What Are Fibroids?

Fibroids, also known as uterine myomas, are the most common type of tumor found in the female reproductive system. They are benign and sensitive to hormones. Typically, they occur in younger women, usually between the ages of 25 to 30. Fibroids originate from the myometrium of the uterus. Depending on the predominant fibers in their composition, they may be called leiomyomas (more muscle fibers), fibromas (more connective tissue), or leiofibromas (roughly equal amounts of both components).

While many women may have fibroid nodules, they often go undiagnosed due to their small size and lack of symptoms. The exact cause of fibroids is unknown, but certain risk factors have been identified, including being overweight, having polycystic ovaries, diabetes, arterial hypertension, and a genetic predisposition, with a direct relative having a myoma increasing the risk of occurrence threefold.

Types of Fibroids

Fibroid nodules initially develop within the myometrium and may remain small and asymptomatic. They can be categorized based on their growth direction:

Intramural Fibroids

These are the most common type and develop within the uterine wall. While small, they may not cause any symptoms, but as they grow, they can deform the uterine cavity or compress nearby organs.

Subserosal Fibroids

These nodules grow towards the abdominal cavity and can become quite large. They may appear separate from the uterus, connected only by a thin layer of tissue, leading to potential misdiagnosis as an ovarian neoplasm.

Submucosal Fibroids

These fibroids grow towards the uterine cavity, causing deformation. They can sometimes be pedunculated, making them mobile. In certain cases, they may rotate and block the cervical canal, leading to necrosis, known as a degenerating fibroid nodule.

Intraligamentary Fibroids

These are less common and grow towards the ligaments that support the uterus.

Parasitic Fibroids

These are subserosal fibroid nodules that develop their own blood supply, become detached from the uterus, and float freely in the abdominal cavity.

Fibroid growth is largely influenced by estrogen and progesterone levels, which typically stimulate their growth.

Symptoms and Clinical Presentation

Most women with fibroids are asymptomatic. However, irregular bleeding, different from menstrual bleeding, is a common complaint, often accompanied by anemia, causing symptoms like headache, palpitations, and dizziness. Pain may occur if a fibroid on a stalk twists and enters the cervical canal, causing spasms in the lower abdomen.

When fibroids press on nearby organs such as the bladder, ureters, or rectum, symptoms like frequent urination, constipation, and hydronephrosis (kidney obstruction) may occur. Additionally, growing fibroids can lead to deformation of the uterine cavity, causing infertility.

Diagnosis and Treatment

Fibroids can be detected during a routine gynecological examination and confirmed with ultrasound, CT scan, or MRI. Treatment options depend on factors like the woman’s age and reproductive plans.

Medical treatments may include pain relief, management of anemia (often with iron supplements), and hormone therapy. Surgical options involve removing the fibroid, known as myomectomy. Small, asymptomatic fibroids require regular monitoring by a healthcare provider every six months.