Uterine Fibroids

Uterine fibroids (uterine myomas or leiomyomas) are very widespread problems of women causing many troubles and sometimes even serious complications.  Therefore, it is important to know at least some basic information about this issue.


First, it is necessary to know more about the womb (uterus).  The uterus is a hollow organ that is located in pelvic region of woman’s body. The uterus is connected to vagina and two fallopian tubes. The main significance of the uterus is the ability to nest the fertilized egg and to allow fetal development. The wall of the uterus consists of three layers. The inner cavity is lined by a mucosa (endometrium), this is covered by a layer of smooth muscle (myometrium) and the most superficial layer is known as serosa.


In this issue, the most interesting is the intermediate layer, i.e. the myometrium. The myometrium often becomes a source of tumors arising from the uterine muscle tissue. These tumors are called uterine fibroids and they are benign, i.e. they grow locally and do not form metastases. However, their local growth may cause further problems.


The exact cause of fibroid occurrence is not clear, but we know many risk factors that may contribute to the problem. Age is a typical risk factor as the majority of uterine fibroids occur in older women. Genetics also plays a role and women in certain families experience more common occurrence of fibroids. Female hormone estrogen has a significant influence on myoma growth and this explains the effect of obesity. Adipose (fat) tissue of obese women constitutes more estrogen increasing its concentration. I have even heard of a connection between uterine fibroids and smoking, but I do not possess any clear information about increased risk of myomas in women smokers.


The fibroids can manifest in different ways, but most often they are asymptomatic. Myomas may cause gynecological bleeding either irregular during the cycle or increased bleeding during menstruation. In addition, fibroids are often responsible for female infertility. Their presence compromises the ability of the uterus to accept a fertilized egg and allow the intrauterine fetal development. Larger fibroids can cause unpleasant chronic pelvic pain and the largest may even compress other pelvic organs such as the bowels and urinary bladder causing constipation or disruption of urine flow.


Myoma growing and protruding into the uterine cavity may rotate around its axis strangulating its blood vessels and this situation stops the blood flow into the fibroid. The myoma tissue succumbs to necrosis, which is accompanied with severe pain. In addition, myoma growing into the uterine cavity may even protrude into the vagina, where it can be seen or palpated. This situation is referred to as “myoma nascens” or “being-born- myoma”.


Uterine fibroids


Schema showing different possible locations of uterine fibroids



Women with any of the above symptoms (including the inability to become pregnant) are usually examined by a gynecologist that can perform abdominal or vaginal ultrasound. Ultrasound is fully sufficient to find a myoma, but in unclear situation it can be followed by hysteroscopy.


Full prevention is impossible. It is advisable to have a lot of physical exercise and prevent obesity. The real question is the use of hormonal contraceptives. There are opinions that their regular usage has a mild protective effect against myomas, but the issue is quite controversial.


The treatment of fibroid falls into the competence of gynecologists. Generally, the fibroids can be treated either with medication or surgery. There are many drugs that are designed to reduce estrogen levels and shrink the already occurred fibroids. Surgical treatment tries to remove fibroid tissue while preserving the uterus of fertile women who want to have children. In women after menopause and in women with numerous and large fibroids, total hysterectomy (surgical removal of the uterus) may be the best option.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources