Is It True That Every Woman Has Fibroids? Risk Factors

• Age: The risk of fibroids increases with age, especially during your 30s and 40s through menopause. Fibroids usually shrink post-menopause.
• Family history: Having a family member or close relative with fibroids increases your risk of getting fibroids. If your mother was diagnosed with fibroids, you are 3 times more likely to get them.
• Ethnicity: African American women have a higher chance of developing fibroids than Caucasian women.
• Obesity: Women who are slightly above the recommended weight are at higher risk of fibroids. For obese women, the risk is 2-3 times greater than average.
• Diet: Eating a diet high in red and processed meat is associated with a higher risk of fibroids. 
• Other causes: Vitamin D deficiency and alcohol consumption are known to cause fibroids in women, but conclusive studies are still lacking.

The exact cause of fibroids is still unknown. However, research and clinical experience have highlighted the following factors:

• Genetic changes: Fibroids may be caused by abnormal genetic changes that are usually not found in typical uterine muscle cells.
• Hormonal imbalance: Imbalances in the estrogen-progesterone ratio have been shown to trigger the development of fibroids. Estrogen and progesterone are hormones that promote the development of the uterine lining during each menstrual cycle in preparation for pregnancy. These hormones may promote the growth of fibroids.
• Increased hormonal production: Fibroids tend to have more estrogen and progesterone receptors than a typical uterine muscle cell. Fibroids usually shrink after menopause due to declined hormonal production.
• Other growth factors: Some growth factors, such as insulin-like growth factors that maintain the tissues, can lead to the development of fibroids.
• Extracellular matrix (ECM): ECM is a material that binds the cells together so that they are held in place. Fibroids are high in ECM. ECM has a special function of storing growth factors and causes biological changes in cells.

Symptoms associated with fibroids may include:

• Heavy menstrual bleeding (using more than 16 pads for the entire duration of the menstrual period)
• Periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Pain during sex
• Feeling of fullness in the pelvic area (lower stomach area)
• Constipation
• Backache or leg pains

Some characteristics of uterine fibroids include the following:

• May grow slowly or rapidly or remain the same size
• May undergo growth spurts whereas some may shrink on their own
• May appear suddenly during pregnancy and shrink or disappear after pregnancy

Fibroids can be physically and emotionally taxing for women because many experience the following complications:

• Anemia
• Heavy menstrual bleeding
• Pain
• Rectal pressure
• Large lower abdomen that makes the woman look pregnant
• Infertility

Most women with fibroids can have normal pregnancies. However, the risk of complications may increase depending on the location of the fibroid in the uterus. The most common problems seen in women with fibroids include:

• Cesarean delivery: The risk of needing cesarean delivery is 6 times greater for women with fibroids.
• Breech baby: In pregnant women with fibroids, the baby may not be positioned well for vaginal delivery.
• Failure of the labor to progress: The labor may fail to progress in the presence of fibroids.
• Placental abruption: This occurs when the placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
• Preterm delivery: Fibroids can lead to preterm delivery of the fetus.

Medications

To treat mild symptoms of fibroids, such as pain and heavy bleeding, your doctor may prescribe the following medications:

• Acetaminophen or ibuprofen to relieve pain
• Iron supplements to prevent anemia

Other drugs commonly used for the treatment of fibroids include:

• Gonadotropin-releasing hormone (GnRH) agonists: Block the production of progesterone and estrogen and put you in a temporary menopause-like state. Commonly used GnRH agonists include:
  • Lupron Depot, Eligard, others (leuprolide)
  • Zoladex (goserelin)
  • Trelstar, Triptodur Kit (Triptorelin)
• Low-dose birth control pills: Prevent the growth of fibroids and help control heavy bleeding.
• Mirena: Intrauterine device that contains a small amount of progesterone-like medication used to control heavy bleeding.
• Tranexamic acid: Taken to relieve heavy menstrual periods.

Surgery

For fibroids that cause moderate or severe symptoms, surgery is the ideal treatment option. Some of the surgeries commonly performed include:

• Myomectomy: Involves the removal of fibroids without invading the healthy tissues of the uterus. Risk of recurrence is higher with this type of surgery.
• Hysterectomy: Involves the complete removal of the uterus. It is the ultimate cure for uterine fibroids because there is a lower chance of recurrence.
• Endometrial ablation: Involves the removal or destruction of the uterus lining using:
  • Lasers
  • Wire loops
  • Boiling water
  • Electric currents
  • Microwaves
  • Freezing
• Myolysis: Involves inserting a needle into the fibroids, usually guided by laparoscopy, and using an electric current or freezing to destroy the fibroids.
• Uterine fibroid embolization (UFE) or uterine artery embolization (UAE): Targets the blood vessels that supply the fibroids. A thin tube is attached to the blood vessels through which tiny plastic or gel particles are injected into the blood vessels, leading to obstruction. As a result, the fibroid shrinks due to a lack of blood supply. Not all fibroids can be treated with UFE. The ideal candidates for UFE are women who:
  • Have fibroids with heavy bleeding
  • Have fibroids with pain or pressure on the bladder or rectum
  • Do not want to have a hysterectomy
  • Do not wish to get pregnant in the future