Fibroids

Fibroids, also called uterine leiomyomas, are benign tumors composed of smooth muscle cells and fibrous tissue that arise from the myometrium. These tumors vary in size and number and can grow within the uterine wall, protrude into the cavity, or develop on the outside of the uterus. They are common in women of reproductive age and may cause symptoms or be discovered incidentally.

Fibroids are not cancerous, but they can cause heavy menstrual bleeding, pelvic pressure or pain, urinary frequency, and reproductive issues such as infertility or complications in pregnancy. They are often hormonally responsive, with growth influenced by estrogen and progesterone; growth commonly occurs during reproductive years and regresses after menopause.

Classification depends on location: intramural fibroids are within the uterine wall, submucosal fibroids project into the uterine cavity, subserosal fibroids lie on the outer surface, and pedunculated fibroids grow on a stalk. Risk factors include age, African ancestry, family history, obesity, and certain growth factors.

Diagnosis is usually based on symptoms and pelvic examination, with ultrasound as the first-line imaging test. Magnetic resonance imaging (MRI) may be used for complex cases or surgical planning.

Management ranges from observation to treatment depending on symptoms, age, fertility goals, and fibroid characteristics. Many fibroids cause no symptoms and require no treatment. Medical therapies can help control bleeding and pain; hormonal options may shrink fibroids temporarily. Surgical options include myomectomy (removal of fibroids while preserving the uterus) and hysterectomy (removal of the uterus). Other procedures include uterine artery embolization to cut blood supply to fibroids and MRI-guided focused ultrasound to destroy targeted tissue.

Prognosis is generally favorable; fibroids do not become cancerous, but symptoms may recur and fertility can be affected by fibroid size and location.