Fibroids are non-cancerous (benign) tumors, commonly seen in women of childbearing age. They are composed of muscle cells and other fibrous tissues, which develop in and around the wall of the uterus (womb).
Based on their location, fibroids can be classified as:
- Subserosal fibroids: Sited in the pelvis, outside the wall of the womb
- Submucosal fibroids: Sited in the muscle layer
- Intramural fibroids: Sited in the muscle wall
- Pedunculated fibroids: Submucosal or subserosal fibroids attached with a thin stalk of tissue
The exact cause for the development of fibroids remains unclear, but their growth seems to depend on the secretion of estrogen, the female hormone. They grow rapidly during a woman’s reproductive years, when hormone levels are highest, and shrink once a woman reaches menopause, when estrogen levels are low. Obese women are at a higher risk of developing fibroids as they have higher levels of estrogen.
The majority of women with fibroids may be asymptomatic. However, the symptoms associated with fibroids include heavy, prolonged and painful menstrual bleeding, abdominal pain, frequent urination, constipation, backache or leg pain and discomfort or pain during sex. In rare cases fibroids can cause complications such as infertility and pregnancy and labor problems (stomach pain, miscarriage and increased chance of caesarean section).
As fibroids often do not cause any symptoms they are usually detected during a routine gynecological (vaginal) examination or tests for other problems. If fibroids are suspected, the diagnosis involves a pelvic examination, followed by ultrasound evaluation. Other tests such as hysteroscopy or laparoscopy (thin tube with a camera is inserted for close examination), or biopsy may be employed to confirm the diagnosis.
Different methods are used for managing fibroids such as medications to relieve symptoms and help shrink fibroids, and surgery for severe cases. The common surgeries performed for the management of fibroids include:
- Hysterectomy: removal of the uterus
- Myomectomy: selective removal of the fibroids in the uterus
Other techniques employed are uterine artery embolization (shrinks blood vessels supplying fibroids), endometrial ablation (removes uterine lining), MRI-guided percutaneous laser ablation and MRI-guided transcutaneous focused ultrasound (destroys the fibroid with laser or ultrasound passed through MRI-guided needles).