Fibroids may arise in different parts of the uterus (see graphic) and are named according to their position within the layers of the uterus. The position of the fibroid determines the type of symptom you may experience and the treatment options available. The growth rate of a fibroid is dependent on hormones (estrogen, progesterone and possibly others). Growth rates vary greatly among women and the cause for this variability is not known. Below the graphic is a list of the different types of fibroids and the symptoms that are typically associated with them.
Submucosal: This fibroid grows below the surface of the uterine cavity. It is associated with bleeding and pain.
Intracavitary: This fibroid grows into the cavity of the uterus on a stalk much like a mushroom. It is associated with bleeding and pain.
Intramural: This fibroid grows within the wall of the uterus and can cause pain and bleeding. If they grow large enough they can cause urinary frequency and bloating.
Subserosal: This fibroid grows below the outer surface of the uterus. It is associated with pain and cramping and can cause urinary frequency, bloating and the sense of being pregnant.
Pedunculated: This fibroid grows off the outer surface of the uterus on a stalk much like a mushroom. It is associated with pain and cramping and can cause urinary frequency, bloating and the sense of being pregnant if they become large enough.
Adenomyosis: This is the ingrowth of endometrial lining into the wall of the uterus. It can imitate the symptoms caused by fibroids. It is responsive to embolization and will be discussed in a separate section.
Symptoms of Fibroids
Bleeding is the most common symptom associated with fibroids. It typically presents as heavy menstrual bleeding, often with passage of clots. As a woman progresses toward menopause, bleeding can become unpredictable or continuous. Anemia, which may be severe, is a common side effect. It is not known how fibroids cause heavy cycles, but they are believed to alter the ability of the uterus to control the degree of bleeding during a menstrual period.
Pain is another common symptom which may present as cramping or pressure. Fibroids can also press on the nerves that supply the pelvis and legs causing pain, which may mimic back problems. Women often experience severe menstrual cramps with the growth of their fibroids.
Frequent urination is due to the pelvis having limited space available for the female genital tract and bladder. As Fibroids grow, they compete for space within the pelvis. This decreases the ability for the bladder to expand resulting in feeling the need to urinate. This can occur during the day or night. Many times women with these issues will change their lifestyle including limiting their intake of fluids to prevent having to urinate frequently.
Bloating is probably the result of the enlarged uterus in combination with the increased blood flow associated with the growing fibroids. As the fibroids increase in size they can compress vascular structures causing heaviness within the pelvis which will progress during the day and will typically worsen during menstruation.
Other suspected symptoms include infertility and/or repeated miscarriage. However, the statistical evidence for infertility is lacking and other factors are more likely to cause infertility in patients with fibroids. Some researchers have suggested that the presence of fibroids may predispose a patient to miscarriage, but reliable evidence to support this possibility is not yet available.
How are Fibroids found?
Fibroids are typically discovered by using symptom history in combination with pelvic examination. It is important to have regularly scheduled pelvic examinations and PAP smear performed by a primary health care provider (Family Physician, Gynecologist, Nurse Practitioner or Physician Assistant). Ultrasound is often used for evaluating the presence of fibroids and ovarian problems. Magnetic Resonance Imaging (MRI) is another imaging tool used to better define the size, extent and distribution of fibroids. MRI allows for more precise treatment planning for alternative therapies or minimally invasive surgical procedures. Once fibroids are confirmed to be the cause of symptoms, a physician can discuss the potential treatments that are available today.
When should Fibroids be treated?
This is dependent upon the individual. The main reason to treat fibroids is to improve a woman’s quality of life. Fibroid related bleeding can cause women to miss work, or compromise their social life and travel plans. Some bleeding can be severe enough to cause anemia or require blood transfusion. In this situation, the treatment is more required than optional. Urinary frequency can impact sleep patterns and also make a long trip in the car difficult. The pain and pressure related to fibroids can even require narcotic medication to make the woman able to tolerate her symptoms.
What are the treatment options for Fibroids?
Medical: Since the majority of fibroids do not cause symptoms, there is a possibility the fibroids may not need to be treated. Once symptoms develop, medical management should be the initial therapy. This includes treatment with non-steroidal anti-inflammatory agents, oral contraceptives, progesterone analogs or gonadotropin releasing hormone agonists (Lupron). The decision for further medical management depends on the patient’s age, the size of the fibroids, the desire for future pregnancy, and the severity of symptoms.
Surgical: For women who do not respond to medical therapy, hysterectomy has traditionally been offered for their treatment. Other surgical options include hysteroscopy (a procedure in which a fiber-optic scope is advanced into the uterus allowing the physician to remove endometrial polyps or submucosal fibroids), endometrial ablation (removing the lining of the uterus in order to control bleeding), and myomectomy (removal of the fibroids off of the uterus). Detailed discussion of the surgical options can be obtained by a consult with your gynecologist.
Additional Treatment Options: Uterine Fibroid Embolization (UFE) and MRI guided focused ultrasound are treatment alternatives for symptomatic fibroids. Uterine Fibroid Embolization has been used since 1999 and has been studied thoroughly. Uterine Fibroid Embolization (UFE) is an effective treatment alternative for women with symptomatic fibroids.