Uterine fibroids are growths that occur within the uterus and are known as clonal neoplasms. This is because fibroids are a type of tumour in which the cells have a common ancestor. Uterine fibroids are also referred to as myomas. These tumours are benign, meaning that they are not cancerous. However, they can impact the health of women in many different ways.1
Fibroids typically affect women at the age at which they can reproduce and can lead to a variety of different issues, such as excessive bleeding during menstruation, which causes many problems. Bowel dysfunction may also occur, as well as pain during intercourse. In addition, uterine fibroids may cause issues with fertility and complications during pregnancy.
Fibroids can be asymptomatic, but in severe cases, these can significantly impact the health of women with these tumours.2 Patient outcomes differ depending on the individual; however, there are some patterns regarding overall physical health and complications associated with fibroids. Some studies suggest that women who are overweight or obese may be more likely to develop fibroids and may experience more severe instances of this condition. However, it has been difficult to draw definitive conclusions.3
An increasing number of studies are being conducted to establish the link between weight and fibroid prevalence and severity. This article will explore the relationship between fibroids and weight by evaluating the link between weight and fibroid prevalence, and how fibroids may lead to weight gain. Management strategies for those with uterine fibroids will also be explored.
Uterine fibroids are tumours within the uterus that are benign, as aforementioned, meaning that they are not cancerous. These tumours affect females when they reach reproductive age, and many women affected are asymptomatic. This means that they present with no symptoms, and therefore, this results in little to no effect on their daily lives.4 These tumours are sometimes referred to as myomas or leiomyomas and can lead to the uterus eventually having to be removed in a procedure known as a hysterectomy.
Fibroids are detected using imaging methods such as ultrasonographic scanning.5 Although the majority of women with fibroids are asymptomatic, those who are not have many characteristic symptoms. The most common symptom is heavy bleeding during menstruation, as well as periods that last longer or may be unpredictable. Periods may occur more frequently in those with fibroids, and this increased bleeding leads to discomfort and other issues. Pelvic pain has also been reported to be chronic in some instances of this condition, and bloating is also common. Pain during sexual intercourse is also a very prevalent symptom, and these symptoms affect women both physically and emotionally.6
Fibroids affect women in different locations within the uterus, and there are three types of fibroids: submucosal, intramural, and subserous fibroids. Submucosal fibroids characteristically appear below the inner lining of the uterus, which is called the endometrium. Intramural fibroids are more common and develop in the myometrium, which is the uterine muscle.7 Finally, subserous fibroids grow outside of the uterine lining and can grow into the pelvis. In some cases, these fibroids are more likely to cause pelvic pain.8
Fibroids lead to both direct and indirect weight gain. Fibroids cause direct weight gain in two main ways: firstly, the amount of visceral fat within the abdomen tends to be higher in women with fibroids. The mass within the abdomen and pelvis increases, thus women experience weight gain due to the size of the fibroids, and the large amount of visceral fat present in those with fibroids.9
Additionally, fluid retention, such as urinary retention, is higher in women with fibroids and may be associated with renal failure. Higher water retention leads to higher water content within cells, and the inability to release urine from the body adequately contributes to weight gain.10
Fibroids lead to indirect weight gain due to a few different mechanisms. Pluripotent stem cells within the fibroids express low oestrogen and progesterone receptor levels. Hormone imbalances and fluctuations are known to cause weight gain in women, particularly in the abdominal area.11
The pain and symptoms caused by fibroids have led some women to reduce their physical activity levels, which in turn contributes to increased weight gain.12 Women are also psychologically affected and are typically more distressed compared to those without fibroids. This leads to stress-eating in some cases to counteract the distress, which unfortunately leads to weight gain over a sustained period of time. (13)
Fibroids lead to weight gain in some instances, and weight is also linked to fibroid development. Oestrogen is strongly associated with fibroid growth. This is due to oestrogen lowering fatty acid oxidation in women; therefore, there is a higher level of body fat in women with high oestrogen in some instances.14 There are also more oestrogen receptors in fibroids as compared to regular tissue; therefore, it is plausible that oestrogen is linked to fibroid development.
Higher levels of visceral fat, due to high oestrogen, lead to higher inflammation levels and have been demonstrated to be closely linked to the rate of fibroid development. It is widely accepted that higher fat levels increase the risk of developing uterine fibroids.15 Obesity also results in higher levels of visceral fat and increases the risk of fibroid development.16
Medical interventions and lifestyle changes can be implemented to manage fibroids and weight. A balanced diet is key to managing weight gain. Studies have shown that diets rich in fibre and whole foods are not linked to fibroid growth. A balanced diet lowers the chance of obesity and high fat levels that are closely related to fibroid growth.17
Exercise leads to lower oestrogen levels and a lower chance of obesity. This decreases the likelihood of oestrogen dominance, which contributes to fibroid development and makes weight less of an issue. Managing stress levels is also crucial in reducing the chance of fibroids and weight gain, as mental health is strongly associated with these physical health outcomes.18
Medical treatments that are available for this condition include hormone therapies. These include hormone agonists that bind to hormone receptors such as the oestrogen and progesterone receptors. This reduces the negative effects of oestrogen to a degree. Gonadotropin-releasing hormone agonists lower the production of female reproductive hormones and are a popular non-surgical intervention.19
Surgical options such as a hysterectomy, in which the uterus is removed (as mentioned previously), and a myomectomy, in which the fibroids are removed from the uterus, also result in positive outcomes. It is important to note, however, that further strategies are being developed due to myomectomies negatively affecting pregnancy outcomes and hysterectomies leading to women being unable to become pregnant.20
Those with fibroids, or who suspect that they have uterine fibroids, should see a doctor when they gain a significant amount of weight in a short period of time. Women may experience an increase in their body mass index (BMI) and their overall weight due to fibroid growth and increased water retention (Viva). The aforementioned symptoms are also indicative of fibroid-related weight gain.
Magnetic resonance imaging (MRI) and ultrasound scans are used to diagnose fibroids and monitor the pelvis during the treatment. These diagnostic methods are crucial in dictating possible treatment plans, which greatly affect patient outcomes.21 Pelvic exams carried out by gynaecologists are also used to detect the presence of fibroids in the uterus, and it is a useful diagnostic method.22 As previously mentioned, improvements in diagnostic methods allow for more tailored treatment plans. It is important that treatment plans are unique to each patient to ensure the best patient outcomes.
In summary, fibroids are linked to weight, as they can lead to weight gain due to increased mass and fluid retention. Fibroids may also lead to potential hormone imbalance, which contributes to weight gain, and the lifestyle of women affected may be less suitable for weight loss, further contributing to weight gain. Weight is linked to fibroid development as fat is strongly associated with high oestrogen levels, which result in fibroid growth. It has been demonstrated in multiple studies that obese women are generally more likely to develop fibroid growth when compared to healthy individuals.
When women experience fibroid symptoms such as pelvic pain, prolonged periods and other related symptoms, it is important to seek medical attention as soon as possible so that a treatment plan can be put into place. Uterine fibroids affect each woman differently, which means that a personalised treatment plan should be implemented for each woman. More awareness of this condition, better treatment approaches, and lifestyle changes for women who are overweight will decrease the prevalence of uterine fibroids. Improved treatment techniques and diagnostic methods will improve patient outcomes in the near future.
