Introduction

Fibroids are growths of smooth muscle cells and connective tissue that form in the Uterus. It's also called Leiomyomas.¹ Leiomyomas are benign tumours. It is mostly found in premenopausal women.

In this article, you will learn about fibroids, their various types classified based on their location. What are the various ways used to detect? In brief, you will learn about its effects on the body and the types of treatment available.

Moreover, you will learn the role physical activity plays in fibroids. Does that decrease the symptoms and effects of fibroids? Is it good to approach and solve problems of fibroids through holistic methods of physical activity?

 Fibroids (leiomyoma’s)

 Leiomyomas are formed from cells arising from the myometrium. They are monoclonal in origin. It arises from the smooth muscle of the Uterus. Many women affected might not have symptoms. Some of the symptoms associated with fibroids are abnormal uterine bleeding, pain and pressure in the pelvic region, not able to conceiving.²

Uterine fibroids are more commonly seen in the reproductive and premenopausal age groups. Fibroid affects 70% of women worldwide. They are known to be benign, and someone rarely dies. The reason for death may be due to severe anaemia caused by heavy menstrual bleeding. It's always advised to consult with the gynaecologist at the earliest and adapt to a healthy lifestyle. Many women undergo a hysterectomy due to fibroids. Fibroids are the main reason for gynaecological and reproductive problems. Also, menorrhagia, pelvic pain, infertility, frequent abortions, and premature delivery are all related to fibroids, which impact our social and financial well-being.

Overview of uterine fibroids

Fibroids are mostly seen in 70% of premenopausal women, and later, the severity decreases after menopause. These fibroids are non-cancerous.

Nearly 20% to 50% of women have heavy menstrual bleeding, which leads to anaemia, urinary bladder problems, and complications with their pregnancy. The cause of symptomatic and asymptomatic fibroids is not completely known. The size and location of the fibroid are also known to impact.⁴  There has been a record of fibroids with variable sizes from watermelon to the size of a tiny stone. They are mostly singular and rarely arranged in groups.

To understand the layers of the uterus to classify fibroids

The uterus comprises three main layers, the perimetrium, myometrium and endometrium. The perimetrium is the protective outer layer. The myometrium is the middle layer, which is muscular and functions by expanding and contracting during pregnancy. The endometrium, which is the inner layer, and it sheds during the menstrual cycle.

Types of fibroids

Intramural fibroids: They occupy the myometrial cavity. It impacts conception during pregnancy and has lower pregnancy rates, and is known to have a continuous abortion rate.⁴

Subserosal fibroids: These fibroids are mainly seen outside the myometrium. It also affects the stability of early pregnancy. It has fewer effects on fertility and causes pain and pressure when they are large.⁴

Submucosal fibroids: These fibroids cause alteration in the muscular wall and reside inside the uterine wall. They disturb the blood supply in the endometrium, which impacts embryo placement. They have lower fertility rates. It is symptomatic and leads to hemorrhage and vaginal bleeding in between menstrual cycles.

Pedunculated fibroids: These fibroids do not occur in an exact location. It is mostly seen with a vascular stalk attached inside or outside the uterine cavity. They do not cause any symptoms unless they are torsioned. They can cause symptoms if they grow and exert force on other masses. They can disengage and become parasitic myomas.

Effects of fibroids (leiomyomas)

Fibroid growths in the fallopian tubes block the passage for sperm, resulting in infertility. Also, it affects the success rate in women who are trying to use ARTs ( assisted reproductive technologies).

Hormones in pregnancy cause fibroids to increase in size. Later, after delivery, these fibroids decrease in size. The reason for this is a decrease in blood flow to the uterus as the placenta tears away from the uterine wall. To compensate for blood loss, the uterus undergoes clotting, which reduces the blood supply to the myomas, thereby reducing their size.

In symptomatic fibroids, like the submucosal type, women undergo heavy bleeding and change their sanitary products every hour. Due to the enlargement of the uterus, they experience pain and pressure in the pelvis. The shape of the uterus changes according to the placement of fibroids. Anterior fibroids are associated with urinary issues and constipation.⁴ 

Causes of leiomyomas (fibroid)

• The causes of leiomyomas are still to be understood. Some of the risk factors are 
• Genetic modifications due to chromosomal abnormalities
• Obesity and if we have a higher BMI index
• Family history of fibroids
• In women who did not conceive or had children
• Age, race, increased blood pressure, and lower vitamin D levels are also risk factors³
• Higher Vitamin E levels
• Changes in reproductive tract microbiome
• Exposure to endocrine-disrupting chemicals, such as organophosphate esters³
• Exposure to a harmful environment during early life
• Alcohol and tobacco usage

Diagnosis of uterine fibroids

Ultrasound scan: using high-frequency sound waves to create an image.

