Uterine Fibroids 101: Symptoms, Causes and When to See a Doctor
Uterine fibroids, also known as leiomyomas or myomas, are noncancerous growths of the uterus that often appear during a woman’s reproductive years. These benign tumours can vary in size, number and location, affecting women differently.
Some uterine fibroids cause no symptoms, while others can lead to significant discomfort or complications that affect daily life. Not all fibroids require treatment, but understanding more about these growths can help you recognise when it’s time to seek professional intervention. Keep reading to learn more.
What Are Uterine Fibroids?
Uterine fibroids are growths made up of muscle and fibrous tissue that develop in or around the uterus. They can grow inside the uterine cavity (submucosal), within the uterine wall (intramural) or on the outer surface of the uterus (subserosal). Their size can range from a tiny seed to a large mass, and women may develop one or several.
According to the National University Hospital (NUH), fibroids affect about 20–30% of women, most commonly within the uterine wall. While rarely malignant, they can cause serious health challenges for some women.
What Are the Symptoms of Uterine Fibroids?
Although many women experience no symptoms, others may experience discomfort that disrupts daily life. The symptoms of uterine fibroids can vary greatly depending on their size, location and number. Common symptoms include:
- Heavy or Prolonged Menstrual Bleeding: Fibroids can cause excessive bleeding (menorrhagia), sometimes with blood clots, which may lead to anaemia if left untreated.
- Pelvic Pain or Pressure: Many women describe a feeling of fullness, heaviness or bloating in the pelvic region.
- Back and Leg Pain: Large fibroids or those pressing on nerves can trigger lower back pain or radiating discomfort down the legs.
- Bladder Issues: Fibroids pressing on the bladder may cause frequent urination, urgency or difficulty emptying it completely.
- Constipation: Pressure on the rectum can lead to constipation or pain during bowel movements.
Other possible symptoms include painful intercourse, fertility problems or pregnancy complications such as miscarriage or preterm labour. In severe cases, these symptoms can affect not only physical health but also emotional well-being and overall quality of life.
What Causes Uterine Fibroids?
The exact cause of uterine fibroids is not fully understood, but several factors contribute to their development:
- Hormonal Factors: Oestrogen and progesterone, the hormones that regulate the menstrual cycle, play a key role in fibroid growth. Fibroids often enlarge during reproductive years or pregnancy, then shrink after menopause as hormone levels decline.
- Genetic Predisposition: A family history of fibroids increases the likelihood of developing them. Certain genetic mutations in uterine muscle cells may also contribute to fibroid formation.
- Lifestyle and Dietary Contributors: Obesity, a diet high in red meat and low in fruits and vegetables, and excessive alcohol consumption have been linked to an increased risk of fibroids. Maintaining a healthy weight and balanced diet may help reduce this risk.
Other factors, such as early onset of menstruation, never having been pregnant or conditions like hypertension, may also increase the risk.
How Are Uterine Fibroids Diagnosed?
Diagnosing uterine fibroids typically involves a combination of medical history review, physical exams, and imaging tests. Common diagnostic methods include:
- Pelvic Examination: A healthcare provider may detect fibroids during a routine pelvic exam by feeling for irregularities in the shape or size of the uterus.
- Ultrasound: This imaging test uses sound waves to create detailed pictures of the uterus, confirming the presence, size and location of fibroids. It can be performed transabdominally or transvaginally for greater accuracy.
- CT Scan or MRI: For more detailed imaging, a CT scan or MRI may be used to assess the size, number and precise location of fibroids, especially when planning treatment.
- Hysteroscopy: This procedure involves inserting a small, lighted scope into the uterus through the cervix to examine the uterine cavity for submucosal fibroids.
- Blood Tests: These may be ordered to check for anaemia caused by heavy menstrual bleeding or to rule out other conditions with similar symptoms, such as thyroid disorders.
Accurate diagnosis is critical to determine the appropriate treatment plan and rule out other conditions, such as endometrial cancer.
How Are Uterine Fibroids Treated?
Treatment for uterine fibroids depends on the severity of symptoms, the size and location of the fibroids and the patient’s reproductive goals. Options range from watchful waiting to medical and surgical interventions:
Watchful Waiting
If fibroids are small and asymptomatic, a fibroid gynaecologist may recommend monitoring without immediate treatment, as fibroids often shrink after menopause.
Medications
- Hormonal Therapies: Birth control pills, intrauterine devices (IUDs) releasing progestin or gonadotropin-releasing hormone (GnRH) agonists can help manage symptoms like heavy bleeding or pelvic pain by regulating hormone levels.
- Non-Hormonal Medications: Tranexamic acid or nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce heavy bleeding or pain.
Noninvasive and Minimally Invasive Procedures
- Uterine Artery Embolisation (UAE): This procedure blocks blood flow to fibroids, causing them to shrink. It is effective for women who wish to avoid surgery.
- MRI-Guided Focused Ultrasound Surgery (FUS): A noninvasive technique that uses high-intensity ultrasound waves to destroy fibroid tissue without affecting surrounding organs.
- Endometrial Ablation: This minimally invasive procedure destroys the uterine lining to reduce heavy menstrual bleeding, suitable for women who do not plan to have children.
Surgical Options
- Myomectomy: A surgical procedure that removes fibroids while preserving the uterus, making it suitable for women who wish to maintain fertility.
- Hysterectomy: A hysterectomy is a complete removal of the uterus and considered a definitive treatment for fibroids. It is usually recommended only for women who do not wish to conceive, have very large or multiple fibroids, or when other treatments have failed.
The choice of treatment should be based on individual needs, considering factors like symptom severity, fibroid characteristics and patient preferences.
When Should You See a Doctor?
You should consult a gynaecologist if you experience:
- Heavy or painful periods that interfere with daily life
- Persistent pelvic pain or pressure
- Difficulty urinating or frequent urination
- Unexplained low energy or anaemia symptoms (e.g., fatigue, dizziness)
- Infertility or recurrent miscarriages
- Any sudden or severe abdominal pain
Many women with fibroids do not have symptoms, but seeing a fibroids specialist in Singapore is important as soon as symptoms affect your quality of life or suggest complications.
Schedule an appointment with our gynaecologist to discuss your symptoms and explore your treatment options.
