Introduction

Fibroids are non-cancerous growths that develop in and or around the uterus. These are made up of muscle and connective tissue and can vary in size. They are also known as fibromyomas, leiomyomas, but most commonly are referred to as uterine fibroids. While the exact cause for the development of fibroids is unclear, research suggests that many factors, such as hormones and genetics, could contribute to their development. Many patients often have multiple fibroids. Within the uterus, the anatomical locations of fibroids are:

• Subserosal
• Intramural
• Submucosal

Prevalence

Uterine fibroids are a major reason for abnormal uterine bleeding, and this condition is common in adult females but very rare in adolescent years, with a ratio of less than 1%. In most cases, fibroids are at their peak during the perimenopausal years and decline after menopause as fibroids shrink.

Clinical significance

Fibroids can cause significant morbidity, which worsens women's quality of life. Abnormal uterine bleeding can contribute to the development of anaemia, a condition where haemoglobin levels drop, weakness takes over, and other symptoms, such as fatigue, dizziness, shortness of breath, and loss of appetite, become apparent.

Epidemiology and risk factors

Despite high pathogenesis, incidence, and prevalence, risk factors are far from being completely understood. There are several challenges in understanding the epidemiology of fibroids. In most cases, the fibroid is asymptomatic, and these undetected fibroids create a strong bias in epidemiological data and evidence on the associated risk factors. It includes a multifactorial aetiology, which is listed below:

Age and demographics

The data shows that young women between the ages of 15-35 years develop fibroids, as myomas do not occur before puberty.

Hormonal influence

Oestrogen and progesterone, the two female hormones, are responsible for the development of uterine fibroids because fibroids are sensitive to these hormones, so an imbalance of any of these can significantly affect women's reproductive as well as overall health.

Genetics

Genetics also play a role in the development and progression of uterine fibroids.  Women with a history of myoma are more likely to develop fibroids. Another reason may be due to any kind of mutation in the human genome.

Ethnicity

Fibroids are predominant in African / Asian women, and they experience more severe symptoms than white women. It may be due to the differences in environmental and chemical exposure.

Lifestyle factor

Another common but important reason for the progression of fibroids is obesity and changes in dietary habits.

Clinical presentation

While many patients with fibroids are asymptomatic, individuals with uterine fibroids show a variety of signs and symptoms.. In these women, myoma may be discovered during investigation for other conditions, like hysterectomy done for other gynaecological conditions-such as cervical or ovarian malignancy, among symptomatic women. Abnormal uterine bleeding is the commonest complaint, along with other issues, which include:

• Pelvic Pressure
• Constipation
• Backache or Leg-pain
• The menstrual period lasts more than a week
• Frequent Urination
• Dysmenorrhea

Rare symptoms

In some cases, typical compression symptoms are found in women with uterine fibroids; for instance, the mass arising from the posterior wall might cause rectal symptoms like tenesmus, backache and constipation. These symptoms might worsen during periods; flank pain on the right side due to compression of the ureter is a rare symptom.

Diagnostic evaluation

To detect the size and histopathology of uterine fibroids, the following methods are included: 

Ultrasound

The most commonly recommended imaging technique is used to diagnose fibroids and identify their size and location, and the most recommended order is pelvic and transvaginal.

Sono hysterogram

It is suggested that the cavity of the uterus be accessed to determine if any submucosal fibroids are present in the uterine cavity.

MRI

Occasionally, an MRI or CT scan is recommended by doctors when there is any disturbing feature to your fibroids. This technique is beneficial for surgical procedures.

Lab test

Individuals with abnormal bleeding are likely to develop anaemia, so the doctor performs a CBC (complete blood count) or another test, like a serum iron test.

Further investigation

Endometrial biopsy

In this short surgical procedure, a sample of the lining of the uterus is taken via a small pipelle, which is placed through the opening of the cervix and into the uterus.

