More than 30% of women of child-bearing age have fibroids. Some women have fibroid tumours but are ignorant of it because the tumours are still small and not yet diagnosed. With the record at hand, it has been forecasted that 30 – 80% of women will develop fibroids sometime during their reproductive years, although only about one-third of these fibroids are large enough to be detected by a health care provider during a physical examination.

In most cases of fibroids, the tumours are benign (non-cancerous). Benign tumours are not associated with cancer and have nothing to with the development of uterine cancer.

What Exactly Are Fibroid Tumors?

Fibroids (also known as Myomas, Uterine myomas, Leiomyomas, or Fibromas) are compact tumours made up of smooth muscle cells and fibrous combinatorial tissue that develop in the uterus (womb). Fibroids are non-cancerous tumours that grow in the womb. They can vary greatly in size; ranging from the size of a pea to the size of a softball or small grapefruit. According to the National Institutes of Health (NIH), about 80% of women develop these tumours by the age of 50. Fibroid Tumors are the most regularly seen tumours of the feminine reproductive system.

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What Are The Types Of Fibroid tumours?

Fibroid tumours are usually classified into four different types; Sub-serosal fibroids, Intramural fibroids, Pedunculated fibroids, and Sub-mucosal fibroids.

1. Intramural fibroids: Intramural tumours are those growing deep in the womb or within the muscular walls of the womb. They are the most common type of fibroids. They are also the most difficult to remove. Intramural fibroids may grow larger and stretch your womb. They constitute most of the hysterectomies performed in the hospitals today. In addition to all the symptoms listed above, these kinds of tumours can cause haemorrhage, belly pressure, and painful intercourse.

2. Sub-serosal fibroids: Sub-serosal fibroids are those growing outside the uterus called the serosa. They are the most easily accessible type of fibroids and are often removed via surgery through a process known as laparoscopic myomectomy. They may grow large enough to make your womb appear bigger on one side. Symptoms include pelvic pain, lower back pain, urinary frequency, congestion, bloating and indigestion.

3. Pedunculated fibroids: These types of fibroids extend from the uterine wall like a stalk. They are attached to the uterine wall by a peduncle. They may be found within the endometrial cavity or growing outside of the uterus into the pelvis. Those that grow inside the uterus are known as Pedunculated sub-mucosal fibroids, and those that develop outside the uterus are known as Sub-serous pedunculated fibroids. Pedunculated fibroids are the easiest of the tumours because they are easy to remove via surgery through a process called Laparoscopy or Hysteroscopy. The symptoms include pain or pressure in a specific area or bleeding depending on where the tumour is located.

4. Sub-mucosal fibroids: Sub-mucosal fibroids are those growing adjacent to the endometrial lining (i.e. myometrium or middle muscle layer of the uterus). They are the major cause of heavy menstrual bleeding. Sub-mucosal tumours aren’t as common as the other types. These tumours impinge on the endometrial cavity and will produce long heavy periods, aches, clots, and cervical pressure.

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What causes fibroid tumours?

Till date, the actual cause of fibroids is unknown. While it is not clearly known, it is believed that each tumour develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen. Researchers have been able to point to the following factors:

1. Genetic changes: A large number of fibroids show alterations in genes that differ from those in normal uterine muscle cells.
2. Family history: Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.
3. Hormones: Estrogen and progesterone, the two human hormones that stimulate the development of the uterine lining during each menstrual cycle in preparation for pregnancy, has been implicated to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in the development of these hormones.
4. Pregnancy: Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you’re pregnant.
5. Other growth factors: Chemicals that help the body maintain tissues, such as insulin-like growth factor, may also affect fibroid growth.

Who is at risk of having fibroid tumours?

Women are at greater risk for developing fibroids if they have one or more of the following risk factors:

• pregnancy
• a family history of fibroids
• age of 30 or older
• African-American
• a high body weight

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What Are The Symptoms of Fibroids?

