asymptomatically for a long time. The main signs indicating the development of the pathological process at the initial stage are:

• irregular menstruation;
• copious discharge;
• prolonged menses;
• spotting and bleeding resulting in anemia.

With an increase in a benign tumor in the uterus, the functions of the excretory system and intestines are disrupted. So, a woman may experience regular urge to urinate, a feeling of pressure on the bladder. With the growth of the tumor, regular constipation is noted, caused by pressure on the rectum.

Myoma on the anterior wall in most cases is the cause of pain in the lumbar region during sex. Patients with this disease note a general deterioration in well-being. With giant fibroids, there is an increase in the lower abdomen, which can be mistaken for pregnancy or weight gain caused by overeating.

A large tumor in the uterus can cause obstruction, resulting in infertility. In this case, organ-preserving techniques are used to remove or reduce the size of the neoplasm.

Leading clinics for the treatment of fibroids perform uterine artery embolization for patients planning a pregnancy. UAE contributes to a gradual reduction in the size of the tumor, it gradually turns into a connective tissue that is not a pathology.

What causes uterine fibroids along the anterior wall during pregnancy

Fibroids in the bottom of the uterus and pregnancy are compatible, a woman diagnosed with myomatous nodes can bear and give birth to a healthy child, but this requires compliance with the doctor’s recommendations. Regular visits to the gynecologist allow you to monitor the course of pregnancy and the condition of myomatous nodes.

A woman in this condition should be prepared for a possible increase in the tumor in the first and early second trimesters. Small knots do not cause unpleasant symptoms. They rarely cause complications. Large uterine fibroids along the anterior wall during pregnancy are often manifested by pain localized in the lower back, nausea and fever. When these symptoms appear, a woman needs emergency medical attention.

Experts recommend treating fibroids before conception, as there is a possibility of various complications developing in the mother and fetus. Large benign tumors in the reproductive organ put pressure on nearby organs, deform the uterus and negatively affect the fetus.

The mechanism of development of uterine fibroids has not been fully studied by specialists, however, the available studies allow us to determine possible complications during pregnancy:

• large myomatous nodes in the uterus located on the anterior wall can contribute to miscarriage. With spontaneous abortion, severe pulling pains, spotting and increased tone of the muscles of the uterus occur. A woman in this condition needs emergency help;
• preterm delivery before 37 weeks of gestation may occur with multiple myomatosis, close location of the tumor with the placenta;
• placental abruption and bleeding occur in women with this disease is extremely rare;
• fetal malposition due to uterine deformity;
• postpartum hemorrhage.

Uterine fibroids on the anterior wall is not an indication for caesarean section, but this operation is performed in most patients. With small myomatous nodes, a woman can give birth on her own without surgical intervention.

Diagnosis of fibroids in the uterine wall

Suspicions of uterine fibroids cause anxiety in many women, they fear that the genital organ will be removed during the treatment of the disease. Comprehensive diagnostics allows you to establish how fibroids develop on the anterior wall of the uterus and what methods are appropriate to use for its therapy.

Gynecological examination, laboratory and instrumental studies are the main methods used to collect data and make a diagnosis. Myomatosis at the initial stage of development may not give characteristic symptoms. Pathology in this case is detected by chance, during an ultrasound or gynecological examination.

Hardware methods for diagnosing myomatous nodes are:

• Pelvic ultrasound using transabdominal and transvaginal probes;
• x-ray examination;
• hysteroscopy and laparoscopy;
• colposcopy;
• magnetic resonance imaging.

In 95% of cases, an ultrasound examination is necessary to make a diagnosis. The main advantages of this method are: accessibility and high information content. A transabdominal examination through the anterior abdominal wall can be used to diagnose a tumor. Transvaginal diagnosis is performed through the vagina.

Fibroids in the uterine wall cannot be diagnosed using laboratory methods alone. They are used to identify concomitant pathologies and changes in the body of a woman caused by the disease. With myomatosis, there is a hormonal imbalance, for the detection of which the level of hormones is determined. A complete blood count is a mandatory study in which iron deficiency anemia can be established.

The use of MRI in most cases is an excessive measure. This study allows us to assess the structure of the neoplasm, its size and the dynamics of the progression of the pathology. To undergo an examination, you must make an appointment with a highly qualified gynecologist who will determine the necessary diagnostic measures and develop a safe treatment program.

