Fibroids (Myomas): The Most Common Benign Uterine Masses
Fibroids, also known as leiomyomas or fibromas, are the most common benign uterine masses that originate from a single smooth muscle cell in women.
Frequency and Prevalence of Fibroids:
Fibroids are seen in approximately 20-30% of all women, but this rate can reach up to 50% in autopsy studies. This high prevalence can be attributed to many fibroids being asymptomatic and undiagnosed before autopsies. Typically, fibroids are more commonly observed in African American women (approximately 50%) compared to Asian and Caucasian women (about 25%). Fibroids are rarely seen in individuals under the age of 18 but often shrink and disappear after menopause.
Types of Fibroids:
Generally, fibroids are classified into three main types based on the layer of the uterus in which they are located. Fibroids can rarely spread throughout the entire body while remaining benign, a condition referred to as myomatosis.
- Subserosal: These fibroids develop just beneath the outer layer of the uterus. Subserosal fibroids can have a stalk and can originate from the uterus with a small stem. Stalked fibroids may receive blood supply from neighboring organs such as the ovaries or other abdominal organs, earning them the name “parasitic fibroids.”
- Intramural: Intramural fibroids develop within the muscular wall of the uterus.
- Submucosal: These types of fibroids are situated beneath the innermost layer of the uterus and often lead to abnormal bleeding. Submucosal fibroids can have a stalk and may even protrude from the cervix.
Clinical Manifestations of Fibroids:
The majority of fibroids do not cause symptoms or clinical manifestations. Individuals with symptoms most commonly experience abnormal bleeding. Abnormal bleeding is attributed to pressure on the uterine lining by the fibroid, resulting in ulcers and irregular shedding.
Fibroids often present as a mass in the lower abdomen and can grow to fill the entire abdominal cavity. Pressure on the bladder can lead to frequent nighttime urination, frequent urination, or urinary retention. Pressure on the large intestine may cause a constant feeling of bloating and constipation. Back pain and radiating pain down the legs can occur due to pressure on the back. Pain during sexual intercourse can result from pressure on the vagina. If the fibroid continues to grow, it can compress the ureters, leading to a condition known as hydronephrosis, causing an accumulation of urine in the kidneys.
Sometimes, a stalked subserosal fibroid may twist around itself or experience structural changes, leading to painful menstruation. Submucosal fibroids with a stalk may protrude from the cervix and are referred to as “pedunculated fibroids.”
Other Issues Caused by Fibroids:
- Miscarriage or Preterm Birth: If a pregnancy attaches over a submucosal fibroid, insufficient placental development may lead to miscarriage, or if not, there is an increased risk of placental abruption (especially if the fibroid is larger than 5 cm).
- Red Degeneration: This occurs due to decreased blood supply to a growing fibroid, resulting in severe pain. However, this pain is typically managed with pain relievers and cold compresses.
- Fetal Abnormalities and Inadequate Cervical Dilation at Birth: Large fibroids can lead to fetal malposition (such as breech birth) or inadequate cervical dilation during labor. These outcomes often increase the rate of cesarean sections.
Please note that the content provided is for informational purposes only, and you should consult your doctor for diagnosis and treatment.
Content Update Date: 26.12.2022