Uterine fibroids are noncancerous growth of the uterus that frequently appears through the childbearing years. Many women often do not have any associated symptoms. In those that do, symptoms are influenced by the location, size and number of fibroids. In women who present symptoms, the most common symptoms of uterine fibroids include:
- Heavy menstrual bleeding
- Menstrual periods lasting more than a week
- Pelvic pressure or pain
- Frequent urination
- Difficulty emptying the bladder
- Constipation
- Backache or leg pains
Types of fibroids by location
Fibroids are described by their position in the uterus (FIGO classification): submucosal (projecting into the uterine cavity), intramural (within the muscle wall) and subserosal (on the outer surface), with some being pedunculated or cervical. Location affects symptoms, fertility impact and the choice of treatment.
Causes and risk factors
The exact cause of fibroids is not fully understood. Hormonal influences, genetic changes and growth factors are thought to play a role.
Fibroids and fertility
Fibroids that distort the uterine cavity may affect fertility or pregnancy outcomes. Many fibroids that do not distort the cavity do not need treatment for fertility reasons. Decisions take into account your age, symptoms and plans for pregnancy.
Treatment options
Management depends on symptoms, age, size, number and location of fibroids, cavity distortion and reproductive plans. No single treatment is the best or fertility-preserving for every patient. Options include:
- Observation (expectant management) when there are no symptoms
- Medical treatment, such as tranexamic acid, hormonal treatments including GnRH agonists or antagonists, and a levonorgestrel intrauterine system for heavy bleeding
- Hysteroscopic myomectomy for submucosal fibroids
- Laparoscopic or open myomectomy (uterus-preserving surgery)
- Uterine artery embolization (UAE), radiofrequency ablation (RFA) and MR-guided focused ultrasound (MRgFUS), which may require referral to a centre with the relevant facilities
- Endometrial ablation for heavy bleeding in selected women not planning pregnancy
- Hysterectomy, when childbearing is complete or other options are unsuitable
Chronic pelvic pain
Chronic pelvic a pain is pain in the area below the umbilicus region that lasts for a period of six months or longer.
Causes
- Endometriosis
- Musculoskeletal problems
- Chronic pelvic inflammatory diseases
- Fibroids
- Irritable bowel syndrome
- Interstitial cystitis
- Pelvic congestion syndrome
Symptoms
Usually, chronic pelvic pain is described in one or more of the following ways
- Severe pain
- Intermittent in nature
- Dull aching type
In addition the patient experiences
- Pain during the intercourse
- Pain during bowel movement or urination
- Pain when you sit down for prolonged periods of time
Diagnosis
- Pelvic examination
- Ultrasound tests
- Imaging tests including computerized tomography, magnetic resonance imaging
- Laparoscopy
Treatment
- Medications including analgesics, antibiotics and antidepressants
- Physical therapy
- Uterine Stimulation
- Trigger point injections
- Psychotherapy
- Hysterectomy