There are two types:

1. Abdominal ultrasound scan - The ultrasound probe is moved outside the body
2. A transvaginal ultrasound scan - A small ultrasound probe is inserted into vagina

Hysteroscopy: In this procedure, the uterus is examined by placing a small telescope through vagina. It takes around 10 to 15 minutes. It is a painful procedure, causing discomfort. It's recommended by the NHS to take painkillers one hour before the procedure.

Laparoscopy: It's a small telescope which has a camera and light source at one end. With the help of a camera, a surgeon can see images of the abdomen and pelvis on a monitor.

During this procedure, a small incision is made in the abdomen to examine.

• Biopsy: A small sample of tissue is removed during hysteroscopy for further examination in a microscope to rule out malignancy
• Saline infusion sonography: Inject the salt solution into the uterus to form the image
• Magnetic resonance imaging(MRI): It uses magnets and radio waves to create the picture
• X-rays
• Computer tomography: (CT) or computer-assisted tomography(CAT scan)

Types of treatment for fibroids in the uterus:

Regular physical activity and general health

Physical activity has many health benefits. Every age group benefits from exercise in multiple ways.

Exercise tends to maintain a healthy weight and body mass index, which prevents us from hypertension and diabetes. It gives a broader range of benefits for everyone.

A good Physical workout helps us fight against many existing health conditions and diseases. It boosts the HDL (high-density lipoproteins) and benefits our cardiovascular system, and strengthens our heart muscles.

When we exercise, our brain releases endorphins, which help us to uplift our mood and make us feel happier and less anxious. It helps in the prevention of hormone-controlled disease.

Exercise enhances our energy levels- It strengthens our muscles and improves our endurance. Our body tissues receive more oxygen, which helps us work more efficiently. When we do regular exercise, we also sleep better.

The connection between physical activity and fibroids

There is very little research between physical activity and fibroids. Women who are very active show significantly fewer fibroids. There were fewer fibroids in women who were active and had a body mass index proportionate to their height, and their risk factors were controlled.⁵

 Women engaged in high physical activity were likely to have fewer fibroids than women who engaged in less vigorous exercise.⁶

Since there is very limited research regarding fibroids and physical exercise, a research program has been proposed regarding this.

Can fibroids be reduced with physical activity?

Fibroid growth is linked to both estrogen and progesterone hormones. They help in the regulation of the menstrual cycle.

When we exercise regularly, there is a balance between estrogen and progesterone. When there is an increased body mass index, it is prone to developing fibroids. By maintaining a lower BMI, the fibroid growth is reduced. 

Although exercise prevents fibroids from growing, there is not much effect on the fibroids that are already symptomatic. When we exercise vigorously, it helps in inhibiting the growth of fibroids quickly. Exercise is not a cure, but it helps in slowing fibroid growth. Therefore, any type of Physical exercise, like walking, running, stretching, yoga, and weight training, is recommended.⁷

Physical activity as part of a holistic management plan

Holistic steps to manage symptoms of uterine fibroids can also be beneficial. Several approaches include nutrition, herbal supplements, stress management, and regular physical activity.⁸

Anti-Inflammatory diet- Including fruits and vegetables, Healthy fats, whole grains and fibre, Green tea. Avoiding red meat, dairy products, and processed foods. When we focus on an anti-inflammatory diet, we may reduce the fibroid symptoms and manage hormone levels by supporting the overall health of the uterus.

Herbal remedies- a few of the herbs like Vitex(chasteberry), Turmeric, Green tea extract, Milk thistle have shown to promote hormonal balance among some women. Further research is recommended.

Stress-reducing Methods- Chronic stress contributes to hormonal imbalances, which aggravate fibroid symptoms. Some techniques to reduce stress are Yoga, Meditation, and deep breathing; these help in reducing the cortisol levels, which impact hormonal balance.

Therefore, by including the above techniques, we can manage stress and reduce fibroid-related problems.

Summary

All in all, fibroids are mostly seen in premenopausal women. There are different types of fibroids based on their location. The majority of fibroids are non-cancerous. Severity of symptoms depends on the type of fibroid. Many women undergo heavy bleeding and suffer from pain and pressure in the pelvic region due to fibroid growth. There are many types of treatment suggested for fibroids. Being active and doing regular physical exercise plays an important role to overall health and preventing the growth of fibroids. Many holistic approaches are also suggested to manage fibroids. It's very important that we do regular physical exercise, maintain our weight and overall health in order to have fewer symptoms from fibroids.