Uterine Fibroids: Symptoms, Causes & Treatment

Uterine fibroids are benign (non-cancerous) growths that develop in the smooth muscle tissue of the uterus. They are among the most common benign tumors in women of reproductive age, affecting approximately 70-80% of women by age 50, though not all experience symptoms. These tumors range from tiny (pea-sized) to very large, potentially filling the entire abdomen.

In Jordan and the Arab region, uterine fibroids represent a prevalent health concern affecting women's quality of life, particularly regarding heavy menstrual bleeding and pelvic pain. Although benign, their impact on fertility and pregnancy necessitates accurate diagnosis and appropriate management.

Symptoms vary based on the number, size, and location of fibroids within or on the uterus. Some women have no symptoms and discover fibroids incidentally, while others experience heavy bleeding, severe pain, and pressure on nearby organs such as the bladder and bowel.

Symptoms vary significantly among women and may change over time. Some women experience no symptoms at all, especially with small fibroids or those located in less sensitive areas of the uterus. Common symptoms include heavy bleeding, pain, and pressure on nearby organs. Symptoms may worsen during menstruation or persist continuously.

• Heavy menstrual bleeding: Bleeding may be extremely heavy, requiring pad or tampon changes every hour or less, or lasting more than 7 days.
• Pelvic pain: Pain ranging from mild to severe in the lower abdomen and pelvis.
• Pain during intercourse: Discomfort before, during, or after sexual intercourse (Dyspareunia).
• Bladder pressure: Frequent urination and difficulty completely emptying the bladder.
• Bowel pressure: Constipation, difficult bowel movements, or gastrointestinal symptoms.
• Feeling of fullness: Sensation of fullness or heaviness in the lower abdomen.
• Abdominal enlargement: Visible abdominal bloating or enlargement.
• Fatigue and weakness: Heavy bleeding may cause anemia, leading to tiredness and weakness.
• Back and thigh pain: Particularly if large fibroids compress nerves.
• Irregular bleeding: Bleeding may not follow a regular menstrual pattern.

• Hormonal changes: Fibroids grow in response to estrogen and progesterone, with higher receptor density than normal uterine muscle.
• Growth abnormalities: May originate from a single abnormal cell in uterine muscle that divides rapidly.
• Genetic factors: Family history of fibroids increases risk of development.
• Proteins and chemical substances: Imbalances in growth-promoting proteins and neurotransmitters in uterine muscle.
• Immune system dysfunction: Weakened immune response may fail to prevent abnormal cell growth.
• Chronic inflammation: Inflammatory states may promote fibroid development and growth.

• Age: Risk increases with age, particularly between 30-50 years.
• Race/Ethnicity: Women of African descent have higher incidence and larger fibroids.
• Obesity: Excess weight correlates with elevated estrogen levels.
• Physical inactivity: Low physical activity increases estrogen levels.
• Red meat consumption: Studies suggest potential association with fibroid development.
• Nulliparity: Women who have never been pregnant are at higher risk.
• Early menarche: Early onset of menstruation increases lifetime estrogen exposure.
• Hypertension: Some studies link high blood pressure to fibroids.
• Vitamin D deficiency: Low vitamin D levels may increase risk.
• Alcohol consumption: Excessive alcohol intake may elevate fibroid risk.

Diagnosis is based on clinical examination, patient history, and advanced medical tests. The physician typically begins with a comprehensive pelvic examination and may order imaging studies and blood tests to exclude other causes of symptoms. Definitive diagnosis is confirmed through ultrasound or MRI.

• Clinical pelvic examination: The doctor palpates the uterus to identify masses or uterine enlargement. Nodular surface may be felt.
• Ultrasound (Transvaginal/Transabdominal): First-line imaging using sound waves to visualize fibroids. Both abdominal and vaginal approaches provide high diagnostic accuracy with determination of number, size, and location.
• Magnetic Resonance Imaging (MRI): Provides highly detailed images of fibroid size and location. Particularly useful for surgical planning and fertility-preserving treatments.
• Computed Tomography (CT): May be used in specific cases for additional information.
• Blood tests: Hemoglobin measurement (Normal: 12-16 g/dL in women) to detect anemia from heavy bleeding.
• Ovarian assessment: Ensuring no other ovarian tumors are present.
• Hysteroscopy: In specific cases, a scope is inserted through the cervix to directly visualize the uterine cavity.