Some fibroids are asymptomatic. That is, many women with fibroids don’t have any symptoms especially those whose tumours are still very small or those going through menopause. Symptoms can be influenced by the location, size and number of fibroid. For instance, submucosal fibroids may cause heavy menstrual bleeding and trouble conceiving. Some women have only mild symptoms, while other women have more severe, troublesome symptoms.  The most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Increased menstrual pain
• Pain during sexual intercourse
• Frequent urination
• Difficulty draining the bladder
• Constipation
• Backache or leg pains

How Can I Prevent Fibroids?

Preventing fibroids may not be possible, but only a small percentage of these tumours require treatment. But, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruits and vegetables, you may be able to decrease your fibroid risk.

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How Are Fibroid Tumors Clinically Diagnosed?

Fibroids are most often detected during a regular pelvic examination. This exam is used to check the condition, size, and shape of your uterus. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician.  In addition to a complete health background and physical and pelvic and/or abs assessment, diagnostic procedures for uterine fibroids may include:

• X-Ray . Electromagnetic energy used to produce images of bone and internal organs upon the film. This can be sued to produce pictures of your uterus, ovaries, and other pelvic organs.
• Transvaginal Ultrasound (also called Ultrasonography). An ultrasound test using a tiny device called a transducer, which is placed in the vagina.
• Magnetic Resonance Imaging (MRI): A non-invasive method that produces a two-dimensional view of an interior organ or structure. This can be used to produce pictures of your uterus, ovaries, and other pelvic organs.
• X-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction.
• Visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
• Endometrial biopsy. A procedure in which a sample of tissue is obtained through a tube which is inserted into the uterus.
• Blood test (to check for iron-deficiency anaemia if heavy bleeding is caused by the tumour).

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How Are Fibroid Tumors Treated?

Treatment of fibroid depends on your age, size of the fibroids, and your overall health. You may receive a combination of treatments.

Certain home remedies and natural treatments can have a positive effect on fibroids; they include; acupuncture, yoga, massage, Gui Zhi Fu Ling Tang (GFLT), a traditional Chinese medicine formula, applying heat for cramps (avoid heat if you experience heavy bleeding). Dietary changes can help as well. Avoid meats and high-calorie foods. Instead, opt for foods high in flavonoids, green vegetables, green tea, and cold-water fish such as tuna or salmon.

Managing your stress levels and losing weight if you’re overweight can also benefit women with fibroids.
Medications to regulate your hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), will cause your estrogen and progesterone levels to drop. This will eventually stop menstruation and shrink fibroids.

Other options that can help control bleeding and pain, but won’t shrink or eliminate fibroids, include:

• An intrauterine device (IUD)that releases the hormone progestin
• Over-the-counter (OTC) anti-inflammatory pain relievers, such as ibuprofen(Advil)
• birth control pills

Surgery to remove very large or multiple growths may be performed. This is known as a myomectomy. An abdominal myomectomy involves making a large incision in the abdomen to access the uterus and remove the fibroids. The surgery can also be performed laparoscopically, using a few small incisions into which surgical tools and a camera are inserted. Fibroids might grow back after surgery.

If your condition worsens, or if no other treatments work, your physician may perform a hysterectomy. However, this means that you won’t be able to bear children in the future.

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Minimally Invasive Procedures To Treat Fibroids

A newer and completely noninvasive surgical procedure is forced ultrasound surgery (FUS). You lie down inside a special MRI machine that allows doctors to visualize the inside of your uterus. High-energy, high-frequency sound waves are directed at the fibroids to ablate or destroy them.

Similarly, myolysis shrinks fibroids using an electric current or laser, while cryomyolysis freezes the fibroids. Endometrial ablation involves inserting a special instrument into your uterus to destroy the uterine lining using heat, electric current, or hot water.

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Another surgical option is uterine artery embolization. In this procedure, small particles are injected into the uterus in order to cut off the fibroids’ blood supply.