What Are Uterine Fibroids?
Uterine fibroids are surprisingly common. In fact, it’s possible that most women of child bearing age may have them. Individual studies have found anywhere between 5-68% of women may have fibroids [1]. Although this is a very broad range of incidence, the variability is based on the assortment of study protocols and the differences in the study population demographics [1]. It is estimated that by age 50, roughly 70% of Caucasian women and 80% of Black women will have fibroids [1]. Despite their apparent pervasiveness, there are still many unknowns about fibroids. But, what do we know?
What are fibroids and how do they develop?
The uterus consists of 3 layers of tissues. The inner lining is called the endometrium and is the tissue that is shed with the menstrual cycle. The middle layer is called the myometrium, which is the muscular layer. And the outside layer is called the perimetrium, which encases the uterus and protects it.
Uterine fibroids, medically called leiomyoma, are noncancerous smooth muscle tumours of the myometrium layer of the uterus [1]. They are believed to develop from a single cell of the myometrium, using atypical signalling pathways to direct its cell division [2]. Instead of contributing to the healthy layer of smooth muscle cells, this disordered cell division gives rise to a mass, which becomes a fibroid. Although it is not known what exactly causes this development, fibroids are known to be hormone-dependent, rarely develop before the onset of menstrual periods, can grow with pregnancy, and shrink after menopause [3]. However, it is suggested that genetics, ethnicity, environmental factors, cell biology factors, hormones, inflammation, chronic disease, nutrition, lifestyle factors, and more, may all contribute to the development of fibroids [4].
Fibroids can be clinically described based on their location. They can be found in, on, or near the uterus, though the 3 most common types include submucosal (within the endometrium), intramural (in the wall of the uterus), and subserosal (from the perimetrium) [2]. There are usually multiple fibroids present, and they can be of varying types and sizes [3]. Since the cells originate from the uterine muscle, they are responsive to estrogen and progesterone hormones, which can promote their growth over the years. Typically, sizes range from a few millimetres to large growths of 20 centimetres or more in diameter [3]. In rare cases they can grow to “giant” sizes. One of the largest surgically removed fibroids weighed over 60 pounds! [5] With this in mind, it is unsurprising that fibroids can cause a number of symptoms.
What are the symptoms?
Although the majority of women may develop fibroids, only about 30% of women will develop symptoms [1]. Diagnosis is informed by the presenting symptoms and physical exam, although ultrasound imaging is commonly used to establish a diagnosis [1]. The size, shape, number, and location of the fibroids will dictate the severity of symptoms. Symptoms can include heavy bleeding with periods, period pain, pelvic discomfort, pain with intercourse, pressure on the bladder, pregnancy loss, preterm labour, and in some cases infertility [4]. The most common presenting symptom is generally heavy or prolonged periods, which can lead to anemia when unmanaged, which can be dangerous.
These symptoms can be extremely impactful on a woman’s health and quality of life, and there is an increased risk of emotional distress, depression, and anxiety [1]. Women with symptomatic fibroids have been found to require more pain relief medication, feminine hygiene products, and health care resources to help manage the condition [6]. Many women find fibroids difficult to live with, and uterine fibroids remain one of the most common reasons for women to seek a hysterectomy [4].
What are the treatments available
Uterine fibroids remain exceptionally difficult to treat. Though fibroids are the most common type of benign tumour in females, treatment choices are somewhat limited. The standard for non bothersome fibroids is to watch and wait, as fibroids will naturally reduce in menopause. For women with symptoms, traditional medical management can range from conservative to invasive, but can include hormonal contraceptives, non-steroidal anti-inflammatory drugs (NSAIDs), other hormonal drugs, uterine artery embolization, and several surgical procedures [1]. Non-hormonal and nonsurgical treatment methods can include supplements, nutrients and practices such as vitamin D, green tea, curcumin, high fibre diet, nutrition and lifestyle choices, acupuncture, and various herbal remedies [7]. Success is unpredictable with alternative medicine techniques, although healthy practices to support cellular health, nutritional needs, and hormone regulation can be good places to start. While most natural treatments may not shrink or reverse the fibroids, they can play a role in preventing their growth.
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