Uterine Fibroids: Causes, Symptoms & Treatments

Uterine fibroids key concepts

• Uterine fibroids are common benign tumors that can affect the size and shape of the uterus, potentially leading to infertility and pregnancy loss.
• Fibroids can alter the shape and size of the uterus, potentially causing infertility issues by blocking the fallopian tubes and affecting embryo implantation.
• The size and location of the fibroids will have an important impact on symptoms.
• Symptoms can include heavy menstrual bleeding, pelvic pain, backaches, constipation and frequent urination.
• Treatment can include surgical removal, medications or a combination of the two. The best treatment option depends on individual circumstances, including the size and location of fibroids, symptom severity and reproductive goals.

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What are uterine fibroids?

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop in or on the uterus. These benign tumors are a common gynecological condition, affecting an estimated 30-70% of reproductive age women, according to the American Society for Reproductive Medicine (ASRM). While uterine fibroids are generally not life-threatening, they can cause significant discomfort and complications depending on their size, location and number.

Depending on the nature of the growth, they can affect a woman’s fertility by preventing the sperm and egg from meeting for fertilization, or afterward by disrupting embryo implantation in the uterus.

Fibroids can actually shrink or grow over time. Fibroids can range from as small as a pea to as large as a melon. In some cases, they can grow to weigh several pounds. Some women may have a solitary myoma while others can be affected with multiple fibroids of disparate size and locations.

They can also can develop in specific parts of the uterus, including the following:

Subserosal fibroids

These fibroids are located on the outer surface of the uterus and are a common type of uterine fibroid. These are also the type least likely to cause infertility or pregnancy loss as they are located outside of the uterine lining.

Intramural fibroids

Intramural fibroids are embedded within the muscular wall of the uterus. They also a common type of uterine fibroid. Intramural fibroids are often discovered during a routine ultrasound examination or during a pelvic exam.

Submucosal fibroids

These are found just beneath the lining of the uterus and can bulge into the uterine cavity. They make up only about 5% of uterine fibroids. Submucosal fibroids may form individually or in clusters. They can act like an IUD and potentially prevent a pregnancy from implanting or developing normally.

Pedunculated fibroids

These are attached to the uterus by a thin stalk. Pedunculated fibroids are somewhat rare and are actually a sub-type of subserosal or submucosal fibroid.

Uterine fibroids symptoms

Many women don’t even realize they have uterine fibroids until they get an ultrasound, as they present few, if any, symptoms.

When symptoms are present, they can include:

• Excessive menstrual cycles.
• Bleeding between periods and irregular periods.
• Blood clots during menstruation.
• Frequent urination or urinary tract infections.
• Painful intercourse.
• Low back pain.
• Constipation.
• Painful bowel movements.

Related reading: When To See a Fertility Specialist

Causes of uterine fibroids and risk factors

While the exact cause of fibroid development remains unknown, several factors are believed to contribute to their growth.

Hormonal imbalance

Hormones play a significant role in the development and growth of uterine fibroids. Specifically, estrogen and progesterone, the hormones that regulate the menstrual cycle, are thought to contribute to fibroid size and number.

Genetics

Genetic factors also play a crucial role in the development of uterine fibroids. Studies have shown that women with a first-degree relative (mother, sister or daughter) who has fibroids are at a higher risk of developing them. This suggests a genetic predisposition to the condition.

Environmental factors

Environmental and lifestyle factors can also influence the development of uterine fibroids.

• Impact of diet: A diet high in red meat and low intake of green vegetables and fruit shows an increase in the risk of fibroids.
• Chemical exposure: Exposure to certain chemicals, such as those found in some types of plastics, has been linked to an increased risk of fibroid development. These chemicals can disrupt the normal hormonal balance, leading to fibroid growth.
• Stress: Emerging research suggests that chronic stress may contribute to the development of uterine fibroids. Stress can lead to hormonal imbalances, which may, in turn, promote the growth of fibroids.

Diagnosing uterine fibroids

Our fertility specialist, Dr. Isaac Glatstein, can typically diagnose issues with the uterus during a pelvic exam or using imaging tests such as ultrasound, HSG or hysteroscopy.

These imaging tests can help your clinical team visualize the size, location and number of fibroids in the uterus. In some cases, a tissue sample (biopsy) may be taken to confirm the diagnosis or rule out the possibility of other conditions.

Uterine fibroid treatment

Treatment options vary on an individual basis. Dr. Glatstein will work with each patient, taking into account their pregnancy plans, age and the specifics of the fibroid’s location and size as well as possible impact on pregnancy.

Medications can help regulate hormones that control the menstrual cycle, reducing fibroid symptoms by shrinking them. Gonadotropin-releasing hormone (GnRH) agonists are commonly used to block estrogen and progesterone production, halting menstruation and shrinking the fibroids. Some birth control medications are also effective but are not suitable for women who wish to conceive.

Noninvasive treatments like uterine artery embolization and radiofrequency ablation can also help by shrinking fibroids and cutting off their blood supply.

Surgical options are usually the most effective for women who experience extreme symptoms or have infertility. For women starting fertility treatments, such as IVF (in vitro fertilization), surgery may help improve implantation success.

• Myomectomy is the surgical removal of the myoma (uterine fibroid) while preserving the uterus. It can be performed laparoscopically (minimally invasive cuts), hysteroscopically (with a lighted scope) or through a traditional abdominal incision.
• Hysterectomy is the removal of the uterus, meaning pregnancy is not possible after this procedure. As such, it is not a good option for those seeking to have a child.

We discuss all treatment options and their potential risks with patients prior to developing a treatment plan.