Uterine Fibroids: Causes and Treatment

Uterine fibroids are benign (noncancerous) growths in the uterus

The exact cause of uterine fibroids is unknown. It’s believed that uterine fibroids may develop from stem cells in the muscular layer of the uterus (myometrium). The cells multiply due to various causative factors creating a firm, rubbery mass.

Based on research and clinical experience, the causative factors include:

• Genetics: Certain genetic changes are seen in the fibroid tissue.
• Hormones: Estrogen and progesterone are female reproductive hormones. These hormones are responsible for the thickening and shedding of the uterine lining during each menstrual cycle. Imbalance of these hormones may cause fibroids. Fibroids have more progesterone and estrogen compared to normal uterine muscle cells. Fibroids tend to shrink after menopause. They may also shrink during pregnancy or after childbirth.
• Growth factors: Some substances that help the body to build and maintain tissues, such as insulin-like growth factors, can lead to the development of fibroids.
• Extracellular matrix (ECM): ECM is what makes the cells stick together, like cement between bricks. ECM is higher in fibroids; these store growth factors and cause biological changes in the cells.

Risk factors of uterine fibroids:

• Race: Any woman of reproductive age can develop fibroids, but black women are at a higher risk to develop fibroids compared to other racial groups.
• Women of reproductive age
• Family history: If a relative has had fibroids, the risk increases.
• Early-onset of menstruation
• Obesity
• Vitamin D deficiency
• A diet that is higher in red meat and lowers in green vegetables, fruit, and dairy
• Drinking alcohol

The treatment options include:

Observation and follow-up: Many women with uterine fibroids may not have signs or have mild symptoms that can be managed conservatively to provide symptomatic relief.

Medications: Medications that target hormones, which regulate the menstrual cycle, treat symptoms like heavy menstrual bleeding or pain. Medications do not eliminate fibroids but may help shrink them.

• Gonadotropin-releasing hormone (GnRH) agonists: They block the production of estrogen and progesterone. This causes menstruation to stop, putting the patient in a temporary menopausal state. As a result, fibroids shrink and anemia often improves.
• Progestin-releasing intrauterine device (IUD): A progestin-releasing IUD can relieve symptoms like heavy bleeding caused by fibroids. It provides an additional benefit of contraception but doesn't shrink fibroids or make them disappear.
• Lysteda, Cyklokapron (Tranexamic acid): This nonhormonal medication is taken to reduce bleeding during periods.
• Oral contraceptives: These can help control menstrual bleeding but don't shrink fibroid size.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can be effective in relieving pain related to fibroids, but they don't reduce menstrual bleeding or shrink fibroids.
• Nutritional supplements: Vitamins and iron supplements may be advised to correct anemia and improve overall health.

Noninvasive procedures:

• A non-invasive treatment option for uterine fibroids that preserves your uterus requires no incision and is done on an outpatient basis.
• Performed while you are inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The images give your doctor the precise location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses the sound waves (sonication) into the fibroid to heat and destroy small areas of the fibroid tissue.
• With newer technology researchers are learning more about the long-term safety and effectiveness. However, so far, the data collected show that focused ultrasound surgery for uterine fibroids is safe and effective.

Minimally invasive procedures:

• Uterine artery embolization: Small particles (embolic agents) are injected into the arteries supplying to the uterus that cuts off blood flow to fibroids, causing them to regress.
• Radiofrequency ablation: Radiofrequency energy is used to destroy uterine fibroids and shrinks the blood vessels that feed them.
• Laparoscopic or robotic myomectomy: During myomectomy surgery, the fibroids are removed, leaving the uterus intact.
• Hysteroscopic myomectomy: The surgeon inserts instruments through the vagina and cervix into the uterus to remove the fibroid.
• Endometrial ablation: A specialized instrument inserted into the uterus. Heat, microwave energy, hot water, or electric current is used to destroy the lining of the uterus resulting in the ending of menstruation or reducing menstrual flow.

Traditional surgical procedures:

• Abdominal myomectomy: In the case of multiple fibroids or very large or deep fibroids, the surgeon may use an open abdominal surgical technique to remove the fibroids.
• Hysterectomy: This involves the removal of the uterus. It is a permanent solution for uterine fibroids.