Periods tracking

The major symptom of fibroids is irregular periods, so the doctors suggest individuals track their periods to help the doctor detect any changes in the pattern of their menses.

Management strategy

It involves a variety of strategies ranging from:

Conservative management

Almost one-third of women with leiomyomas go through symptomatic treatment for mild cases. New treatments have been developed to provide an alternative to surgical intervention. The medication used for management is Ulipristal Acetate, which comes under the category of selective progesterone receptor modulators (SPRMS); this method is suitable for those women seeking to preserve their fertility.

Surgical intervention

The current management strategy involves surgical intervention, but the treatment plan is designed according to the patient's age and desire to preserve fertility, such as hysteroscopy and laparotomy by myomectomy.

Fertility consideration

Fibroids presence does not affect ongoing pregnancy, while some patients with fibroids may face pregnancy-related issues. Submucosal fibroids can cause a spontaneous abortion. Patients with a symptomatic fibroid do not require treatment before attempting conception unless they have had a previous history of miscarriage.

Prognosis and follow-up

The prediction of uterine fibroids is based on their recurrence, which is low because many females endure no symptoms or sometimes mild symptoms and require no treatment, but regular monitoring to prevent complications.

FAQs

What are uterine fibroids?

Uterine fibroids (leiomyomas) are benign smooth muscle tumours of the uterus. Diagnosis is determined by pelvic examination, ultrasound, or other imaging studies.

What causes uterine fibroids?

The exact cause of uterine fibroids is unknown, but healthcare providers believe the hormones estrogen and progesterone play a role. Fibroids tend to grow when hormone levels are higher (like during pregnancy) and shrink when hormone levels are low (like during the transition to menopause). Research suggests that each tumour develops from an abnormal muscle cell in the uterus and multiplies rapidly when encountering the estrogen hormone, which promotes the tumour's growth.

What are the symptoms of uterine fibroids?

Fibroids frequently cause abnormal uterine bleeding and pelvic pressure and sometimes urinary or bowel symptoms, infertility, or pregnancy complications.

Are uterine fibroids life-threatening?

Uterine fibroids are not life-threatening or dangerous. They are benign growths that occur on the lining of the uterus. In some cases, uterine fibroids do not bother if they are small in size and fewer in number. However, in other cases, uterine fibroids can be symptomatic, like constant fatigue, irregular periods, or excessive cramping, and generally affect the quality of life.

Why do uterine fibroids occur?

Uterine fibroids are usually referred to as abnormal growth that emerges around the uterus. The reason for the occurrence of uterine fibroids may differ from one woman to another. The most common reasons are:

• Hormonal changes during pregnancy
• Hereditary

What is the conventional method for the treatment of fibroids?

Treatment of patients depends on symptoms, desire for fertility, and patient preferences. Treatment may include estrogen-progestin contraceptives, progestin therapy, tranexamic acid, gonadotropin-releasing hormone agonists/antagonists, uterine artery embolisation, and surgical procedures (e.g., myomectomy, hysterectomy).

Do uterine fibroids affect fertility?

If uterine fibroids are minor, they usually do not bother. However, if they are multiple in number and larger in size, such uterine fibroids can affect fertility in women. Uterine fibroids generally cause irregular periods and may interfere with ovulation. In most cases, if the uterine fibroids are submucosal, they may hinder conception or the maintenance of pregnancy.

Can I prevent uterine fibroids from developing?

Yes. One can prevent uterine fibroids from developing or progressing if they are in the early stage. The following tips may help you prevent the condition:

• Adopt healthy lifestyle choices 
• Doing regular exercises to maintain a healthy body weight
• Refrain from smoking
• Avoid drinking alcoholic beverages
• Eat fruits and vegetables.

Summary

Uterine fibroid is a common concern in women of fertile age, causing heavy bleeding and pain symptoms, which can have an impact on women's health by declining their quality of life. While early detection of fibroids and their management are required to improve female reproductive health, fibroids do not need to be treated if they are not causing any symptoms.