What are Fibroids?​

Fibroids are noncancerous (benign) tumors of the uterus that are also known as uterine leiomyoma or myomas. They are muscle cells that grow into fibrous masses or tumors in the uterus. You can have a single fibroid or many. 

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Types of Fibroids​

There are four types of fibroids categorized by where and how they grow:

• Intramural fibroids grow within the muscle wall of the uterus and are the most common type of fibroid tumor.

• Pedunculated fibroids grow inside and outside of the uterus and attach to the uterine wall with a stalk-like growth called a peduncle.

• Subserosal fibroids grow outward from the uterus just beneath the uterine lining and can cause heavy bleeding.

• Submucosal fibroids push into the uterine cavity as they grow in the middle muscle layer of the uterus; they are not as common as other types of fibroids.

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Symptoms​

Some women with fibroids never experience any symptoms, while for some, fibroids may interfere with normal daily life or hinder the ability to get pregnant or carry a fetus to full term. Symptoms may include:

• Heavy or long menstrual cycles

• Spotting or bleeding between menses

• Bloating

• Increased urination

• Pelvic pain or pressure

• Discomfort

• Anemia

• Painful intercourse

• Constipation or bowel dysfunction

• Low back pain

• Fertility problems

• Kidney injury from pressure on the ureters

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Fibroids and Reproduction

• Fertility. Fibroids that affect fertility include those that are inside the uterine cavity (submucosal) or very large (>6 cm in diameter) within the wall of the uterus (intramural). Removing those fibroids may increase the pregnancy rate.

• Submucosal fibroids have the worst effect on fertility. They can act almost like an IUD, either by preventing a pregnancy from implanting on the uterine wall or by making it less likely that the pregnancy will remain attached to the wall. Therefore, these tumors should be removed before pregnancy.

• Fibroids can cause pain in pregnancy. Fibroid-related pain occurs in up to 15% of patients. Mild to moderate pain can usually be controlled with acetaminophen. For more severe pain, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or indomethacin (Indocin) can be used for a short time.

• Miscarriage. Contrary to previous assumptions, miscarriage rates are no different for women with and those without leiomyomas, regardless of location, size, or number.

• Having fibroids during pregnancy is associated with an increased risk for complications such as fetal malpresentation (fetal body position that is not “head down”), preterm labor and preterm birth, placenta previa, placental abruption, cesarean delivery, and postpartum hemorrhage. Babies born to people with large fibroids may weigh less at birth than babies born to people who don’t have fibroids.

• Fibroids can cause preterm labor and delivery. But surgical removal of fibroids before pregnancy is not associated with improvement and may even worsen the outcome, leading to c/section.

• Vaginal delivery with fibroids. Most patients with fibroids can have a natural birth (delivery through the vagina). However, fibroids do increase the risk for a C-section. Patients with fibroids are six times more likely to need a C-section, compared with pregnant patients without fibroids.

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Treatments​

MEDICATION:

• Birth control pills: can be used to reduce bleeding symptoms and cramping.

• Mirena IUD: slowly releases the hormone progesterone to help reduce menstrual bleeding.

• Tranexamic Acid: a clotting promoter It can treat heavy menstrual periods caused by fibroids.

• Naproxen: a nonsteroidal anti-inflammatory drug (NSAID) to relieve mild pain and reduce heavy menstrual bleeding caused by fibroids. 

• Oriahnn: used to control heavy menstrual bleeding related to uterine fibroids.

• Myfembree: used to control heavy menstrual bleeding related to uterine fibroids.

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SURGERY:

• Uterine fibroid embolization (UFE), performed by interventional radiology, involves the use of a catheter to deliver small particles that block the blood supply to the fibroid, causing the fibroid to die.

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• Myomectomy: is the surgical removal of fibroids. The surgical approach typically depends on the size, number, and location of fibroids. Fibroid removal can be done with an abdominal incision, through the vagina, or using a robotic/laparoscopic approach as described:

  • Laparoscopic/robotic myomectomy: using three to five small incisions, the fibroids are removed after being reduced into smaller pieces.

  • Vaginal myomectomy (hysteroscopic myomectomy): removal of submucosal fibroids through the vagina without incisions.

  • Abdominal myomectomy: an incision is made at your bikini line, allowing the surgeon to reach the uterus and remove the fibroids while sparing the uterus.

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• Hysterectomy: Removal of the uterus, with the possibility of removing your ovaries or cervix. Hysterectomy does not necessarily mean that you have to remove your ovaries. The decision to keep or remove your ovaries is a choice that you and your doctor will make together. Additionally, depending on the type of surgery and your medical history, you may keep or remove your cervix. The different approaches to hysterectomy are abdominal incision approach, vaginal approach, or robotic/laparoscopic approach. There are different types of hysterectomies, such as:

  • Vaginal hysterectomy: the uterus and cervix are removed through the vagina.

  • Supracervical hysterectomy: your uterus is removed, but your cervix is left in place.

  • Total hysterectomy: the uterus, ovaries, and cervix are removed.

  • Regardless of your age, having fibroids should not mean your only choice is a hysterectomy. The uterus has as much emotional importance as it does a physical one. It can be a difficult decision to make.

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THINGS YOU CAN DO AT HOME:

1. Supplemental vitamin D and green tea: have been shown to suppress fibroid growth.

2. Reduce excess body fat. Women with a higher waist-to-hip ratio, higher BMI (body mass index), larger waist circumference, or a greater percentage of body fat are more likely to have fibroids.  

3. Manage your stress! Chronic stress can lead to weight gain and weight loss resistance via adrenal hormone imbalance. Effective stress management strategies, such as mind-body practices (e.g., Yoga, meditation) and careful exercise programs, may improve hormonal imbalances associated with fibroids.

4. Eat phytoestrogens. These are compounds that naturally occur in plants and act as weak estrogens or anti-estrogens. This blocks the ability of other, more powerful estrogens from stimulating fibroid growth. Examples of phytoestrogens include:

• Flaxseed lignans.

• Resveratrol (sources: peanuts, pistachios, grapes, blueberries, green tea).

• Hops (can be used to make beer, teas, yeast, sauces, dressings).

• Flavonoids (sources: berries, red cabbage, kale, parsley, tea, dark chocolate).

• Isoflavones (lentils, beans, peas, potatoes, vegetables, fruits).

• Eat cruciferous vegetables (cabbage, kale, cauliflower, broccoli, Brussel sprouts, etc.) and citrus fruit each day to lower fibroid risk.

5.  Licorice herbs interfere with estrogen-induced fibroid growth and help rebalance hormones.

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