Medications

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen and naproxen reduce pain and bleeding. Taken during menstruation or before.
• Hormonal medications:
  • Oral contraceptives: Reduce menstrual flow and pain.
  • Hormonal IUD (Mirena): Releases progesterone locally, very effective in reducing bleeding.
  • Progestins: Injections or pills to reduce bleeding.
• 5-Alpha Reductase Inhibitors: Such as finasteride may help reduce fibroid size.
• Newer medications (SPRMs): Ulipristal acetate and asoprisnil directly inhibit fibroid growth.

Procedures and Surgery

• Uterine Artery Embolization (UAE): Non-surgical procedure blocking blood vessels feeding the tumor. Effective and safe with rapid recovery, but may affect fertility in some cases.
• Laparoscopic Myomectomy: Fibroid removal while preserving the uterus. For women desiring future pregnancy. Small incisions and shorter recovery time.
• Hysterectomy: Complete uterus removal. Definitive and permanent solution but eliminates fertility. Recommended for women who have completed childbearing.
• Open Myomectomy: Traditional surgery for fibroid removal, used for large or deeply embedded tumors.
• Hysteroscopic Myomectomy: For fibroids protruding into the uterine cavity. Easy procedure with quick healing.
• Radiofrequency Ablation: Tumor destruction using high heat. Relatively new option.
• Focused Ultrasound Surgery (FUS): Non-surgical modern technique for fibroid ablation.

Lifestyle Changes

• Maintain healthy weight: Obesity increases estrogen levels; weight loss may help.
• Regular physical activity: 150 minutes weekly reduces estrogen levels.
• Reduce red meat consumption: Increase vegetables, fruits, and whole grains.
• Increase vitamin D intake: Through foods or supplements (Recommended daily dose: 600-800 IU).
• Manage stress: Chronic stress increases cortisol and other hormones.
• Limit alcohol: Excessive consumption may increase fibroid risk.
• Adequate rest and sleep: 7-9 hours nightly important for hormonal regulation.

• Anemia: Heavy and prolonged bleeding causes significant blood loss reducing hemoglobin. Iron levels drop causing fatigue, weakness, and shortness of breath. Severe cases may require blood transfusion.
• Infertility and miscarriage: Large fibroids or those inside the uterine cavity may affect embryo implantation or fetal growth. Can cause recurrent miscarriages or inability to conceive.
• Pregnancy complications: Fibroids may cause severe pain, premature labor, or slow fetal growth.
• Torsion: Subserosal fibroids on stalks may rotate causing severe pain and requiring emergency surgery.
• Inflammation and infection: Large fibroids may impede drainage of secretions increasing infection risk.
• Degeneration: In some cases, blood supply to the fibroid is interrupted causing sudden severe pain and tissue necrosis (mimicking appendicitis).
• Pressure on vital organs: Large fibroids may compress the ureter causing urinary obstruction and kidney infection, or compress the bowel causing obstruction.
• Surgical complications: Fibroid removal surgery may cause bleeding, infection, or scarring affecting fertility.

• Maintain healthy weight (BMI: 18.5-24.9): Obesity raises estrogen levels. Losing 5-10% of body weight may improve symptoms.
• Regular physical activity: 150 minutes weekly of moderate exercise (brisk walking, swimming) reduces estrogen.
• Eat a balanced, healthy diet: Increase leafy vegetables, fruits, whole grains; reduce red and processed meats.
• Increase vitamin D intake: Fatty fish, dairy products, eggs. Check vitamin D levels (normal: 30-100 ng/mL) and supplement if needed.
• Reduce alcohol consumption: Limiting alcoholic beverages decreases risk.
• Manage stress: Yoga, meditation, and enjoyable activities reduce cortisol.
• Adequate and regular sleep: 7-9 hours nightly regulates hormones and boosts immunity.
• Avoid smoking: Smoking may affect hormonal balance.
• Regular screening: Women aged 30-50 should undergo periodic check-ups, especially with risk factors.