Myomatous nodes in the development process can affect other organs and systems, so their identification should be treated. A safe alternative to surgical removal of the tumor is uterine artery embolization, which disrupts the nutrition of the tumor. After this procedure, patients give birth to healthy children and do not experience unpleasant symptoms.

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References:

1. Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of tumor nodes in uterine myoma // Obstetrics and Gynecology. – 1983. – T. 4. – S. 13-16.
2. Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
3. Meriacri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib honey journal 1998; 2:8-13.
4. Bobrov B.Yu. Uterine artery embolization in the treatment of uterine fibroids. The current state of the issue // Journal of obstetrics and women’s diseases. 2010. №2. pp. 100-125
5. B. Yu. Bobrov, SA Kapranov, VG Breusenko et al. Uterine artery embolization: a modern view of the problem. «Diagnostic and interventional radiology» volume 1 № 2 / 2007

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Subserous uterine fibroids – causes, symptoms, diagnosis, treatment and prevention

• Causes of subserous uterine fibroids
• Subserous uterine fibroids and pregnancy
• Symptoms of subserous uterine fibroids
• Diagnostics
• Treatment at ON CLINIC
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Subserous fibroids can be single or multiple. Single nodes are enclosed in a special capsule consisting of muscle fibers, and multiple nodes can be located intramurally, that is, in the thickness of the muscle layer. The size can range from a few millimeters to several centimeters. It is also called interstitial subserous uterine fibroids.

The tumor can have both a wide base, attached to the muscular wall, and a thin stalk. In some cases, it is freely located in the abdominal cavity or localized in the ligaments of the uterus. The growth rate depends on whether it is simple or proliferating (that is, capable of increasing in size).

Causes of subserous uterine fibroids

Risk factors include:

• hormonal imbalance,
• chronic infectious diseases,
• diseases of the thyroid and adrenal glands,
• obesity,
• stresses,
• heredity.

If your mother and grandmother had fibroids, you are at increased risk.

Termination of pregnancy, lack of childbirth and breastfeeding, chronic diseases of the female genital area and long-term use of oral contraceptives can also cause the development of the disease.

Subserous uterine fibroids and pregnancy

In most cases, this problem does not prevent pregnancy and childbirth. However, tumors that are large and thin-stalked (which increases the risk of torsion) can still lead to complications. In addition, it disrupts the hormonal background, which affects the muscles of the uterus and can contribute to miscarriages and premature births. Pregnancy in a woman with fibroids requires increased attention from doctors.

Symptoms of subserous uterine fibroids

Most often it does not manifest itself in any way, but nevertheless in some cases it makes itself felt:

• menstrual disorders,
• bleeding,
• developing as a result of this iron deficiency anemia.

Also, the tumor disrupts the function of the urinary system and intestines, which can lead to stagnation of urine and constipation.

If the formation is located on the front wall, then it can interfere with urination, which can ultimately lead to impaired renal function and the formation of stones, the development of renal colic. Perhaps the development of pyelonephritis, the treatment of which must necessarily be combined with the treatment of the underlying disease. When the myomatous node is localized on the back wall of the uterus, it can disrupt the functioning of the digestive organs. In this case, the woman is concerned about constipation, leading to anal fissures and hemorrhoids.

The growth of the neoplasm can also lead to pain in the lower abdomen, radiating to the lower back and legs. There is a feeling of discomfort during intercourse. Symptoms from other internal organs are also possible – pain in the heart and headache.

Torsion of the myoma stem and lack of nutrition of the tumor tissue are accompanied by severe pain, dizziness, fainting, sweating and fever. This condition is a medical emergency.

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Diagnostics

Quite often it is detected by chance, during a preventive examination by a gynecologist, as well as during ultrasound.

To clarify the diagnosis, the doctor performs x-rays of the pelvic organs, as well as computed or magnetic resonance imaging.

Treatment at ON CLINIC

When drawing up a treatment plan, the doctor takes into account:

• tumor size,
• its localization,
• patient age,
• her plans for further pregnancies.

Large fibroids must be removed surgically.

Turning to us, you can be sure that the doctors from the ON CLINIC medical center will do everything possible to avoid hysterectomy – removal of the uterus. We practice sparing intervention – arterial embolization or myomectomy. We also use conservative methods of treatment, including hormone therapy.

If you suspect or confirm such a diagnosis, seek help from ON CLINIC gynecologists, who will do everything possible to make the treatment as effective as possible. Your health is in our hands!

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