What is a fibroid?
Myomas develop from a convoluted arrangement of normally orderly, smooth muscle cells of the uterine wall (leiomyomas) and form an increased amount of ground substance around them (so-called extracellular matrix, a kind of putty). However, they can also occur in a wide variety of organs. Depending on their position on the uterus and their size, they can cause different symptoms.
- Submucosal myoma: The myoma grows under the lining of the uterus and often into the uterine cavity.
- Intramural myoma: The benign tumor grows within the muscle layer of the uterus.
- Subserous myoma: The myoma develops above the muscle layer under the peritoneum of the uterus and continues to grow outwards from there.
- Transmural fibroid: It grows through all layers of the uterus.
A uterine fibroid can be inconspicuously small and only several centimeters in diameter, but it can also grow considerably. In this case, the uterus sometimes has a circumference similar to that of an advanced pregnancy. In addition, several fibroids can form in and on the uterus, medically known as uterus myomatosus.
Over 50 percent of all women over the age of 40 have one or even several fibroids. This makes uterine fibroids the most common benign tumor affecting the female reproductive organs.
Fibroids: causes and risk factors
Why a fibroid forms in the uterus is not yet fully understood. A certain predisposition plays a central role (familial, but also in terms of origin, e.g. African descent). The female sex hormones then drive the fibroids to grow.
In the phases of a woman’s life when the body does not produce these female sex hormones, fibroids do not grow. A girl cannot develop these tumors before puberty, and existing fibroids usually recede after the menopause or no new ones develop.
However, the actual factors that determine whether an area of the uterus grows are still unknown. However, three risk factors for fibroids are known:
- Genetic predisposition: If your mother or grandmother already had fibroids, your risk may be slightly higher.
- Childlessness: A woman who has never been pregnant is at increased risk.
- Overweight: Women who are very overweight are particularly likely to develop fibroids. Here too, the exact cause of this phenomenon has not yet been found.
Symptoms: Pain and heavy menstrual bleeding
Not every fibroid has to cause signs and symptoms. Around half of all women who have a fibroid do not notice it at all. Small tumors in particular, which occur outside the uterine cavity, are usually completely asymptomatic and do not need to be treated. However, if a fibroid is larger and presses on neighboring organs, symptoms may occur.
The most common complaints are so-called “abnormal menstrual bleeding” with primarily heavy menstrual bleeding (hypermenorrhea) or (more rarely) bleeding lasting longer than seven days (meno- to meno-metrorrhagia). The heavy bleeding can lead to severe cramp-like pain during the period and also to anemia (iron deficiency anemia). Typical statement: “I can hardly leave the house on the first few days of my period.”
In addition, large fibroids located outside the uterine cavity can lead to so-called “pressure symptoms” in the pelvic area. Fibroids of this size can lead to urinary bladder problems, constipation/flatulence or a general feeling of heaviness and pain in the pelvic area – especially during sexual intercourse.
Pain during sexual intercourse can also be caused by a fibroid. Almost half of all symptomatic women have such severe symptoms that they have a significant reduction in their quality of life and therefore have to take regular absences from work. Last but not least, fibroids can lead to sterility. However, they are often not the reason for sterility.
The following complaints and symptoms are also typical and occur depending on the location of the fibroid. In addition to the typical symptoms mentioned above, back pain, low back pain or sciatica can also occur in rare cases because the fibroid puts pressure on the sacrum and other areas in the pelvis where the sciatic nerves exit.
Myomas: Diagnosis by us
Sometimes a fibroid is discovered by chance during a routine examination. However, the diagnosis is usually made when the affected person already has symptoms and goes to the doctor. Then we will first ask the woman about her symptoms, when they occur, how her period is and more. This medical history is followed by a physical examination:
- Palpation examination: We feel the position of the uterus via the vagina, rectum and abdominal wall. Sometimes we can already identify a fibroid as a nodular thickening.
- Ultrasound examination: Sonography via the vagina and abdominal wall usually shows the position and size of the fibroid or fibroids reliably.
Additional diagnostic options are only available if the results of these examinations are inconclusive and further clarification is required:
- Endoscopy of the uterus (hysteroscopy)
- Magnetic resonance examination (MRI) of the uterus
- Laparoscopy (laparoscopy)
- Blood tests to check hormone levels
- Scraping in the case of heavy menstrual bleeding, whereby the removed uterine lining (top layer) is examined histologically in order to detect or rule out a carcinoma as the cause at an early stage.
Fibroids: prevention, early detection, prognosis
There are no known ways of preventing fibroids. The only important advice to every woman in connection with fibroids is:
Make sure you have regular check-ups with your gynecologist. In this way, a fibroid can be detected as early as possible and, if necessary, counteracted with the appropriate therapy.
You should seek medical advice immediately if you have symptoms or notice irregular menstruation.
Progression and prognosis of fibroids
Myomas usually have a tendency to grow. Only when they have reached a certain size do complaints arise. This is why women often come to us relatively late because of a suspected fibroid. Then there is already a risk that the tumor will impair the function of organs that it is crowding as it grows.
Depending on their location, fibroids can lead to chronic bladder irritation, but also to kidney disease and impaired bowel function. Heavy menstrual bleeding can cause anemia in the long term.
However, the fear that a fibroid can become malignant and that the muscle tumor can develop into a carcinoma is unfounded in the vast majority of cases. This risk only affects less than one percent of fibroids.
Nevertheless, even against this background, it is important to have fibroids checked regularly, at least once a year, even if they are small and do not cause any symptoms.