What is a uterine fibroid?

What is a uterine fibroid?

A uterine fibroid is a benign (non-cancerous) tumour that develops in the wall of the uterus, i.e. on the uterine muscle, either singly or in groups. It is the most common solid non-cancerous tumour in women of childbearing age.

In fact, these tumors generally appear in women over the age of 30 (30% to 50% of women over 30 are affected, and the percentage increases with age), and particularly in women of African origin, who are 3 to 4 times more likely to develop a uterine fibroid. The risk of developing a uterine fibroid is also higher if the mother has developed one herself.

The number, location and size of fibroids vary from woman to woman.

Different types of fibroids

There are 3 types of uterine fibroid, distinguished by their location:

• intramural or interstitial fibroids (the most common type of fibroid: around 70%): these form in the muscular layer of the uterine wall.
• subserous fibroids: develop towards the outside of the uterus
• submucosal or endocavitary fibroids (the rarest): these grow under theendometriumand may occupy a large space in the uterine cavity.

Causes of uterine fibroids

Little is known about the causes of uterine fibroids. For the moment, it seems that the fibroid originates from a single cell in the uterine wall which undergoes a genetic mutation and begins to multiply uncontrollably. Estrogen then acts on this fibroid, enabling it to grow.

A number of factors favour their development, such as :

• a family history of fibroids on the 1ster degree (mother, sister)
• ethnic origin: fibroids are more common in African-American women
• hormonal fluctuations hormones play a role in the growth of fibroids. That's why they don't appear until puberty, and often stop growing after the menopause. Finally, during pregnancy, it is not uncommon for fibroids to appear and/or grow.
• overweight and obesity, as body fat produces estrogens that contribute to fibroid development
• excessive alcohol consumption

Symptoms

In most cases, fibroids cause no symptoms at all, and are therefore often discovered by chance during a check-up with a specialist.

Nevertheless, fibroids can sometimes cause pain in the lower abdomen, frequent urination, constipation, painful intercourse or other symptoms. painful intercourseabnormally long and heavy periods and/or bleeding between periods, and sometimes even fertility problems, a risk of miscarriage or premature delivery.

Moreover, it is often the size, location and number of fibroids that influence the occurrence and intensity of symptoms.

Examinations

As we've just said, it's often the clinical examination that leads, somewhat by chance, to the discovery of a uterine syndrome.

Once a fibroid is suspected, an ultrasound scan is performed to determine its size and location.

This is followed by a hysterography to determine the appearance of the uterine cavity and its possible deformation. A hysteroscopy will show the inside of the uterine cavity.

Finally, a blood test may reveal anaemia in cases of heavy bleeding.

Treatment for uterine fibroids

As a general rule, a fibroid that causes no symptoms requires no treatment. However, there are treatments available if symptoms do occur. These differ according to the size, location, number of fibroids and age of the patient.

• Regular physical activity reduces the risk of developing uterine fibroids.

• Applying warm compresses (or ice) to painful areas can help relieve pain.
• To counter constipation: eat plenty of fruit, vegetables and dietary fibre. You can also take laxatives.

• Drug treatments: drugs can help reduce symptoms (pain, cramps, regulation of the menstrual cycle, etc.). Medications may also be prescribed to reduce the size of fibroids. They are often prescribed in preparation for surgery, to facilitate the surgical procedure. If patients experience heavy blood loss, iron supplements or IUD insertion may be prescribed to help reduce the quantity and duration of menstrual flow.
• Surgery:
• Myomectomy to remove one or more fibroids while preserving the uterus for future pregnancies. However, fibroids may reappear afterwards.
• Endometrial ablation for women who no longer wish to have children, and to reduce heavy bleeding.
• Hysterectomy to remove the uterus, the only solution offering a definitive result.

• Uterine artery embolization: to deprive the fibroid of oxygen and nutrients by blocking the blood vessels that irrigate it. In this way, fibroids dry out and gradually lose around 50% of their volume. However, this method is not recommended for all types of fibroids.
• Laparoscopic uterine artery ligation: placing a clip over the arteries. However, this method is less effective than embolization.

Other techniques are also available, depending on the type of fibroid and the symptoms it generates, and these can be suggested by a specialist doctor.

The choice of treatment depends on the patient's age and desire for pregnancythe importance of symptoms and possible complications, the type of fibroid and the patient's general condition.

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