Many women have uterine fibroids (also called myomas, fibromyomas, leiomyomas, and leiomyomatas), which are non-cancerous (i.e., benign), connective tissue-based tumors that develop on the exterior or the interior muscular wall of the uterus.[1, 2] Fewer than 0.5% (i.e., less than 1 in 200) of uterine fibroids eventually become malignant (i.e., cancerous).
Some women have a single fibroid, whereas other women have multiple fibroids. Based on location, the three main types of uterine fibroids are:
Subserosal fibroids
Intramural fibroids
Submucosal fibroids
Subserosal i.e., under the surface) fibroids develop under the outside covering of the muscle wall of the uterus and can grow outward through the wall of the uterus. Although subserosal fibroids generally do not cause increased menstrual bleeding, subserosal fibroids may cause a variety of other symptoms.
Intramural (i.e., inside the wall) fibroids develop within the lining of the uterus and can grow inward. The most common type of fibroid, intramural fibroids can result in an increase in the size of the uterus. An abnormally enlarged uterus can be felt during a pelvic exam by a gynecologist. Intramural fibroids may cause a variety of symptoms.
Submucosal fibroids (i.e., under the mucosa) develop under the lining of the uterus and can grow inward into the lining itself.[2] Although submucosal fibroids are the least common type of fibroid, they typically cause the most symptoms. Regardless of size, a submucosal fibroid can result in heavy and prolonged menstrual bleeding.
A tendency to develop fibroids can result from a combination of:[2]
A genetic predisposition of (i.e., tendency towards) susceptibility of uterine tissue to form fibroids in response to stimulation by particular hormones, such as estrogen
Other risk factors (such as abnormal function of certain endocrine glands that normally secrete appropriate levels of hormones, hormone medications, and high levels of heavy metals in the body) that create an internal environment in which the uterine tissue forms fibroids in response to hormone stimulation by particular hormones, such as estrogen
Evidence that estrogen can stimulate the growth of fibroids include the following observations:[1-3]
Size of fibroids tends to increase significantly during pregnancy, a time during which the level of estrogen rises.
Size of fibroids tends to decrease after pregnancy, a time during which the level of estrogen is less.
In women who already had fibroids prior to menopause, but do not take hormone replacement therapy (HRT) after menopause, the size of fibroids tend to diminish.
Leiomyomas have increased levels of estrogen.
Animal studies show that injection of excess estrogen can lead to uterine fibroids
Also, it is possible that natural progesterone and synthetic progestin (which is one of the ingredients in birth control pills and one of the components of some types of hormone replacement therapy) can stimulate the growth of fibroids.[1] However, progesterone levels in leiomyomas vary.
Therefore, pre-menopausal women who have fibroids are advised that taking birth control pills (which contain estrogen and progestin) could result in an increase in the size of the fibroids.[1] Furthermore, post-menopausal women who have fibroids should be advised that receiving hormone replacement therapy (HRT) could result in increased size of the fibroids.
High excretion of certain heavy metals (i.e. mercury and cadmium) have been reported in some women with hormonal disturbances, including women with:[1]
Dysfunction of the thyroid
Uterine fibroids
Contamination with the toxic metals, mercury and cadmium, can contribute to the formation of uterine fibroids by:[1]
Causing thyroid dysfunction
Mimicking the activity of estrogen
Practitioners of traditional Chinese medicine believe that uterine fibroids result from the stagnation of blood in the pelvis. Furthermore, alternative medicine practitioners believe that some fibroids are caused by a blockage in the flow of energy in the 2nd chakra (a region of energy patterns in the body), which occurs when life energy stagnates due to women feeling "stuck" in important situations.
