By Dr Joan Okemo
If you are a woman in your reproductive years or older, there is an 80 percent chance that you may develop uterine fibroids at some point in your life—though not everyone will experience symptoms.
Below is a comprehensive overview of uterine fibroids, including their risk factors, symptoms, diagnosis, and treatment options, to empower you to monitor your health and seek timely, appropriate care.
What Are Uterine Fibroids?
Uterine fibroids are common, non-cancerous growths that develop within the muscular wall of the uterus. While generally benign, they can cause a variety of symptoms depending on their size, number, and location.
Many women may have fibroids without knowing it, especially when they are small. However, in others, fibroids can lead to considerable discomfort and complications.
What Are the Risk Factors?
Several factors can increase your likelihood of developing uterine fibroids:
Age: Most common between ages 30 and 40, with risk increasing as women approach menopause.
Genetics: A family history of fibroids increases your chances—particularly if your mother or sister had them.
Ethnicity: Black women are more likely to develop fibroids earlier, and often experience more severe symptoms.
Hormonal Factors: Oestrogen and progesterone—hormones that regulate the menstrual cycle—can promote fibroid growth.
Obesity: Higher body fat can increase oestrogen levels, contributing to fibroid development.
Diet: High consumption of red meat and low intake of fruits and vegetables may increase risk.
Reproductive History: Women who have not had children or delay childbirth may be at greater risk. Pregnancy appears to reduce the risk due to hormonal changes.
Vitamin D Deficiency: Studies suggest that low vitamin D levels may increase fibroid risk.
Hypertension: High blood pressure has been linked to a higher likelihood of fibroids.
What Are the Symptoms?
Fibroids vary in size—from tiny nodules to large masses—and some women may remain asymptomatic. However, larger or multiple fibroids can cause significant discomfort.
Common symptoms include:
Heavy menstrual bleeding: Prolonged or heavy periods, sometimes leading to anaemia and fatigue.
Pelvic pain and pressure: A feeling of fullness or bloating in the lower abdomen, sometimes mistaken for pregnancy.
Bladder and bowel issues: Frequent urination or constipation due to fibroid pressure on adjacent organs.
Fertility challenges: Fibroids that distort the uterus can affect conception or increase the risk of miscarriage and pregnancy complications, such as improper baby positioning, the need for C-section, or postpartum haemorrhage.
How Are Fibroids Diagnosed?
If fibroids are suspected, your doctor will likely perform a physical examination and order imaging tests. A pelvic ultrasound, including a transvaginal scan (TVS), is the most common method. These tests use sound waves to produce images of the uterus and identify any fibroids.
What Are the Treatment Options?
Treatment depends on your symptoms, the size and location of the fibroids, your age, and whether you wish to have children.
If your fibroids are not causing symptoms, no treatment may be necessary. However, if they are affecting your quality of life, various options are available:
1. Medication:
Medications can help manage symptoms like heavy bleeding and pain, but they do not shrink or eliminate fibroids.
2. Myomectomy:
Surgical removal of fibroids while preserving the uterus. This option is ideal for women who want to maintain fertility. The method used—abdominal, laparoscopic, or hysteroscopic—depends on fibroid size and location.
3. Uterine Fibroid Embolization (UFE):
A minimally invasive procedure that blocks blood supply to the fibroids, causing them to shrink. UFE is not recommended for women planning future pregnancies, as it may affect fertility.
4. Endometrial Ablation:
Destroys the uterine lining to reduce bleeding. While effective for symptom control, it does not remove fibroids and is not suitable for women planning to conceive.
5. Hysterectomy:
Complete removal of the uterus—a permanent solution that eliminates the possibility of recurrence or pregnancy. Recommended when other treatments are ineffective or when fibroids severely affect quality of life.
While fibroid surgery is common—particularly among African women who tend to experience more severe symptoms—many still have concerns about undergoing a procedure. It’s important to understand that untreated fibroids can lead to serious complications, such as severe anaemia or blood clots.
Discussing your symptoms and treatment goals with a qualified healthcare provider is key to making the best decision for your health and well-being.
The author is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi and Senior Instructor, Aga Khan University’s Medical College.