Emotional reasons for the stagnation of life energy include conscious or unconscious frustration, anxiety, or stress due to any of the following types of situations:
A job that is perceived to be "dead-end" (i.e., offering no opportunity for advancement)
A romantic relationship that is unfulfilling or a lack of a romantic relationship
Feeling stifled because creativity has not been allowed to be expressed
Feeling stifled because a different type of emotional or intellectual need has not been realized
Feeling stifled because another type of conflict in life has been unresolved
Because small fibroids in certain parts of the uterus may not create symptoms, small fibroids often are not noticed by women and sometimes are not diagnosed by gynecologists during a pelvic examination.[1, 3] Large fibroids, however, may cause symptoms and often are palpable (can be felt) by a healthcare professional during a pelvic exam. Other than by the size and location of the fibroid, physicians cannot predict whether a fibroid will cause symptoms.[2]
Typically, women with fibroids may not experience symptoms until they are in their late 30s or 40s.[2] Approximately 25% of women with fibroids eventually experience symptoms, including:[1-6]
Pelvic discomfort, pressure, or pain (e.g., from subserosal and intramural fibroids)
Menstrual cramps
Discomfort or pain during intercourse
Pressure, pain, or constipation in the bowel, due to pressure from uterine fibroids
Feeling of being bloated, due to constipation
Pain in the bladder, due to pressure from uterine fibroids
Frequency or urgency of urination, due to pressure on the bladder
Inability to control urination (urinary incontinence), due to pressure on the bladder
Pressure on the ureter, which, although a rare symptom, can result in damage to the kidney
Pain in the lower back or legs, due to pressure (e.g., from subserosal and intramural fibroids) on nerves that go to the pelvis and legs
Abnormal enlargement of abdomen
Increased discharge from the vagina
Fatigue
Unexplained (e.g., irregular) uterine bleeding, called metrorrhagia (e.g., from submucosal fibroids)
Heavy bleeding during menstruation (e.g., from intramural and submucosal fibroids)
Prolonged menstruation (e.g., from submucosal fibroids)
Blood clots during menstruation (e.g., from submucosal fibroids)
Anemia due to heavy menstrual bleeding
Shorter menstrual cycles
Infertility
Miscarriages, as the fibroid can grow during the estrogen-rich months of pregnancy and sometimes can cause harm to a developing fetus
Generally, diagnosis of uterine fibroids involve:[2]
Palpation (i.e., feeling the exterior) of the uterus during a pelvic examination to determine whether the uterus is enlarged. As many fibroids do not cause symptoms, most fibroids are detected during routine pelvic exams.
Analysis of clinical symptoms
Confirmation of the clinical diagnosis by either abdominal ultrasound, transvaginal ultrasound, computed tomography imaging (CT scan), or magnetic resonance imaging (MRI). These painless imaging methods reveal the size, shape, and texture of the uterus and can help the gynecologist determine whether a fibroid may interfere with fertility.
Confirmation of the clinical diagnosis by diagnostic hysteroscopy. The procedure, which may be performed with or without administration of a local anesthetic, involves insertion of a lighted instrument into the vagina, cervix, and uterus. The gynecologist examines the uterus for tumors and can take samples of tissue for biopsy (i.e., examination under a microscope). Also, the procedure can help the gynecologist determine whether a fibroid may interfere with fertility.
For information on treatment of fibroids, see our Q&A called Treatment of Fibroids.
REFERENCES
1. Life Extension Foundation Uterine Fibroids. In Disease Prevention and Treatment, 4th edition. Hollywood, FL: Life Extension Media.
2. Uterine fibroids symptoms and diagnosis. Society of Interventional Radiology. Accessed at www.airweb.org/patPub/uterine.shtml.
3. J. Reichenberg-Ullman. Homeopathy for uterine fibroids. Townsend Letter for Doctors and Patients. 11/04.
4. Uterine fibroid embolization: a new way to treat fibroids. Accessed at www.familydoctor.org.
5. I. Ikenze. Menopause & Homeopathy: A Guide for Women in Midlife. 1998. Berkeley, CA: North Atlantic Books.
6. J. Reichenberg-Ullman. Whole Womans Homeopathy. 2004. Edmonds, WA: Picnic Point Press.
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